maturation process

[q-school]

what you think you look like

(borrowed from biography.com)



 

what the freshly graduated doctor you hired thinks you look like

(from aarp)



 

roughly when does this happen?  after fifteen years of clinical experience? twenty? more?

literally no one will call you by your first name?

 

actually i do have a question for the board.

i think most young physicians are outraged when they first learn that there is something called grandfathering with respect to board certification.  that if you happen to be above a certain age, that your certificate is unlimited and you don't have to retest periodically.  they bemoan the fact that the older generation sold them out.  i certainly felt that way many moons ago.

so now having been in practice for a long time and have had a chance to see how decisions get made in 3 reasonably sized organizations.   i can't tell you how many times a new policy or rule is developed and someone asks well what about dr. x who has been doing this for 30 years.  so a grandfather clause is made with the expectation that time will solve the problem and avoid prematurely ending someone's career or practice pattern or whatever.

question for discussion is- how do we feel about grandfathering?  is it something with nuance or just plain wrong and policies should be developed with blind eye toward how it affects specific individuals.  for the sake of our discussion, which hopefully will remain civil, let's just talk about medical policies, rather government or other stuff.  eventually, if lucky, we will all be on the other side of the slope, and no longer specifically trained in procedure x or surgery y.   is everything going to be like ACLS?  take some computer class to authenticate your diabetes management?

thanks for any thoughtful comments.

 

 

[White.Beard.Doc]

Finally, when I look in the mirror, clearly I am well preserved, something like this:

 

 

[MPMD]

grandfathering in board cert never bothered me at all, maybe it should? obviously for EM lots of people were considered board certified through practice experience, again seemed like the only way to handle this.

i'm not actually aware of hospital policies from which older docs are given a pass. i have seen multiple places introduce EMR and quite the opposite has been true, in all cases the hospital was very clear -- you learn this or you leave, no exceptions no messing around. knew of an older (but not ancient) doc who came to the end of the training period with the emr after having received lots of ATE support and declared themselves unable to manage the EMR. they were out the door. admittedly there were other issues.

would really be curious to hear about other's experience with stuff like this.

[q-school]

MPMD wrote:

grandfathering in board cert never bothered me at all, maybe it should? obviously for EM lots of people were considered board certified through practice experience, again seemed like the only way to handle this.

i’m not actually aware of hospital policies from which older docs are given a pass. i have seen multiple places introduce EMR and quite the opposite has been true, in all cases the hospital was very clear — you learn this or you leave, no exceptions no messing around. knew of an older (but not ancient) doc who came to the end of the training period with the emr after having received lots of ATE support and declared themselves unable to manage the EMR. they were out the door. admittedly there were other issues.

would really be curious to hear about other’s experience with stuff like this.

Click to expand...

to be clear, it's not that it is written that doctor x gets an exception, the policy is revised or addendums made to allow for these circumstances.  in lieu of certification, 20 years of direct clinical experience can serve blah blah blah.

 

we did the same for EMR, but that is literally the only policy i can recall which wasn't modified to allow for special circumstance.  even that one was modified a number of times to allow more gradual adoption ultimately.  but no one was exempt.  that was largely because of federal mandate/inducement iirc.

 

[jfoxcpacfp]

LOL - this is exactly how I feel in my office. It's like one day I walked in to work and almost everybody was 2 - 3 decades younger and I didn't even see it coming.

[Dreamgiver]

Lol I started shaving my head. Granted I and my better half like the look, but it does hide premature graying secondary to the stress of the job

[Lordosis]

I am currently the youngest person in my office by almost 10 years.  However I never get any "too young to be a Doc" issues due to my baldness.  I am in the contemplation stages of shaving my head.

 

To the point of grandfathering.  Most of the people who are exempt from retesting seem to be the ones who need it the most.  At least in my experience.

[artemis]

Grandfathering is a practice born of necessity.  Older physicians often have an option the younger ones don't:  they can quit.  Revoke their lifetime certifications, and many of them would have done just that, leading to a physician shortage.

(Do I think older physicians should have fought harder against MOC?  Yes, absolutely - which of course if the other reason grandfathering lifetime certifications was done.  It meant fewer physicians in positions of power would stand up to the nonsense, since it wasn't going to directly effect them.)

[q-school]

artemis wrote:

Grandfathering is a practice born of necessity.  Older physicians often have an option the younger ones don’t:  they can quit.  Revoke their lifetime certifications, and many of them would have done just that, leading to a physician shortage.

(Do I think older physicians should have fought harder against MOC?  Yes, absolutely – which of course if the other reason grandfathering lifetime certifications was done.  It meant fewer physicians in positions of power would stand up to the nonsense, since it wasn’t going to directly effect them.)

Click to expand...

the question is whether it is a bribe or just how things get done in the real world with multiple competing interests.

