I spent the last few weeks studying and taking tests so I can continue my Board Certification (in Family Medicine). Physicians and other health care workers are licensed by the State of Rhode Island and must pay a hefty fee for that privilege, as well as show evidence that we have studied the new developments in medicine and in our specialty. Physicians must complete a three-to-five-year residency and pass a certifying examination in order to become Board Certified. Nurse practitioners must pass a certifying examination in order to become licensed. Physicians and nurse practitioners then have to go through a process that tests our knowledge and ability in our own specialty every five to ten years.
Essentially all practicing physicians and nurse practitioners become certified and maintain our certification, because you can’t get paid by insurance companies, or get hospital privileges, without becoming Board certified in a specialty or certifying as a nurse practitioner. (Interestingly, Medicare doesn’t require Board Certification for generalist physicians – internists and family physicians – but nurse practitioners must be certified.) Board certification is not required to practice if you don’t take insurance, like most psychiatrists and growing numbers of family physicians and internists.
What struck me, as I studied, is how much there is to know and how much more we know than we used to know, even thirty years ago. More than ten different types or classes of diabetes medications, each with its own mechanism of action, its own set of indications, contraindications and side effects, with up to eight different drugs in each class. And many types of insulin. Much more diagnostic precision in mental health – much better ways to classify mental and behavioral disorders, with better drugs, better talking therapies, and better recommendations for or against drugs for each type of disorder. Lots of new drugs for asthma, and a very precise way of classifying the severity of asthma, so we know what drugs to use in which situation. The same is true for heart disease and cancer – better understanding about risks and prognosis, better prevention and lots and lots of better treatments.
At the same time, I remembered an old saying — if you’re so smart, why ain’t you rich? Applied here, we might ask in the same way, if we are so good at medications and treatments, why ain’t we healthier? Why does health care in the US cost so much, and produce such poor public health outcomes, remembering that we spend twice as much as other developed nations, but the way we understand public health – life expectancy, infant and maternal morbidity and mortality, cancer and heart disease mortality and so forth – ranks us about 50th in the world.
Why? The answer made me admire and respect the people in practice even more. Our performance is expensive and miserable for two reasons – one, because we don’t have a health care system that brings the same set of essential services to everyone, as it nurtures and supports its health care workers; and two, because we allow money guys to profit from both health care as well as the products and culture that drives our illnesses, our crappy food, our stressed, isolated lives, and our lazy lifestyle that has us all spending all day at screens instead of being with the people and communities and in the nature we love.
All this impacts health care workers just as much as the rest of us, but the for-profit piece of the health care market means that health care workers have to both work their brains all the time to learn about and keep up with what works, and have to deal with bosses who want to push them around, ignore their professional integrity and push them to the limit of what a human being can stand, as a worker, as a cog in a wheel.
Our health care workers are heroes. They are our modern Jedi knights, and it’s crazy that our culture doesn’t recognize them as such, and start nurturing, supporting and protecting them from the money guys, so our health care workers can do their jobs, and take care of the rest of us.
As I recertified, I came away with an overwhelming sense of gratitude for my colleagues and doctors. You guys have to know a tremendous amount. You have to learn and share what you know. You carry the responsibility of applying that knowledge to people in their families and communities and doing that with decency and kindness, patience and empathy.
Thank you. You stand up for us. It’s crazy we haven’t learned to stand up for you as well.
You can find Michael Fine’s commentaries and short stories on
https://michaelfinemd.substack.com/and on http://www.michaelfinemd.com