Friday, March 25, 2016

Let's Get Government Out of the Physician Certification Business

By Michel Accad

Are all certification outfits created the same? Should the government impose free market features? Any pro-market health economists out there?

H.L. Greenberg wrote a scathing indictment of board recertification last week in Medical Economics. He makes excellent points regarding “quality” but he also argues that the board re-certification process offered by National Board of Physicians and Surgeons (NBPAS) as an alternative to the American Board of Medical Specialities (ABMS) program for Maintenance of Certification (MOC), is itself problematic and unjustifiable. On what grounds can NBPAS claim to measure quality? Greenberg’s point is valid, but only to an extent. The real issue is that board certification is mandated by hospital regulations, which are themselves established under strong governmental pressures. That leaves physicians with no margin of maneuver away from this arbitrary and coercive system. If MOC or certification was not mandatory, there would be nothing wrong with physicians electing to pay an independent organization (like NBPAS or any competing organization, including ABMS) to verify their competence by whatever means is mutually agreeable. Whether this arrangement would or would not have any traction with patients, who are the ultimate determiners of quality, is a separate question.

Should the government impose features of the free market?  If that sounds oxymoronic to you, relax, you are sane. Those who favor government intervention, on the other hand, see no irony in the idea. For example, some health economists and policy wonks lament that the supreme court rejected the imposition of price transparency. They don’t realize that the lack of transparency is directly related to the fact that healthcare is a government boondoggle. In a free healthcare market, price transparency would never be an issue. Providers could not survive without being upfront about charges. If you have any doubt, learn about the Surgery Center of Oklahoma. Some other wonks also lament that public ratings of physicians and hospitals are not more prevalent. Here again, this is the direct result of boondoggling. If healthcare was left alone, it would be in the interest of patients and of providers to allow independent rating agencies to bridge the information asymmetry. The moment the government gets involved and makes transparency and ratings compulsory, it immediately turns these aspects of the free market into a “gaming” business, as is the case with most quality measures.

Apparently, Wikipedia keeps a list of prominent health economists. If you wonder why so few of them support free market principles in healthcare, ask yourself: how many healthcare economists and policy wonks would a free market employ?

Michel Accad, MD, practices cardiology and internal medicine in San Francisco, offering individualized care in a free-market setting. His blog about health care and medicine is

The above originally appeared at

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