Medical Board recommends
physician proficiency requirement

Texas State Board of Medical Examiners (TSBME) executive director Donald W. Patrick, M.D., J.D., was in Laredo recently to announce that the TSBME formally endorses legislation for the implementation of a program requiring periodic demonstration of current proficiency by all physicians in Texas. On August 16, the TSBME adopted a resolution of support for that legislation which could be implemented by 2005.
The announcement was made recently in the company of Laredo physicians, including TSBME board member Dr. David Garza of Laredo.
Currently the board is complaint-driven, identifying and remediating competency problems only after patients or peers have filed a complaint with the board. "Patient safety would be better served if we could actively identify practitioners at risk of poor performance. Physicians who have passed a monitored exam like a board-certification exam have demonstrated current knowledge and cognitive ability," said Dr. Patrick.
"If we require proficiency testing of out-of-state doctors, it should also be effective for assuring proficiency among in-state doctors as well," said Dr. Patrick. "The proficiency requirement is an extension of the process of taking written examinations that physicians began while in college."
Reports and studies advocating some method of re-testing for physicians began appearing in the early 1980s. The Statewide Health Coordinating Council was the first Texas body to address the issue in the Texas State Health Plan: 1999-2004 Ensuring a Quality Health Care Workforce for Texas. The Texas report echoed recommendations of a report published in 1995 by the Pew Health Professions Commission's Taskforce on Health Care Workforce Regulation.
In its 1999 report on medical errors, the Institute of Medicine recommended that "health professional licensing bodies should implement periodic re-examinations and re-licensing of doctors, nurses, and other key providers based on both competence and knowledge of safety practices."
In 1998, the American Board of Medical Specialties examined how to assess physician competence and determined that all 29 of its specialty boards would demand re-testing of their diplomates by 2006. Most are already doing so but some have provided that physicians already certified could be "grandfathered" and exempt from the re-testing requirements.
"After all their research, the American Board of Medical Specialties concluded that they would make it mandatory for physicians who wanted to maintain their 'boarded' status to re-certify every 10 years," said Janet Tornelli-Mitchell, M.D., board vice-president. "This is already mandatory for physicians who have obtained certification since around 1990. Physicians who were boarded prior to 1990 are not held to this standard and they are actually the physicians who need to re-certify the most. I feel all physicians should be held to this standard, not just physicians who have graduated since 1990."
The TSBME proposal would require that those physicians whose certification does not require passing a monitored exam, who are exempted from the examination by a board's "grandfather" policy, or who have not pursued board certification, would be subject to periodic proficiency evaluation. This proposal would fill in where the specialty boards do not reach, and would require re-testing every 10 years.
Physicians who fail to demonstrate proficiency would not face immediate loss of license. Under the present proposal, physicians would have three chances to take and pass the Special Purpose Exam (known as the SPEX.) If the physician fails in those three attempts, there are other evaluation resources, such as the Colorado Physician Evaluation Program, which is already in existence providing proficiency testing and remediation for physicians. The National Board of Medical Examiners and the Federation of State Medical Boards may also be tapped to provide testing and evaluation. The board will review other evaluation and remediation programs in the process of developing the program.
"When physicians look for health care for their families and themselves, we look for the best possible doctors we can," said TSBME board member David Garza. "We have the inside track about who those doctors are, but everyone should have a healthy level of comfort when it comes to choosing a physician."
Garza said that the state boards that regulate the profession of medicine are the profession's best hope for seeing to this necessary, albeit sometimes painful, duty.
"The steps we are trying to implement through legislation will benefit the citizens of Texas and the profession in general. Anything we do to help the public and enhance public safety will bolster the reputation of our profession. Any step we can take at the state level to achieve this is one step further away from federal regulation, which is something no one wants," he said.