Doctors protest proposed competency tests

By Timothy Pratt (contact)

Thursday, May 1, 2003 | 11:16 a.m.

Angry doctors and administrators crowded a workshop Wednesday on a state proposal to require them to demonstrate competency every two years.

The state Board of Medical Examiners is considering regulations that would require physicians to demonstrate competency every two years in order to keep their licenses to practice in the state.

Under the proposal physicians would have to take a test every 10 years unless they could demonstrate competency through one of three other options. Texas is the only other state with a similar set-up, board member Dr. Paul A. Stewart said.

"The public wants to know: Is a physician competent today?" Stewart said in explaining the regulations. "Right now, the board can not honestly answer that question."

A who's who of Southern Nevada health care opposed the ideas at the Sawyer State Office Building, aiming their harshest criticism at the proposed exam.

The opposition ranged from calling the regulations ineffective to claiming they would scare away new physicians in a state already threatened by a medical malpractice crisis.

"Taking this exam would not make me a better practitioner," said Beata Kwiatkowska, a pathologist and medical director for United Blood Services.

"Like most practitioners today, I am specialized and this exam would not test my knowledge in my field," she said.

The test, called the Special Purpose Examination, is prepared by the Federation of State Medical Boards of the United States.

Stewart said the board asked the federation to prepare exams for areas of specialization three years ago, "but that hasn't happened yet."

However, the regulations would also allow physicians to demonstrate competency in several other ways: by being certified through a member board of the American Board of Medical Specialities; by having ongoing relationships with two nationally certified hospitals or medical centers during the two years preceding the application for a new license; or by passing a peer review.

Stewart said all but about 100 of the 5,000 physicians certified by the board fulfill the second requirement by maintaining what are called hospital privileges at certified hospitals.

Still, most attention Wednesday was focused on the test.

"Adding more testing is not the answer ... for physicians who are already working 14 hours a day to make a living," James Kilber, chief executive of Desert Radiologists, said.

Lawrence M. Preston, president of Professional Medical Consultants Inc., said that the regulations could make it more difficult to attract health care professionals to the state.

"It has to be possible to sell our state," Preston said. "It shouldn't be so onerous that physicians don't want to come here."

Dr. John Holmes said, "If these rules had been in effect in 1965, I would not have come here."

Others stressed that the regulations would not serve their underlying goal -- to allow a person to know if a doctor can be trusted.

"You have to differentiate between clinical competency and accountability," said Dr. Raj Chanderraj, a cardiologist and immediate past president of the Clark County Medical Society.

"I can assure you that almost all the physicians who have had medical malpractice suits filed against them could meet the competency requirement proposed today," he said.

Dr. George Mead Hemmeter, former chief of staff for Sunrise Hospital, held a similar position.

"These proposed regulations are absolutely silent on the issue of relicensing truly errant and medically negligent physicians," he said.

Dr. Leonard Kreisler, former chief of staff for the University Medical Center, said that the board already has rules for weeding out incompetent or crooked doctors.

"All you would have to do is increase surveillance of what's already on the books," he said.

But several board members pointed out that physicians and administrators are often remiss to report cases of medical fraud for fear of being sued for defamation.

"We're tugged in two different directions," said board member Donald Baepler.

At one point the meeting grew so heated that board member Stewart tried to calm the critics by saying the board and those in the room were on the same side and not in conflict.

"You are attacking us because you think we are attacking you," Stewart said. "There is no faith between you and us ... but 'us' is you.

"We're here trying to develop something we can use, not to hear that we're idiots for bringing this forward."