Times change, and, as with Darwinian natural selection, those who adjust survive and those who don’t perish. Henry Ford’s assembly line greatly ramped up the production of automobiles but put many people out of work. The elevator operators of my childhood are long gone. Those who have embraced new technology have usually thrived; those who have fought it or failed to understand it have suffered. Witness the success of Amazon versus the demise of Borders.
Medicine is a conservative business. Who else still uses beepers and fax machines? Doctors have been slow to adapt to new technology, such as Electronic Health Record systems. Nevertheless, despite challenges, I don’t see doctors going the way of elevator operators, at least for the foreseeable future. But there is a medical industry that does need to go the way of the dinosaurs: the medical testing industry.
To briefly recap, doctors used to take a board certification exam after residency that provided lifelong certification. In the case of internal medicine doctors the examination agency is the American Board of Internal Medicine (ABIM) which is one of the specialty boards that make up the American Board of Medical Specialties. Arguing that the rapid changes in medicine warranted periodic recertification, but probably also noting that once per lifetime certification is not as lucrative as repeated certification, the ABIM subsequently imposed a requirement that certification testing had to be renewed every 10 years. Still not satisfied, the ABIM came up with Maintenance of Certification (MOC), consisting of a lot of busy-work for the already busy physician that includes a mandate to carry out non-IRB approved research on physicians’ patients.
Judging by social media, MOC has really hit a nerve among physicians. I and many others (e.g. see Dr. Wes’s website, containing many good articles on MOC and exposés of the ABIM) have written about MOC, and the whole board recertification fiasco has finally reached the mainstream media in a recent New York Times article. Despite the aversion to MOC, many physicians don’t seem to be as upset by the every 10 year retesting. Yet the whole concept of sitting down to take a test as a means to assure that a doctor knows what he is doing is as outmoded as using a dial-up modem to assess the internet.
When I was in academics, my colleagues played a game that consisted of arguing a point by quoting some obscure statistic from some obscure study. Something like: “Well, in the MADEUP-VII trial, subgroup analysis of incidence of restenosis based on horoscope sign showed that Scorpios had a 32% risk reduction compared with Virgos, with p less than 10 to the minus 20th.” I was never too good at that game, which is one reason I went into private practice, only to learn that private practice docs played the same game. I’ve considered doing a study comparing these off-the-cuff literature quotes with the actual published data. I don’t think the correlation coefficient and p values would be very good.
There’s really no need to play that game anymore. Just as with the invention of writing poets no longer needed to memorize the poems of Homer, and with the invention of the printing press monks no longer needed to copy books by hands, with modern technology I don’t have to memorize detailed results of medical studies for later regurgitation at Grand Rounds. Today I carry around in my pocket a computer with always-on internet access — a computer much more powerful than the computers that were used to send men to the moon. I have apps that can check drug doses and watch out for drug interactions. I can look up anything in a few seconds. With this capability it is not only unnecessary, but would be reckless for me to rely purely on my memory, especially when dealing with the potentially catastrophic results of making a mistake.
I’m not saying that doctors don’t need to know any facts or memorize anything. I’m not saying that doctors shouldn’t attend lectures, go to medical meetings, or carry out Continuing Medical Education. But the fact is that, as with any craft, the best teacher is the work itself. Being asked to regurgitate memorized facts on a test is not a test of anything other than the ability to memorize facts. It is not a reflection of how doctors do their jobs today, and is not a indicator of competence in the field of medicine.
The medical testing industry needs to go the way of the elevator operator.