Docs have poor prognosis for state plans to test them

Wednesday, Jan. 28, 2004 | 11:03 a.m.

Las Vegas doctors are concerned that the state's plans to periodically test them for competency won't weed out incompetent physicians and will be an inconvenient hurdle for all doctors.

The Nevada State Board of Medical Examiners will try to quell those objections with a workshop about the proposal to require competency testing of physicians at 10 a.m. Thursday in the Sawyer State Office Building, 555 E. Washington Ave.

The regulations, if passed, would force doctors to take competency tests every 10 years as part of their biennial registrations to practice medicine in Nevada. The board will hold a public hearing on the plan on March 12 in Reno and could vote then.

Local doctors say that while they naturally support competency in the medical profession -- and constantly study to learn the latest advances in their fields -- the act of jotting down correct answers to questions on a piece of paper will not necessarily prove that a doctor is competent.

Some doctors say the state board is being forced to consider the issue that first came up and received a cool reception 3 1/2 years ago and again last year because of political pressure that arose from medical malpractice issues.

"The board sits in a political hot seat and has to make regulations in response to such issues," said Dr. John Nowins, president of the Clark County OB/GYN Society and a local gynecologist. "All we as doctors can do is say: 'What new thing is required of us now?' "

Dr. John Ellerton, an oncologist who is chief of staff at the University Medical Center, said legislators confused the issues of medical malpractice and medical competency.

"I just don't want to see a competency test substituted for the board doing its job of addressing problem doctors," he said. "If there is a problem with a physician -- and I'm not talking about one malpractice lawsuit, but a documented series of complaints -- then the board should deal with that doctor specifically."

But Stephen Quinn, deputy general counsel for the Board of Medical Examiners, said the board's job is to determine the continuing proficiency of Nevada doctors and periodic testing is one way to do that.

"Doctors are required to update and maintain certain levels of knowledge in their fields," Quinn said. "A number of specialties require that they be tested every 10 years to remain board-certified."

That is one of the options for testing, provided that recertification comes from a member board of the American Board of Medical Specialists.

Other exemptions to testing every 10 years -- and the latest revisions to the ongoing debate over competency examinations -- include:

Under current law licensed physicians from other states who want to practice in Nevada must have passed a major examination in the past 10 years before being allowed to work in Nevada. The proposed regulations, in effect, would extend that restriction to all doctors.

Texas is the only other state with a similar requirement, officials said.

Quinn said that while many states don't require competency testing, many states also do not have as stringent rules for doctors as Nevada does.

For instance, he said, while other states allow doctors to get their licenses after graduating from medical school and serving a brief internship, Nevada requires potential new doctors to serve a three-year residency before initial licensing -- the most demanding requirement of its kind in the nation.

"For 90 percent or more of doctors in Nevada, this (competency test) won't be a problem," Quinn said, noting that competent doctors should be able to pass such an exam once every 10 years.

Ellerton and others say without a clear-cut definition of what medical competency is, a single written test cannot resolve the problem because licensed doctors who are incompetent have gone through many years of school and have been before boards and -- all along the way -- have passed many written tests.

Nowins said: "I'm sure that a doctor passing a competency test will make his patients feel better that their doctor has passed it, but in the long run that won't guarantee that a doctor who passed such a test is competent.

"Any such test must be relevant, logical and actually prove what it is intending to prove."

Ellerton and Nowins said state law already requires doctors to take 40 hours of continuing medical education classes every two years to keep up with changes in their profession.

Ellerton said he believes doctors should be given credit toward competency consideration for teaching and conducting research projects. Ellerton teaches at the Nevada School of Medicine and does research work.

Ellerton and Nowins said it would be a shame if the competency test is either too far-reaching or so complicated that doctors wind up having to take two weeks off from their private practices or hospital duties to bone up for the exams.

"The testing should not be disruptive to patient care," Ellerton said.

A proposal that would require physicians to take competency tests every 10 years first came before the Medical Examiners Board in 2000.

Several members of the board, which is comprised mostly of physicians, objected at the time that a doctor may not be able to pass a general competency exam but still could be certified, qualified and competent to practice his own specialty.

The issue returned again in April, when angry doctors and administrators protested the proposed requirement at a crowded Board of Medical Examiners workshop. The opposition ranged from calling the regulation ineffective to claiming it would scare away new physicians.

After that meeting, the proposal went back to a committee that came up with the options to the 10-year testing that will be reviewed and perhaps added to at the workshop this month and at the public hearing in March.

"We were able to tweak it to meet some of the concerns, and if necessary we are prepared to tweak it again," said Dr. Cheryl Hug-English, president of the Board of Medical Examiners.

"We feel this is a better proposal than the one offered last year because it offers more flexibility."