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What’s the Point of Medical Licensing?

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Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 10,300 followers on Twitter.

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Skeptical Scalpel (click to view)

Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 10,300 followers on Twitter.

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"Word of mouth and reputation are the best indicators of a surgeon's ability, anything beyond that is useless."

A surgeon emailed me the following:.

OK, I know this is radical but consider my argument…

Medical licensing protects no one and costs physicians hundreds to thousands of dollars each year. If a physician is negligent, can the injured party sue the state that licensed him? I’m guessing not.

When I moved to my current location, I had to send lots of documentation to the state medical board so they could verify that I was a true and competent surgeon. I provided my employer with the same info so they could also verify my credentials. Now my employer can and will get sued if I commit a negligent act and absolutely should verify my credentials prior to handing me a scalpel. But the state? Its license is useless.

Most people choose a surgeon based on recommendations and word-of-mouth reputation, and these are by far better indicators of quality than any credentialing board. Nobody asks to see my license, and, even if they did, it would not protect them any more than their trust in the health system in which I work.

If I was in private practice and had my license displayed on my wall, it may give some reassurance to my patients, but it does not say anything about the quality of my work. Most doctors who really screw up due to negligence are licensed by the state.

I contend again, that word of mouth and reputation are the best indicators of a surgeon’s ability, anything beyond that is useless.

Caveat emptor, “let the buyer beware” remains the mantra of the informed consumer.

Thanks for letting me vent.

Of course this is a bit of exaggeration to make a point. We obviously need some sort of medical licensing or the public would not know if we were the same as the “butt enhancement” people who operate out of motel rooms.

But it’s true that we—doctors and the public—don’t get much bang for our buck. As I mentioned in my post about the Texas neurosurgeon who ran amok before that state’s medical board took action, licensing fees are generally used by most states as a type of tax.

For example in the state of Texas, only $11 million of the $40 million in licensing fees collected per year goes to the medical board for policing the profession. The rest is left in the state’s general fund.

My state also uses medical licensing fees as a tax rather than as a means to run a more effective medical board. I wonder how many other states do the same thing?

The surgeon who sent me this email has the same conclusion as a researcher who recently found no relationship between hospital quality and patient satisfaction.

As the article about that paper states, “He [the researcher] suggested choosing a hospital the old-fashioned way: find a doctor you trust and ask for a recommendation.”

PS: I’m surprised that lawyers haven’t thought of suing states for allowing bad doctors to keep licenses.

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 10,300 followers on Twitter.

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