If you want to become President of the United States, how much testing do you have to go through? Theoretically, none. How about running a hospital or an insurance company? Same answer. Contrast their requirements with those of doctors, who after finishing college and the Medical College Admission Tests (MCATs) then embark on a journey that puts them through the testing wringer. For now, let's ignore the plethora of internal tests that they have to take as part of medical school and residency and stick to the standardized tests that doctors across the country have to take. Each of these tests has an acronym that sounds like someone talking with one's mouth full. First there's Step 1 of the USMLE (United States Medical Licensure Exams) after the first two years of medical school, then Step 2 of the USMLE near the end of medical school, then Step 3 in the year after medical school during internship, then the board exams for the residency that you complete. If you want to further specialize, there are more board exams. And the testing doesn't end there: Every several years, doctors are asked to re-certify, which includes...you guessed it...more tests. This re-certification requirement is still a relatively new requirement. Prior to the 1990s, for most specialties, once you achieved initial board certification, you had it for life. But then something happened in the 90s besides Nirvana and N*SYNC: specialties began requiring newly minted specialists to keep re-certifying every decade or so. Of course, the older doctors who were making these decisions didn't require themselves to re-certify. Additionally, as medical and surgical fields have become increasingly super-specialized, more sub-sub-sub-specialty tests continue to emerge to the growing testing burden. We aren't at the point where someone needs to take a special pinkie finger specialty board exam after taking a hand exam, but who knows? And some tests are splitting into multiple parts like a successful boy band, such as consisting of both a written and an oral component. Oral exams not only requires travel, which...you guessed it...you have to pay for, but also put you in front of a group of older doctors who can torture you with obscure questions. By the way, each test is not cheap, costing from a couple thousand dollars to even more. Additionally, mini-industries have emerged to prey on the fears of anxious doctors and doctors-to-be, offering them courses, review materials, books, videos and even personal tutoring and coaching. Each of these things costs money as well. So, is all this testing: Just right and worth it? Too much and wasting the already limited time of doctors? Too much and wasting the already limited time of doctors? Answers 2 and 3? All of the above except for 1? Electronic databases such as Epocrates now can carry what doctors used to have to carry in their brains The argument for the increasing testing is that medical knowledge is expanding, meaning that doctors have to know a lot more than they did in earlier generations. However, other things have changed as well. There is something called the Internet now. And computers. And smartphones. These can not only allow you to access pictures of cats but also medical information so you don't have to hold it all in your head like urine in a bladder (medical information, not cat pictures). Additionally, with medicine becoming increasingly subspecialized, a doctor may not need to know everything anymore. You don't want doctors who have squeezed so much information into their heads that they begin to lose other important information such how to interact with patients and how to use a toilet. With different ways to access information, what's more important is general judgement, knowing how to manage and find information and knowing when to get help. Doctors are transitioning from being a repository of all information to a manager of repositories of information, an important distinction. Testing should follow suit. Moreover, how relevant are these tests to patient care and being a good doctor? Many of the questions ask about minutiae that a doctor won't need to know in daily practice. A written test can't really simulate what a doctor has to face each day in patient care, unless your patients are multiple-choice questions. (Hello, I: a) am going to throw up, b) am really going to throw up, c) just threw up on you, or d) am going to throw up again.) How many studies have actually found a correlation between performance on these board exams and quality of care? Has the increasing testing burden really improved patient care? Or could excessive testing have the opposite effect? Every hour spent studying for the boards is one less hour that the doctor can think about or talk to patients, conduct some research or rest and recharge (because doctors are not machines and everything, including smartphones, needs re-charging). The medical world has changed dramatically since the Brady Bunch was first on the air. The Internet now includes websites with medical information such as WebMD and other databases and capabilities. But has the type and amount of testing that doctors have to go through changed accordingly? The board exams also don't cover important knowledge that may affect patient care these days. The skills, abilities and knowledge that a doctor needs to succeed in today's world is not the same as it was several decades ago. Nowadays, doctors have to navigate through many business, legal and insurance issues to deliver good care. In order to have a voice in healthcare, doctors must understand policy, politics, communications and economics. To run a good practice, it helps for a doctor to be well-versed in management, organizational behavior and operational principles. However, the board exams have not changed adequately to match these differences. Many bright and talented doctors have the ability to juggle multiple responsibilities, including those that involve life-or-death decision making. Therefore, they have been adapting and adding the increased testing to their increasingly packed portfolio of responsibilities. But does it really need to be this way, and at what cost to doctors and patients? Please choose an answer. Source
