Remedial program good for those who can improve

The Institute for Physician Education program in Aurora, CO, offered by the Philadelphia-based National Board of Medical Examiners (NBME) is most appropriate for physicians who are having trouble in some areas but seem capable overall, and who are willing to improve. It’s not for the truly bad physicians who should leave medicine and never look back. Here are some situations in which the program can be a good option:

The physician is good overall but has had one or more bad outcomes.

If so, the program may help the doctor uncover shortcomings in medical education or skills that can be improved, says Martha Illige, MD, medical director of the program and an assistant professor at the University of Colorado Health Sciences in Denver. The intense review can pinpoint the cause of the bad outcomes without going to the extremes of either dismissing them as unimportant or concluding that the physician has lost his or her skills completely.

The physician’s performance has declined recently.

If an otherwise good physician has slipped in recent months, there could be any number of causes — everything from a physical or mental illness to distracting personal problems, such as a divorce. An assessment by uninvolved investigators may bring out problems that the doctor is unwilling to reveal to colleagues.

You keep seeing the physician’s name come across your desk for problems, even if they’re small ones.

Many of the program participants are referred not because of any one major event but because someone got tired of seeing his or her name connected to lawsuits, complaints, or minor infractions. Those physicians often can improve their performance before they get involved with a major adverse event. Unfortunately, those physicians often are defensive from years of being accused and trying to protect their privileges, Illige says.

The physician is resistant to improving on his own.

Some physicians are more willing than others to take criticism and improve their performance. Older physicians, in particular, can be resistant and refuse to acknowledge that they are not providing the best possible care, say Illige and Bob Spencer, JD, an attorney in Greenwood Village, CO, who represents both physicians and hospitals in peer review. "With some, you can just give them the data and they’ll say, Oh, I’m not treating my asthma patients right,’ and then they’ll go off and make the changes they need to," Illige says. "But those aren’t the ones who are going to be problems for you. The people you worry about are the ones you give the information to and then they walk off and don’t change a thing."

The physician is not in any trouble at all but wants a thorough assessment.

These cases are the minority, but Illige and Spencer emphasize that the program can be an excellent tool for someone who wants to be proactive in assessing his or her own skills. "We had a rural physician once who was concerned that he wasn’t keeping up in his skills and his education because of his isolated practice," Illige says. "He wanted feedback. We found that there were areas where he could use development, and [we] helped him seek that out, but we also reassured him that he was still a good doctor."

Spencer and Illige say the IPE program definitely is not appropriate in two circumstances:

Drug or alcohol abuse.

There are plenty of other programs available for treating physicians with addictions, and they may be able to help a doctor save his or her career. But the IPE program does not address those problems, except that its assessment may uncover hidden drug or alcohol abuse as a causative factor.

Criminal conduct or serious wrongdoing.

Though the IPE program can be a way to salvage a doctor’s career, some careers should not be saved. When a physician has committed egregious conduct such as a criminal assault or misappropriating large sums of money, it is very likely that the IPE assessment will determine the doctor is too risky to be granted privileges. In those cases, there’s no need to spend the money or the time.

The IPE program encourages health care professionals to contact its staff and ask if a particular situation is appropriate for intervention. The IPE name is not fully in use, so all listings are for CPEP, the original Colorado program. Contact the program at Colorado Personalized Education for Physicians, 14001 E. Iliff Ave., Suite 206, Aurora, CO 80014. Telephone: (303) 750-7150.