 

[Panscan]

I've never understood why the guy who graduated 10 years ago has to do MOC and recertification exams, but the 75 yr old Dinosaur who was trained in a completely different area is exempt. Which person is more likely to deviate from standard of care or not be up to date?

It makes no sense to me.

[Brains428]

I think those in the doctor's lounge have finally determined that I'm a physician and not just a student in scrubs running in to steal food. I don't have time to chat, since those ED head CTs aren't going to read themselves (yet). I do, however, find time to post here.

 

[artemis]

q-school wrote:

artemis wrote:

Grandfathering is a practice born of necessity.  Older physicians often have an option the younger ones don’t:  they can quit.  Revoke their lifetime certifications, and many of them would have done just that, leading to a physician shortage.

(Do I think older physicians should have fought harder against MOC?  Yes, absolutely – which of course if the other reason grandfathering lifetime certifications was done.  It meant fewer physicians in positions of power would stand up to the nonsense, since it wasn’t going to directly effect them.)

Click to expand…

the question is whether it is a bribe or just how things get done in the real world with multiple competing interests.

Click to expand...

The latter, I think.  The entities that really wanted MOC were willing to do what they needed to do to get it passed.  (Unfortunately, they succeeded.)

[Zzyzx]

q-school wrote:

so now having been in practice for a long time and have had a chance to see how decisions get made in 3 reasonably sized organizations.   i can’t tell you how many times a new policy or rule is developed and someone asks well what about dr. x who has been doing this for 30 years.  so a grandfather clause is made with the expectation that time will solve the problem and avoid prematurely ending someone’s career or practice pattern or whatever.

question for discussion is- how do we feel about grandfathering?  is it something with nuance or just plain wrong and policies should be developed with blind eye toward how it affects specific individuals.  for the sake of our discussion, which hopefully will remain civil, let’s just talk about medical policies, rather government or other stuff.  eventually, if lucky, we will all be on the other side of the slope, and no longer specifically trained in procedure x or surgery y.   is everything going to be like ACLS?  take some computer class to authenticate your diabetes management?

thanks for any thoughtful comments.

Click to expand...

COUNTERPOINT: a new grad has 30-40 future yrs to give to the practice and specialty, so they should have more voting power on policies than a grandfathered doc with one foot out the exit.  Yes there is a nuanced discussion to be had about the out of date physician, but we should not be handing out golden parachutes.  I also reject the argument that too many docs would retire without grandfathering leading to a shortage, those in academia know we have a surplus of med school grads now and the bottleneck is that we do not have enough residencies/fellowships.

MOC in theory for continuing education is perfectly reasonable, but the price gouging and the time suck is outrageous.  Adding on new rules for incoming diplomates was easy as they had no say and no clue what was happening, but they couldn't do that to all the established diplomates for fear of restriction of trade lawsuits.  However, they ingeniously split the potential lawsuit pool by more than half by letting one group out of MOC and won by complacency.  Can't help but notice the grandfathered group was also the wealthiest group as they had minimal school debt and have been in practice the longest while accruing some of the highest income to cost of living ratios for physicians ever recorded.

/end rant

[artemis]

Zzyzx wrote:

I also reject the argument that too many docs would retire without grandfathering leading to a shortage, those in academia know we have a surplus of med school grads now and the bottleneck is that we do not have enough residencies/fellowships.

Click to expand...

Who cares?  All those med school grade are a minimum of 3 years away from being able to practice.  They can't be used to fill vacancies that happen now.

My department is currently looking to recruit an additional pathologist.  We've been looking for a couple of months now, and so far haven't found anyone we're willing to extend an offer to.  It will probably be next August before we have that additional pathologist added to our group; in the meantime, the rest of us are being pushed to the limit.  If anything happened to take one or more of us out for more than a few days, we'd be in significant trouble.

Under-staffing hurts patient care.  I'm sure that was considered when the idea of MOC was initially being tossed around.

Zzyzx wrote:

MOC in theory for continuing education is perfectly reasonable, but the price gouging and the time suck is outrageous.  Adding on new rules for incoming diplomates was easy as they had no say and no clue what was happening, but they couldn’t do that to all the established diplomates for fear of restriction of trade lawsuits.

Click to expand...

And that's the bigger reason for grandfathering in lifetime certifications.  Trainees had no grounds on which to sue.  Established diplomates most certainly did - and they would have had an excellent chance of winning such a suit.  The MOC devotees decided to take the less-risky route to accomplish their goal, knowing that the physicians with lifetime certifications would eventually retire and cease to be an issue.

(As for MOC being a good idea, no.  We already had a CME requirement for licensure.  Any issues could have been dealt with simply by tightening the requirement of what qualifies as adequate CME.  There was no need to add MOC.)

[Panscan]

Who cares if they want to retire? Let them go. Being a doctor is lifetime learning, you don't get to just shut it off because you're old. If you want to do that, then retire.