This post was authored by Blair D. Erb, Jr., MD, FACC, founder of Cardiology Consultants of Bozeman in Montana and chair of the ACC’s PINNACLE Network Work Group.

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A recent article in Cardiology magazine that reviews the subject of Maintenance of Licensure as well as a session at the CV Summit I attended gave me pause to consider the future of our profession.

While we have witnessed magnificent strides in the management of cardiovascular disease in the last 30 years thanks to new tools and pharmacotherapy, I fear we have sacrificed some of that which characterizes us as a caring profession as we unleashed this sometimes monster of technology in an unguided fashion.

I am saddened that ICAEL has evolved from a voluntary vehicle for the demonstration of my commitment to quality to yet another mandatory hurdle for payment. Now the carrot of pride has become the stick of punishment.

I am saddened that we have failed so miserably as a profession to regulate ourselves that we now find it necessary to create tests and certifying agencies so we can “prove” to the public that we are good.

I am saddened that we have allowed ourselves to become the political pawns of a dysfunctional government and that we must lobby a Congress that knows nothing of what we do.

I am saddened that new doctors seem to have lost the notion of the “physician.” Bayes’ theorem has disappeared. The Oslerian concept of “listen to the patient and he will give you the diagnosis” has vanished. Now we order tests and round up consultants in hopes that one will give an answer.

I am saddened that the majority of us, who come to work each day and do our best, continue to be dragged down by a few opportunists.

I believe a cynic could be convinced that all the board exams, lab certifications and so forth just represent an ailing profession attempting to heal itself. I believe there is something more fundamental at the root of this issue. There are almost too many to count external pressures threatening our profession. These pressures seem to be resulting in a gradual transition from physician to medical worker. This is what we (the curmudgeons) fear. This is the real challenge before us.

In Hamlet, Shakespeare wrote, “the lady doth protest too much.” Does a wall full of board certifications and diplomas make a good physician? Does a list of five fellowships after the MD in a signature signify quality? By bagging a slew of parchments in the hope that wall coverings will prove our worth, are we not becoming the lady in Hamlet?

I recognize the efforts of the ABIM and others and applaud their attempts at quantifying quality. I would argue however, that these measures are at best artificial. I would also suggest that they are more focused on weeding out the fakers, than supporting those with integrity. When we are asked to help a patient with symptomatic coronary artery disease, we are in fact dealing with the final stages of a lifelong disease. To really work on the prevention of coronary disease, we must focus on youth.  In the same way, our work at ensuring quality in our colleagues must begin with our fledglings. Doing the right thing at the very best of our ability must become central to our professional lives. We must make quality something real and applied in everyday practice. The transition from episodic test taking to the demonstration and application of quality initiatives in our daily lives must happen. Only when this occurs will we have achieved real quality, worth or value -- improved patient care.

The ACC leads the way in creating the tools necessary to do this. Witness the PINNACLE Registry, FOCUS, and our life-long learning portfolio. These are some of the tools that can help to restore the carrot of professionalism and banish the stick of outside regulation. I believe the College is in a position to steer the future of our profession. We will be successful only if we are bold and act with the strength of commitment to this cause.