Special JAMA Issue Addresses Professionalism and Self-Regulation in Medicine

Maintaining physician competence and professionalism is the overarching focus of the May 12 issue of the Journal of the American Medical Association (JAMA). Leaders from the health care community, government and academia provide thoughtful perspectives on timely and important issues like reforming the continuing medical education (CME) system, the role of self-regulation, the function of maintenance of certification (MOC), state medical licensing and the future of undergraduate and graduate medical education funding.

Cardiology and the practice of medicine as a whole are facing multiple challenges ranging from rapidly changing health care delivery and payment systems, to new parameters for relationships with industry, to calls for new levels of accountability. Most recently, new requirements for maintaining certification have sparked much-needed debate over self-regulation of the profession of medicine. The viewpoints presented in JAMA provide both an extensive and unique look at all of these issues through the lens of professionalism. Highlights from the issue include:

  • Donald Berwick, MD, MPP, of the Institute for Healthcare Improvement, writes that “neither patients nor physicians are well-served on a battleground between professional self-regulation and external accountability.” He suggests that “from a struggle for local control, health care needs to emerge into an era of wholeness—shared and respectful stewardship. So does the system that prepares physicians for that future.”
  • Robert Huckman, PhD, and Ananth Raman, PhD, MBA, of Harvard Business School in Massachusetts caution that physicians and other health care professionals need to substantially improve quality and innovation in the near-term or run the risk of “outside forces, such as regulators and policymakers, [becoming] more involved in certification and mandating approaches to improvement.”
  • Paul Teirstein, MD, and Eric Topol, MD, offer a perspective on the role of MOC programs in governance and professionalism. They write that “all stakeholders should have an open mind toward innovation in learning.” The also stress the importance of physicians assuming “the responsibility for self-governance and [educating] the public as to what is important and relevant for maintaining board certification, ensuring lifelong learning and improving medical care.”
  • Richard Baron, MD, of the American Board of Internal Medicine, stresses the need for new approaches to professional self-regulation in a changing world. “The days of self-declared expertise are over, both for individual physicians and for organizations like boards that articulate and implement community standards,” he writes. “For the medical profession to continue to have its voice heard clearly, institutions and physicians need to work together and find ways to do important work using new approaches.”
  • Noam Levey of the Los Angeles Times/Tribune Washington Bureau in Washington, DC, urges more patient engagement to help fortify public trust in medical professionals. “Patients across the country are experiencing new models of care that are more coordinated, more transparent, more responsive and more personal... If physicians are viewed as standing in the way of these models, they risk the trust the profession has worked so hard to earn.”
  • Steven Nissen, MD, MACC, of the Cleveland Clinic in Ohio, calls for reforms of the CME system, including development of standardized and consistent national requirements for licensure and certification to replace the current patchwork of individual state regulations. “Failure to reform the approach to physician CME will inevitably lead to a future with physicians falling further and further behind in needed medical knowledge,” he writes.
  • Humayun Chaudhry, DO, MS, J. Daniel Gifford, MD, and Arthur Hengerer, MD, of the Federation of State Medical Boards in Euless, TX, write that the principles of physician engagement, public participation, communication, transparency, innovation and collaboration are what have “enabled state boards to retain their relevancy, adapt to changing circumstances, preserve the public’s trust, and earn the tacit respect of physicians the organizations that represent them.

(Read more perspectives in the full issue.)

Professionalism is at the crux of the ACC’s mission to transform cardiovascular care and improve heart health. In terms of education, the College’s educational curriculum is driven by evidence-based learning needs. Understanding gaps in learning knowledge, performance and competence is the first step in the process to designing meaningful, effective continuing medical education. In addition, the ACC has embraced a broad array of learning formats that move way beyond the traditional didactic lecture, including interactive clinical cases, skills-based practice, patient provider encounters and peer-to-peer learning. ACC’s suite of NCDR registries, as well as its many quality initiatives aimed at helping close identified gaps in guideline-based care, are also playing roles in tracking and measuring performance and patient outcomes. The College is also listening closely to its members regarding CME and MOC and is diligently working to improve the current systems, while also carefully examining alternative options for its members.

We agree with many of the voices included in JAMA that it is time to recalibrate the process in a manner that assists physicians in providing professional, knowledgeable, and compassionate care, while balancing the need to demonstrate ongoing competence,” says ACC President Kim Allan Williams, Sr., MD, FACC. “Collaboration will be key.”

Keywords: American Medical Association, Certification, Curriculum, Education, Medical, Continuing, Government, Licensure, Medical, Medicine, Patient Participation, Physicians, Registries, Social Responsibility

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