CME Helps Physician Compliance

With more and more studies showing that America is going to be facing a significant shortage of physicians in the near future—150,000 by 2025—any other factors that could reduce the doctor workforce will hurt patients significantly, especially now that health care ‘reform’ has passed.

Unfortunately, a recent Wall Street Journal article noted that shortages will not be the only problems because “as many as 10% of the nation's 750,000 physicians will demonstrate "significant deficiencies in knowledge or skills" at some point in their career, according to Harvard University patient-safety expert Lucian Leape. What this means is that doctors are going to need more continuing medical education (CME) programs to address these ‘significant deficiencies in knowledge or skills.” This need will also be critical as millions of patients enter the health care system.

But who is going to pay for all this training and CME to address the deficiencies? Our recent research into the health care legislation did not see any direct funding for CME.

One possible solution, which WSJ covered, is a program called Physician Assessment and Clinical Education Program, or PACE, at the University of California, San Diego. PACE, which is widely regarded as the largest and most comprehensive, started in 1996 by San Diego family physician William Norcross, initially focused on serving the California medical board.

The board often requires participation in PACE or an equivalent program for doctors who have been disciplined or had their licenses suspended, or those with malpractice settlements in excess of $30,000 who have been determined by the board to be incompetent or negligent. Doctors generally pay for the PACE program, which can cost from $6,900 to $17,000, out of their own pocket, and may pay thousands of dollars for their own legal counsel. PACE has also found that older doctors can be unfit to continue practicing.

PACE uses a mix of computer-based simulations, multiple-choice exams, cognitive-function screenings and hands-on observation, PACE faculty and staff tests doctors' knowledge, skills and judgment, providing remedial courses and a weeklong mini-residency supervised by UCSD medical faculty.

The program starts out by “evaluating participants' using tests and faculty and volunteers who role-play as patients.” In this two-day program, doctors also take a test that screens for cognitive impairment, as well as exams based on their practice specialty, ethics and other areas. “Depending on their specific issues, participants then may take courses in areas such as prescribing drugs and medical record keeping, and are required to do a medical research project to hone their skills at keeping up with medical literature.”

Once the results from this round of testing are evaluated, a second phase is tailored to the individual doctor, in which PACE “participants go through a week-long mini-residency at UCSD under the supervision of a faculty physician.” After both phases, Dr. Norcross and his team at PACE review the test results and get feedback from supervising faculty.

Overall, PACE has performed over 1,000 competency assessments, with about half who were found to be completely competent with no need for remedial training, while the remaining 40% had deficiencies that required weeks or months of remedial education. If a doctor passes, there are three types of grades in PACE: pass without further action, pass with minor recommendations and pass with major recommendations. In all, PACE has provided the courses to more than 2,300 doctors.  

This kind of program and testing was crucial because it allowed doctors to evaluate patients when they were given only each patient's chief complaint and vital signs. From this information, they had to perform an appropriate history and physical exam, and then order pertinent tests to diagnose and treat each patient's condition. PACE is also extremely important because it allows doctors to take courses in prescribing and chronic-pain management, and allows them to learn how to perform more accurate charting and use electronic medical records. Although “Dr. Norcross acknowledges that the tests are intensive, he said they are largely based on basic skills doctors need to master to get through medical school.”

In the end, a growing shortage of physicians and the potential threat to a safe patient care at one time or another calls for more support of programs like PACE to help doctors stay up to date on their knowledge and skills. As WSJ noted, “medical regulators say putting doctors back into practice with a honed set of skills and a better grasp of professional standards is better for patients in the long run, especially when access to care is a growing problem in poor and underserved communities.”

As a result, PACE should serve as a model for similar programs, some of which are already under development. Using this kind of educational approach to prevent physicians from making mistakes will ensure that our physician force remains strong.


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