At the last Editorial Board Meeting we received a report concerning the proposed medical board fee increase. We were told that there is absolutely no question that the Medical Board of California (MBC) needs an increase in fees from physicians. This is because over a 20-year career, a physician beginning practice today in California may have as much as a 50% chance of being investigated by the MBC and almost a 20% chance of being disciplined. (Would the usual 40 year professional life of a physician have twice as many chances of being investigated and disciplined?)
But these conclusions are based on the wrong data. In the course of setting standards, one should eliminate those that are three or at the maximum two standard deviations outside of the norms. This usually is interpreted as the lowest 2 or 3 percent on a bell curve of practitioners. Since American Medical Schools are the world’s best, and even if we doubled the number of physicians that might conceivably be practicing substandard medicine allowing for the influx of foreign graduates, we would be looking at a maximum of 5% of physicians. With the medical board looking at 50% and thinking that 20% of us are substandard, it is disciplining four times as many as is reasonable or justifiable. Thus at least three-fourths of the medical board’s work and expenses are related to disciplining physicians who are well within the norms of practice. It is not a public service, but a tirade of hostility toward physicians that is driving this action. Thus instead of an increase in the fees for the MBC, three-fourths of the current fees should be eliminated which should be more than adequate in order to eliminate only the substandard doctors–not those at the very top of the curve or what would be the high end of the curve in 90% of the countries of the world. Unless leaders of our organizations immediately act to reduce the MBC fees to the appropriate one-fourth necessary to discipline one-fourth as many physicians (or $150,) they will continue to lose members. To our leaders, it may seem that rank and file doesn’t appreciate their superior knowledge, but the dues paying members won’t continue to pay organizations they feel don’t act in their interests.
Richard W Heifetz, MD, an anesthesiologist, has opened an anti-aging clinic in Santa Rosa. According to Sonoma Medicine, which devoted an entire issue on aging, he is a member of a new breed of physicians who belong to the American Academy of Anti-Aging Medicine. This group views aging as a normal process of degenerative diseases which can be slowed. They feel the current focus on the later stages of disease processes, e.g. Alzheimer’s, heart disease, diabetes, and strokes. If we focus on slowing or reversing the onset of “aging,” we could push back the onset of disease, thereby extending life span, and improving the quality of our later years. Dr Heifetz feels we can be as fit and vital at 75 as we were at 45.
Vital Signs, the Fresno-Madera Medical Society’s official publication continues to publish the installments of our editorial board member Dr David Gibson’s three part series we published in November and December 1998 and in January 1999. The importance of Dr Gibson’s analysis of significant healthcare issues is recognized by this small publication. We should have Doctor Gibson present his data to a general meeting of our society and invite all nonmembers. Having 2,600 physicians present would create more excitement than 26 (or was it 27?) at last meeting of 1998.
Samuel A Roth, Orange County Medical Association’s assistant executive director, reports on UCI College of Medicine’s annual “Health Care Forecast Conference” in The Bulletin of the OCMA titled “Things Can’t Get Much Worse Than 1998.” Arnold Milstein, MD, the medical director of the Pacific Business Group on Health (PBGH), pointed out a 3% frequency of errors in hospitals leading to additional injury, illness, or disability. (Could any human undertaking have less than a 3% error rate?) He detailed the very deliberate process undertaken by PBGH to develop appropriate quality survey instruments to complement consumer surveys. Ultimately, PBGH began to drop plans based on quality, added others, and promoted those with the best results. PBGH found that consumers do not necessarily use comparative information. “When patients trust their physicians, they tend to have better outcomes,” he noted. It’s been known since at least the late 1950s that the best clinicians did not necessarily come from the top of the class.