Proto readers opine on the effectiveness of physician recertification, Judith Warner’s take on medicating children, stemming a brain drain and reversing blindness.
A recent Proto story poses a worthy question: “Why Recertify?” (Summer 2010). As the article notes, board certification—widely considered an important measure of physician competence—once lasted for life; now many physicians must take tests to recertify. (And as a point of correction, the American Board of Medical Specialties is not the only organization offering certification and recertification; the American Board of Physician Specialties and the American Osteopathic Association do too.)
The current recertification process is a waste. It tests a physician’s ability to pass a test at a discrete point in time; it does not assess competence at all. But some health plan payers require certification and recertification as a placeholder for competence because we have not yet developed mechanisms to qualify and quantify care.
As the story points out, it is expensive for physicians to continually recertify, though they may be able to recoup their costs if they comply with payers and with the new health care law, which will provide increased income for being certified and participating in defined programs. But what is missing from all this is the patient, who is not best served by this system.
Lewis W. Marshall Jr. // Chairman, Emergency Medicine, Brookdale University Hospital and Medical Center, Brooklyn
GETTING THE STORY STRAIGHT
When Judith Warner set out to write a book about the willful overmedication of children for psychiatric problems but instead discovered an entirely different story, she could have ignored the facts and written a book that would have sold well by pandering to the public’s fears (“Medicating Young Minds,” Summer 2010). Unlike others, who, in recent years, have written sensationalist books about attention deficit/hyperactivity disorder and other psychiatric diagnoses, she took the high road, and for that she deserves our respect. As a journalist and an advocate in the field of ADHD for many years, I can tell you that’s pretty rare these days.
Gina Pera // Author, Is It You, Me, or Adult A.D.D.?, San Francisco
STEMMING THE BRAIN DRAIN
I appreciate the tortuous path graduates of international schools must tread to practice medicine in the United States (“Coming to America,” Spring 2010), but there is another side to this story. India and other developing nations support the education and training of their own physicians through taxpayer funds, as do we in the United States. If we make it easy to immigrate to this country to practice, India does not receive a return on its investment. And it would be hard to argue that we need more physicians in this country than are needed in the rest of the world.
Jean R. Elrick // Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital
Your story on futuristic treatments to restore vision (“Hope in Sight,” Winter 2010) contained an error: You asserted that before approval of the drug Lucentis, a diagnosis of age-related macular degeneration meant “certain and complete blindness.” Even without treatment, the rate of vision loss is never certain, and AMD does not lead to complete blindness.
Clive Novis // Ophthalmologist, Johannesburg, South Africa