what a diploma really means

Monday, November 10, 2014

For football fans of the University of North Carolina, the issue should be about trust, not scapegoating individual players. It should be about perspective, putting academics above athletics. Unfortunately, the UNC story is about scandal and the loss of integrity. Michael McAdoo came to the UNC campus to play football with the promise that he would get a world class education. He had academic aspirations in criminal justice but those in charge of nurturing his football talent placed him in a major that would fit his football practice schedule. Though he was a solid high school student with a 2.9 GPA, he was enrolled in sham courses and others helped write his term papers. He was dismissed from the team fro academic impropriety and presumably scapegoated, because during an 18 year time frame, dozens of other athletes followed the same path to a degree and allowed to succeed on the football field.

Imagine though, if the same game plan was followed by those trusted with our health care. Imagine a university medical school that failed to give adequate training and testing before conferring an MD. Consider the consequences of postgraduate internships and residencies where failure to perform was considered acceptable. Remember that the person who graduates last in their medical school is still called doctor. The public has to have faith that the degree on the wall actually has validity. When the University of North Carolina president signs the diploma in bad faith, it calls into question the good standing of all graduates.

In medicine, there are more than a few checks and balances but also some major loopholes. Training physicians depends on building expertise on the base of a previous level of training. Not all doctors can be brilliant but they certainly must meet a minimum level of competence coming out of medical school. But four years of undergraduate education and four years of med school is only enough to get a newly minted doctor into the postgraduate training of internship and residency. At least three years more are devoted to learning a primary care specialty (family medicine, internal medicine or pediatrics). For other specialties and subspecialties, the training may last up to ten years.

The doctors in charge of the training program have a responsibility to make certain that a certain level of expertise is reached after each year of training. There are national exams to pass, but more importantly, the art of medicine at the bedside needs to be developed like an apprentice. A problem can occur when performance lags. It’s tough to fire a resident or ask them to resign. More frustrating is that after one or two post graduate years of training, that physician may qualify for a medical license, regardless of whether they completed their training. While hanging out an independent shingle in the new corporate world of medical care is difficult, that career path of general practice remains an option.

After a successful residency training, the next step is to enter practice and then take board certification examinations. Pass the exam and you’re a specialist. Fail and you can try, try, try again. Not passing on the first attempt is not uncommon and does not presume incompetence, but failing to finally pass those certification exams may be a red flag.

Once in practice, there are other safeguards to insure good care, especially for those doctors who practice in a hospital. The credentialing committee and medical staff certify the ability of their physicians every two years and review not only their degrees and training, but also any recent complaint and malpractice allegations. This information is not publically available and often state medical examining boards aren’t aware of hospital decisions. Each state has a medical examining board that is charged with making certain that physicians are safe and not a danger to their patients. Unfortunately, the states don’t often talk to each other and suspect physicians can slide for years from one state to another.

The public trust in the medical degree is only as good as each patient-physician interaction. When a physician defrauds Medicare or Medicaid or runs a pill mill to dispense narcotics or performance enhancing drugs, every physician’s reputation suffers. It’s no different than the UNC football players who did it right and graduated without the “help” of others. How much would the football fans be disappointed had Mr. McAdoo shown up on campus at 6 foot tall and weighing 180 pounds, instead of 6’7” and 245? How sad are the UNC fans knowing that the university administrators took advantage of their gridiron heroes and stole their opportunity for an education. And how upset are these same alumni knowing that their diplomas have been devalued?

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