- Joined
- Jul 23, 2004
- Messages
- 11,775
- Reaction score
- 2,027
It seems to me that quality control in the production of doctors gets shunted to the next system (this would make a great paper; maybe someone has already written it?). Pardon me if this comes across as overly provocative (I have been riding a caffeine wave for three days preparing for a case):We are the last point of quality control.
QA certainly doesn't happen at the entry to medical school level. If you include allopathic, osteopathic, and international medical schools, pretty much anyone capable of graduating college successfully can get into medical school if they are willing to go anywhere and pay anything.
QA doesn't typically happen at the medical school graduation level. I'm not sure of the stats in general, but last I heard, U.S. allopaths graduate at a rate of about 95%. When you rule out folks who change careers, have health consequences, etc., I've heard that it's only about 1.5% of U.S. allopaths not graduating due to academic reasons. I know firsthand from doing education rep work in medical school that programs bend over backwards to make sure each person gets through the year. In ways that far exceed even what your average community college would do to get folks passed.
QA doesn't seem to happen at the residency level either. I'd be curious to hear from PDs on this, but I know that residents being kicked out for poor performance is extremely low, even in psychiatry (which although rising in competition is still not up there in requirements). I have met many, many residents that I would not want to refer patients to. And almost all folks I have heard about (in substantiated ways) that were kicked out from residency were for professionalism (sex, drugs, etc.) reasons rather than can't-execute-even-the-fundamentals. SDN seems rife with applicants wanting to tar any program that has ever given a resident the boot, even prior to hearing about circumstances.
QA doesn't seem to happen post-residency level much at all. From doing malpractice cases, I feel comfortable saying that a psychiatrists abilities have to be at the point of outright dangerous before they will lose their license or even get reprimanded.
I have no solutions. I just find it interesting that for such a safety-oriented field, we do not have a very good quality assurance process for how we create doctors.