We assume that when physicians graduate, complete a residency, and pass specialty board examinations, they are competent to practice. For the most part this is true. But not all doctors specialize, and not all specialists stay current in general medical knowledge.

After time, especially in this era of advanced technological science and abundant information, it becomes impossible for anyone to remain current in all areas of medicine. This, of course, is one of the reasons why medicine has become so specialty-driven.

The public trusts that providers are competent in their fields. We do require recredentialing of some very basic things-CPR, for instance. But we don't test skills in the areas that take a much higher level of knowledge. We should.

Measuring competency doesn't just imply scoring well on a knowledge-based multiple choice test. It also requires evaluating doctors' technical skills and their ability to communicate with their patients.

Other professions such as airline pilots must recredential and demonstrate their ability to fly, every six months. The public trust should demand no less from physicians.

Why is there resistance to this concept? At its core, fear. Or, less palatable, it may be arrogance. Physicians may feel no one has the right to question their practice, or that they are above any form of ongoing demonstration of competence.

CME makes a lot of sense, of course. For hospital staff physicians, such retraining is often a condition of employment. This is a wise thing. All physicians need to be constantly learning.

But I have strong reservations about mandatory recertification. In this age of
increasing specialization, many physicians have moved beyond the basic material of their areas and have become experts in very rarified subjects. For them, an arduous course of study for a recertification exam that concentrates on basics would be a waste of time. Nor would it improve patient care.

If we were talking about learning new material that has been shown to help patients, then we would need to consider this proposal.

But if we are not improving the quality of patient care, where does the benefit lie?
It's not a matter of arrogance. Most physicians work in hospitals that have quality-
assurance committees, engaged in a constant process of ongoing review.

In addition, the hospital-accreditation process is essentially ongoing. Physician
incompetence is likely to be discovered there.

Conversely, when a physician has a problem in his or her private practice, a recredentialing examination seems unlikely to reveal that problem. Examinations of this sort don't separate a good doctor from a bad doctor. All that we get from the exercise is a performance on an examination that may or may not have a bearing on practice.