Front page above the fold Courier Journal story today, available online only via subscription:
http://www.courier-journal.com/
Panel doesn't recognize Paul certification
The national clearinghouse for ophthalmologist board certifications says Rand Paul has not been certified for the past five years. Rand Paul has claimed to be board certified, but it turns out he is certified by a board (National Board of Ophthalmology) that he incorporated and heads, and of which his wife is vice-president. The CJ could only find seven ophthalmologists besides Paul who were members of or were certified by Paul's group, and all of them also had the "real certification" of the American Board of Ophthalmology.
It seems that the American Board began requiring ophthalmologists to recertify overy 10 years, but the older ophthalmologists were grandfathered in so that they did not have to recertify. This angered Rand Paul and some young ophthalmologists, who decided to make their own board which requires everyone to recertify, young and old. While this "recertification for all" rule sounds fair to me, the American Board of Medical Specialties (which works with the AMA) did not recognize Rand Paul's group (for unknown reasons,) and so Paul had not had a nationally recognized certification for years. That hasn't stopped him from advertising to his patients that he is board certified.
Is this a tempest in a teapot? Will this impact the image Paul has (in teabagger circles) of being a straight-shooter?
I am a DFA organizer, and my group endorsed Jack Conway in the primary and will support him in the general election. So I come to this story with my own ideas here. But I wonder how a neutral observer will regard this front page story.
My brother-in-law is a doctor, so I know a bit more about board-certifications, payment negotiations, and malpractice suits than the average person. I tend to have sympathy for the challenges that an independent doctor faces in today's marketplace. Most doctors are being bought up by hospitals and the independent practitioner is a dying breed. But even with these challenges, it seems to me that Paul was not fully honest. I'm not ready to claim he intentionally lied or deceived, but this does not pass my smell test.
updated 1:15PM EST:
Kossacks, thanks for putting this story on the recommended list. I believe this race deserves national scrutiny, and DailyKOS gets a lot of attention. Maybe this will get picked up by the echo chamber.
Also, some great comments happening below. Please check out the comment threads. Here are a few:
skywriter tells us that TPM covered the story with a different angle here:
http://tpmmuckraker.talkingpointsmem...
second gen gives us a link to educate us on board certification here:
http://www.quackwatch.org/...
LoneStarLefty offers a doctor's opinion as a double boarded sub-specialist:
As a D.O. that trained at an M.D. institution for both my general residency and sub-specialty fellowship, I could have chosen to take my boards through either the ABMS route or through the Osteopathic route. Both are equivalent and accepted universally by insc co's and hospitals and which one you decide to take loosely depends on the affiliation of the institution where you do your postdoctoral training. There are alternatives to ABMS, including the Osteopathic boards (parallel medicine and surgery programs to the MD's) and Podiatric boards (feet/ankles only, don't ask.. I don't get it either!). In a family of physicians (one of whom I went to school with, same class!), Dr. Paul knows better than to pass his own board off as legit. The streak of being to good for, too patriotic for, or somehow exclude-able from the rules every one else plays by is SOP in the conservative manual. Half of the names we hear from the right in society today would be in jail if they had to play by the same rules we do, North, Liddy (longer term), Rushbo, Bush 41 & 43, Cheney, Rummy, Rice, Powell, Uncle Ronnie (were he alive to carry out the sentence), the list goes on ........ I'm not saying what he's doing is illegal, but certainly it is deceptive and puts the burden of proof on the hospitals and insc co's to decide if his board exam is equivalent.
As a double boarded sub-specialist, I call SHENANIGAN'S!!!
And I added a comment about political views reflecting on competence. I see a lot of disdain for Paul's politics, but I think we have to be cautious about assuming that means he is a bad doctor. Here it is:
I hesitate to pronounce a person competent or incompetent based on their political views or even their logic skills. I have known many professionals who are very good at their niche job despite having some very odd religious or political beliefs, and despite having what I perceive as a weak ability to apply logic and reason to politics and policy. I think this is because some skills can be mastered by rote, and do not require thoughtful analysis. I also think that when emotions and ideology get involved, otherwise competent people can develop massive blind spots.
Imagine if a conservative customer decided I wasn't a good computer technician just because I am a "loony lefty liberal." It doesn't really follow. I happen to be a very good technician. I'd like to think my ability to carefully analyse and determine cause and effect - and evaluate evidence - have also led me to progressivism. But either way, if a client fires me because I am liberal then in my opinion the client is losing out.
So I don't judge Rand Paul's doctoring skills in this diary. I have no idea. He might be a good doctor.
I do disagree strongly with him on political matters, and I think his reasoning is deeply flawed.
updated 3:47PM EST:
A second doctor chimes in:
never forget 2000 in comment "board certified"
I am a board certified physician and was "grandfathered" as my specialty moved towards periodic re certification. Now, my specialty is moving everyone (grandfathered or not) towards MOC or maintenance of certification, requiring physicians to re certify every 5 - 10 years. At my age, it is a breakeven whether to go through MOC as my state has not made it a requirement of licensure yet.
The purpose of certification, I believe is twofold. One is to hold the physician responsible for a certain minimum of knowledge and expertise to practice in a specialty. The second is to assure the public (patients and payors) of a level of demonstrated competence.
Certification is also a weak means of quality control in a profession, that til recently, had a 'guild' mentality. The knowledge base require of even your average physician is enormous. The gulf between what I learned in med school thirty years ago and what is being taught now is mind boggling.
Dr. Paul may be an excellent ophthalmologist. But he is ethically and professionally wrong on this one. As I understand it, his National Board of Ophthalmology doesn't have any written procedures or testing for certification. In other words, it is a sham and a fraud perpetrated on the public. And while one can understand his pique at the inequality of the ABO, to create a sham organization which does less than the ABO and collects money for it is a con.
I may not like his politics but his ethics are what offends me most.
A third doctor chimes in:
hdwh in comment "The difference is legitimacy"
The American Board of Medical Specialties is a recognized organization that dots all the i's and crosses all the t's when it comes to board certification. Other, non-ABMS groups spring up for a variety of reasons, some legit, most not, but the problem is, you don't have a good way to tell if they are legit. A competing board a la Paul's does reek of not legit, of course. Board certification used to be for life. Then in the 1990s, the ABMS decided it makes sense to require re-certification every 10 years. This makes great sense. But you can't ex post facto require already certified docs to re-certify. Hence the grandfathering that so bothered Paul. However, most specialty boards have created a mechanism for grandfathered folks to re-certify, and many hospitals departments societies are encouraging everyone to do so, even if grandfathered. I did in December, even though I'm grandfathered-- and clearly it was valuable to refresh my knowledge. If Paul's group requires all to re-certify (as it states in the diary), that wouldn't distinguish it from the ABMS boards because all of his certified folks got that way after ABMS started requiring re-certification (ie, no possibility for grandfathering anyway).
I also went back and corrected my spellings of opHthaLmologist. I had left out the first H and the center L. You Kossacks are too darned good at speaky da Englitch.