Back-to-school time for MDs too?

Physician competency is taking fire from all sides. An editorial in the August 17 CMAJ (see the cover story "Should you be forced to keep up to date?") and coverage in the Globe and Mail and elsewhere directly attack the current system for evaluating and improving physicians' skills. The solution to this problem, they say, is regular recertification to reduce medical errors and help doctors keep abreast of the latest medical research.

While medicine ? like all professions ? has its share of people of questionable ability, most physicians are doing the best they can with limited time and resources. Studying for re-examination takes time away from patients and throws further bureaucratic obstacles at the already overburdened Canadian physician. Let's not forget that we're a nation suffering from a physician shortage. Launching a recertification program at a time when we need more doctors certainly won't improve our lot. More likely it will discourage physicians from remaining in practice in Canada.

Public ire at adverse events, especially if they were preventable, is usually directed solely at the physician. But this isn't always justified. Cases like that of Dr Jon Witt ? the ER doctor who blew the lid off critical understaffing at a Saskatoon hospital ? reveal a very different picture of how medical errors can occur. Canadians are getting hip to these cracks in the system. The latest CMA report card shows a drop in national satisfaction with healthcare (refer to "Canada's dismal healthcare report card"). The decidedly less than stellar grade also reinforces a clear need to fix the system. Will mandatory recertification solve this problem? It may only serve to strengthen the view that medical errors are due to physician incompetence when, in fact, the problem is much more complex.

Then there are those who feel that CME programs are an inadequate way to judge competency. Granted, these are legitimate concerns ? simply clocking time spent at conferences is no way to gauge skill. But CME was never meant to do that. It was set up to encourage the continuation of the learning process and disseminate the latest medical research. How will recertification improve this? It may succeed in evaluating certain skills, but a physician's dedication, commitment to learning and self improvement, professionalism and ethical behaviour can't be judged by a simple test. These are personal decisions that individuals choose to honour ? they can't be taught or empirically measured.

? Shereen Joseph, Editor