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NEWS: Owen Dyer Government plans to revalidate doctors every five years BMJ 2008; 337: a988 [Full text]

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Recertification and Racketeering

Richard A Rosin   (2 August 2008)

Revalidation will not identify poor practice

Michael R Jarmulowicz   (4 August 2008)

Necessary Kick Up the Backside

Jay Ilangaratne   (5 August 2008)

Recertification and Racketeering 2 August 2008
Richard A Rosin, Consultant Psychiatrist Vancouver BC V6R 1S3, Canada Send response to journal: Re: Recertification and Racketeering	The proposition that there should be a way of ensuring that doctors maintain their knowledge and skills is clearly sound and not something to which anyone could reasonably object. Who, after all, would permit surgery to be performed on themselves if they knew the surgeon did not keep up to date and who would see a psychiatrist whose knowledge of psychopharmacology had not progressed beyond 1990? The problem is not whether, but how, to revalidate and recertify. In the US, Board Recertification has been in place for at least 15 years. Those who devised it often did not have to do it - the proverbial 'grandfathering' in of qualifications previously obtained. Thus there is more than a smattering of physicians who have not been required to re-take Board Examinations. Those of us who do have wondered about it and the best answer so far received is that those certified before a certain date were told that certification was for life and that attempts to change this might result in lawsuits. This is perplexing, since surely the importance of having competent physicians outweighs their disgruntlement at being required to demonstrate that their knowledge is current? The other issue of course is that the cost of these board exams is prohibitive. It is hard to avoid paying less than about $2500 on average and that is before paying for transport to the examination venue and accommodation while there. From the Medical Specialty Board's point of view, recertification is a financial bonanza. They collect huge fees from first time candidates and it just goes on and on. They have massive late application penalty fees ( $500 ). From the doctors' point of view the whole scenario reeks more of racketeering than recertification. Hopefully the real spirit of revalidation will be retained in the UK, but given the tendency to follow the trends across the Atlantic, it may be that recertification begins to resemble money-laundering. It will benefit the wine cellars of the Royal Colleges and any benefit to patients will be secondary. Competing interests: None declared
Revalidation will not identify poor practice 4 August 2008
Michael R Jarmulowicz, Assistant Medical Director Bostwick Laboratories, W1T 5HE Send response to journal: Re: Revalidation will not identify poor practice	Sir, For how long will our professional leaders give support, however guarded, to the proposed scheme of revalidation and relicensing which political leaders are claiming is required to reassure the public that all doctors are practising competently. Despite a wealth of papers on medical error, I have yet to hear in the discussion around revalidation a definition of competence. We are human and it would be foolish to suggest that no doctor will ever make a mistake or miss a diagnosis. So what is an ‘acceptable’ error rate? Surveys of medical errors showed a wide range of error rates, with those looking at medical mismanagement suggesting that 4% of patients suffer an adverse effect from a medical error.[1] The very recent case of the incorrect diagnoses of an unnamed pathologist (who has not yet been declared incompetent) should be an important lesson for those thinking that the proposed annual assessment will identify a poorly performing doctor. In histopathology the evidence on which a diagnosis is made remains for others to verify. The review of his work took 6 months to complete (at unknown cost). 5404 cases were reviewed and identified a diagnostic error rate of 2%.[2] Of course I support the principle that we must remain fit to practice, but it is equally obvious that no routine annual assessment in the format suggested, could have identified this error rate. So why are we going to waste a vast amount of time and money for a system which will not provide the reassurance that it is claimed? I confidently predict that it will only be a matter of time after introduction of revalidation when a doctor’s work will need to be reviewed in a similar way; and quess what? – It will show that they have passed their annual assessments with flying colours [1] Epidemiology of medical error. Weingart SN et al. Br Med J. 2000 18; 320: 774–777. [2] Hereford County Hospital Press Release. 30th July 2008 (http://www.herefordhospital.nhs.uk/Portals/0/Press_Media/2008/Press%20Release%2030th%20July%202008.pdf) Competing interests: None declared
Necessary Kick Up the Backside 5 August 2008
Jay Ilangaratne, Founder www.medical-journals.com Send response to journal: Re: Necessary Kick Up the Backside	Albeit,very much a belated effort to reassure the public, revalidation would be a ncesssary kick up the backside.However, only time will tell, how effectively it would be managed and enforced as it would be another entirely self-regulated process. Competing interests: As a patient,I am one who would very much like to see upto date,competent, and courteous doctors who do not put up smokescreens or evade difficult issues.