Well Sourced: Why ‘MD’ doesn’t cover all the bases

Doctors usually train in a specialty – pediatrics, oncology, anesthesiology, etc. – but they don’t have to practice in that specialty. And, in most states, they don’t have to tell you how they trained before they treat you.

Kate Murphy wrote in The New York Times in 2012 about the trend of doctors from fields outside of plastic surgery deciding they wanted a cut of those “self-improvement” profits, unbeknownst to their patients.

After moving from New York to Los Angeles in 2010 to take a job with a financial services firm, Joan, now 59, believed she needed to freshen her look. So she got a face-lift and tummy tuck from a board-certified doctor in Beverly Hills.

What she did not realize was that his certification was in otolaryngology — ear, nose and throat — not plastic surgery. The outcome was less than ideal: thick scars on her temples and a wavy abdomen.

For stories like this, here’s a resource you need to know about.

SOURCE: Medical specialty boards

WHAT THEY DO: Certify doctors in a wide variety of specialties: Cardiology, anesthesiology, orthopedics, etc. They require doctors to undergo a specific amount of training and then require them to pass an exam, known as “the board.” Most of them also require doctors to maintain their level of skill by taking exams at certain intervals.

WHAT THEY DON’T DO: Force older doctors who earned their certification before the renewal rules went into effect to keep up their skills. Nor do they regularly discipline doctors or go after doctors who are claiming to be certified when they are not. Remember, these are not government agencies. They are run by the doctors, which brings with it all the problems associated with self-policing.

RECORDS: If a doctor says he is a specialist or if a hospital hypes its expertise, check with the group that governs the specialty. Not all of them make their records public. A good first stop is the American Board of Medical Specialties Maintenance of Certification program. Also, go to the individual board and ask them whether the doctor in question is certified and what is required for certification. ABMS sometimes lags behind the actual board in updating its information, and it provides a list of many of the specialty boards here.

Another place to check is the American Board of Internal Medicine. Many specialties require an internal medicine certification before a doctor can acquire another level of specialization.

More than 80 percent of specialists have their certification. In some areas, like anesthesiology, the number is closer to 100 percent.

DRAWBACKS: A doctor doesn’t always have to be board-certified to diagnose and treat patients in a particular area. Doctors who are foreign-trained may have undergone a similar level of certification outside the U.S., although many retrain here and take the boards. If you find a hospital or medical group has an inordinate number of doctors working outside their specialties, it could be cause for concern.

SUGGESTION: Put together a list of all the directors of the various divisions at your local hospitals and then check to see how many of them are certified in their specialties. Remember, too, that there’s a difference between being a “fellow” in a specialty or a “diplomate” and actually being board-certified. Some specialty groups are really just professional organizations that elect members to these positions or give them the designation for attending a conference. Those designations are not necessarily a validation of the doctors’ skills.

EXAMPLE: Dr. Kevin Pho – who is board certified in internal medicine – wrote an interesting piece in April 2014 on Kevin MD about the drop in pass rates for people taking the internal medicine board exam for the first time. He noted that in 2009, it was 90 percent. In 2013, the first-time pass rate had dropped to 78 percent.

No matter how it’s framed, that’s an alarming drop.  Especially considering that maintaining certification is a condition of staying employed by many hospitals and health systems. And while physicians can retake the exam, it’s a time consuming and stressful process. Especially when their jobs are on the line.

There has been a long running debate about whether doctors should be forced – by hospitals, governments, medical boards – to become board-certified. The American Medical Association and state medical associations have argued against requiring board certification in order to be licensed to practice medicine.

For now, though, board-certification is the standard. And there are many stories to be told in which doctors are practicing without the training most patients would expect. As Dr. Joel Aronowitz, a plastic surgeon and clinical assistant professor at the University of Southern California, told Murphy:

“A doctor may be good and well trained in his or her specialty, but it takes more than a weekend seminar to achieve mastery in plastic surgery.”

Photo by Phalinn Ooi via Flickr.