Professionalism, Governance, and Regulation

Though it is a dry topic, as I transition from training to independent practice, I find the paperwork of medicine is a big deal. At the same time, there is a lot of talk and argument about the governance of medicine within the medical specialty and in the greater public community.

The state medical licensing board protects the public by licensing medical practitioners. However, I am not convinced this has been working ideally. In 2014, less than half of 1% of physicians in the U.S. had any disciplinary action against their licenses. Is this too much? Is it too little? In an ideal world, I think we would be quite pleased to have such a low rate of license limitations, suspensions, or revocations. However, I suspect that the mechanism of regulation simply does not catch all those who need to be disciplined. State licensing boards only identify the very worst offenders, those who've had so many complaints or such egregious violations of the law that their licenses must be reconsidered. But a state licensing board is not positioned to regulate those physicians who are only slightly under par, not completely up-to-date, or mildly technically deficient.

The other issue with state licensing boards is that in the future, I expect more health care will be delivered across state borders. Telehealth will become a tool to shore up geographic differences in health care delivery. Locum tenens work has been used for a long time to provide care to areas that need physicians. The world is getting smaller, and to me, there shouldn't be a reason why standards for physicians should differ by state (though I do understand that the legal rights of the states were broadly vested in the Tenth Amendment to the Constitution and specifically articulated in the Medical Practice Acts that govern licensure state-by-state).

In addition, there are other regulatory, accrediting, and certifying organizations such as the Joint Commission. What is their role and relationship for the individual physician? Where to specialty societies fit in? How do we guarantee that all this bureaucracy improves physician self-governance, education, quality, and safety challenges? From this side, as a consumer, I feel so much is duplicated from organization to organization. There is so much paperwork and red tape. Like most, I just want to be a doctor, and I hope the systems that have arisen are more aid than hindrance.