Author's Reply to Readers' Response to “Time to Reform Physician Relicensure”

Mr. Lohse sets up several false dichotomies and another troubling one.[1] He seems to believe that the fact that patients differ means that physician licensing and practice standards cannot be improved or that minimum national standards cannot be set without undermining critical thinking or offending “political sensibilities.” More troubling, he also seems to believe that physicians who work with underserved populations should be held to lower standards. I couldn't disagree more on both counts. I believe that our professional responsibility to our patients requires that we set and constantly improve standards of competency and care. The robustness and heterogeneity of medical thinking is enhanced by the ongoing effort to understand and improve standards of practice nationwide. This has been amply demonstrated, for instance, by the model efforts of the ABMS to enhance the certification and recertification processes.

I appreciate Dr. Journeau's concerns about working out the details of supervision and oversight of provisionally licensed physicians.[1] However, our profession, like others, has always been based upon exactly this sort of mentoring and apprenticeship and I am confident that it can be further adapted. There are examples to draw from in other professions, such as engineering and teaching, where such advanced proctoring is routinely provided in order to qualify for full licensure. I also agree that we need to revisit many aspects of our educational process (which has not changed significantly since it was established early last century) and have said so in a number of articles and presentations.

I continue to believe that we have much to do to improve our education and training, as well as our practice standards and systems. A national licensure process would be a rational step forward.