Address patient safety with pay levels that cover time needed for good care

Regarding "Stricter requirements sought for relicensure as medical boards draft proposal" (Article, Dec. 24/31, 2007): According to the article, "Medical board leaders are considering more rigorous maintenance of licensure because of a greater public demand for physician accountability."

As a board-certified family physician who has been in practice for more than 20 years in a variety of clinical settings, I have some thoughts on this subject.

I am not aware of any individual who has expressed the need for greater physician accountability. I think most people would agree that physicians are regulated and held to standards much higher than any other profession. We deal with people and at times some very complicated problems, all day long. What we do is deemed so important that making a single mistake, or seeming to, can result in a malpractice lawsuit with the potential of large financial liability. Yet at the same time we are told that the government and the insurance industry place such small value on what we do that we are subject to yearly pay cuts.

When reimbursement declines, physicians have to work faster because they are compelled to see more patients, in an attempt to maintain revenue. This is a downward spiral with no end in sight. In many cases, the end result is less time with each patient and a greater potential for error or miscommunication. This simple concept is the underlying basis for potential compromise of patient safety. So, if patient safety is a chief concern, provide proper reimbursement to physicians so they can take the time necessary to address a patient's complicated medical needs.

As a "response" to calls for safety, the Federation of State Medical Boards wants to create more requirements for physicians seeking relicensure. Why? This will not fix the underlying problem. Physicians still will lack time to spend with patients.

Perhaps the "public" that FSMB wants to represent is not aware of what physicians do and how they are credentialed to do it. Perhaps FSMB should be more concerned with educating the public instead of creating more burdens for physicians.

Further, how much will it cost physicians to acquire this extra level of relicensure? Will it require more time away from our families and our practices? What will it cost financially in terms of lost revenue? Is it really necessary?

Perhaps FSMB can reimburse physicians for the amount of missed practice time and costs associated with attending to all the requirements that it feels are so important. Alternatively, perhaps the individual who believes that this extra level of accountability is so important should pay the physician who attains it. But under no circumstances should physicians be required to do more than what they already do without appropriate reimbursement.

Ken Ricci, DO, Canton, Ga.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2008/03/17/edlt0317.htm.