Special Report: Credentialing

Tougher standards are coming your way

16,000 incompetent doctors slipped through cracks

New competency requirements might be in the wind for your organization. A recently issued report by the Pew Health Professions Commission at the University of California in San Francisco recommends stronger regulations and more frequent skill tests for doctors to protect the public from incompetent doctors and health care workers.

The commission would like to see doctors prove their competence throughout their careers, not just when they get their license to practice. It wants boards to be more accountable in certifying specialists, and states to implement nationally uniform scopes of practice for all the professions. Minimal standards, states the report, have served only to make certain that the most egregiously incompetent professionals are prohibited from practicing.

"The report has been released," says Elizabeth Lynch, spokeswoman for the Center for the Health Professions at the University of California, San Francisco. "We’re doing our best to promote it within the regulatory and policy-maker communities that would be interested. Beyond making recommendations, there’s not a specific time line for them to be implemented. We hope they will be implemented, but that’s not something we can ensure."

The Pew report cites a recent Rand Corporation document that found "large gaps between the care that people should receive and the care they do receive." It also cited a Public Citizen annual survey of doctors who have been disciplined for incompetence, crimes, negligence, and over- or underprescribing drugs. This year the survey named more than 16,000 doctors and said this was only a small percentage of the true number of incompetent doctors.

The Commission’s recommendations are a mix of policies demanding changes at the state, federal, and private-sector level. Other recommendations include:

• requiring individual professional boards to be more accountable to the public by significantly increasing their public members (the Commission recommends that public members make up at least one-third of each board’s membership);

• requiring states to regulate practitioners to demonstrate their competence in the knowledge, judgment, technical skills, and interpersonal skills relevant to their jobs throughout their careers;

• having states require policy oversight and coordination of professional regulation through consumer-dominated boards or central agencies;

• having Congress establish a national policy advisory body that would research, develop, and publish national scopes of practice and continuing competency standards (the body would be required to develop uniform standards of practice authority, including model legislation for use by individual states);

• having states require boards to provide relevant information about health care practice licenses to the public in a comprehensible manner;

• having states develop alternative mechanisms for existing professions to resolve their scope-of-practice disputes until national models can be developed and adopted;

• having Congress enact legislation that facilitates professional mobility and practice across state boundaries;

• having states enact and implement scopes of practice that are nationally uniform for each profession and based on the standards and models developed by the national policy advisory body;

• requiring states to provide the resources necessary to adequately staff and equip all health professions’ boards to meet their responsibilities.