June 30th, 2009
02:46 PM ET

Doctor qualifications take center stage

By David Martin
CNN Medical Senior Producer

Michael Jackson’s sad and sudden death has brought the issue of physician qualifications to center stage.

Jackson’s personal doctor, Conrad Murray, was a cardiologist who was not board certified in cardiology. Board certification isn’t necessary to practice medicine, but many hospital systems require their doctors to be board certified in their specialties. Still, Murray had not been subject to any state or federal disciplinary in the last five years, according to HealthGrades, and Jackson reportedly got along well with him. That counts for something. In the coming days and weeks, investigators will determine whether doctors were prescribing narcotics for Jackson. For his part, Murray’s attorney has denied that Murray prescribed or administered the powerful painkillers Demerol or OxyContin to the pop star.

Unlike the rest of us, Jackson had the means to employ a personal physician, the kind of round-the-clock care that is usually privileged preserve of presidents and potentates.

When we choose a doctor, we simply want someone who will see us when we’re sick, who takes the time to listen, who can draw on knowledge and experience to find the right treatment when we need it. We assume the doctor is licensed. We assume if the doctor had been endangering patients, we’d know about it.

A couple of recent reports call that into question.

Medversant Technologies, which provides Web-based management tools for hospitals and others, recently reviewed the credentials of more than 7,000 practicing doctors and found that 1 percent were unlicensed or had licenses that were suspended or terminated because of state or federal sanctions; 6 percent more had expired licenses.

And last month, Public Citizen published a report taking a closer look at the National Practitioner Data Bank, designed to protect patients from incompetent or unprofessional physicians.

Hospitals that revoke or restrict a doctor’s privileges for more than 30 days because of misconduct or ineptitude are supposed to report this to the federal data bank.

But Public Citizen says hospitals look for ways to avoid reporting doctors. Some hospitals allow doctors to take a leave of absence rather than discipline them in a way that would require reporting to the database, the non-profit group said in the report, while others impose sanctions of 30 days or less to avoid reporting.

In 2006, the American Journal of Medical Quality published a study that found 60 to 75 percent of reportable actions were not reported.

How thoroughly have you checked out your doctor’s credentials? Have you ever gone to a doctor who you found out later was unqualified or unlicensed?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

soundoff (20 Responses)
  1. CA Dover, NH

    I have to admit I haven't. I've gone so far on trust, mostly: trust that the major hospital I typically go to has done their homework to make sure the doctors in their employ are credentialled for the work they have been hired to do. Quite naive on my part, I agree, but I admit I've been lucky. I've steered away from practitioners who do not listen accurately to what's happening with me, or from doctors who cannot provide quality care, but I've never been in the postion where paying for an independent doctor or specialist has been one of my medical care options.

    June 30, 2009 at 18:31 | Report abuse | Reply
  2. joy

    Diprivan is the trade name for propofol. Propofol is the most common drug for inducing general anesthesia in the US today. It has replaced pentothal. In most states, the drug can only be administered by an anesthesiologist or under the direct supervision of an anesthesiologist. Propofol should only be used in conjunction with use of standard anesthesia monitors( BP, ecg, pulse oximeter and capnoraphy), oxygen, intubation and ventilation equipment).

    Propofol alone is an induction agent for general anesthesia, and even in small amounts (2cc or 20mg) can cause apnea if other drugs are on board, i.e. narcotics, other sedatives.

    It is profoundly negligent for a non anesthesiologist to administer this anesthetic agent in a non-hospital or surgcenter setting.

    June 30, 2009 at 23:37 | Report abuse | Reply
  3. notmd

    If you enter a doctor's office you will see all types of diploma's on their wall..i would like to see a certificate that states they are committed to health care and take it personally..so the certificate should provide the following..
    1)do they smoke?
    2)are they considered overweight?..
    3)do they exercise for at least 1/2 hour each day?
    4)do they limit their alcohol intake to a maximum of 2 drinks a day?.
    5)do they have an annual physical each year?..

    good start to walk the talk..

    July 1, 2009 at 20:19 | Report abuse | Reply
  4. J. Georgino

    Agreed one does not have to be Board certified to practice medicine, but certainly, doesn't one have to be board-certified in Cardiology, as is the case here, to call himself or be termed a "cardiologist" or specialist doc in the heart and vascular issues???? for that matter, at least BC'd in Internal Medicine, the requirement for BC in Card I believe...

    July 2, 2009 at 13:22 | Report abuse | Reply
  5. messengermuse

    I have a question for Dr. Gupta:

    In a special filmed interview with Michael Jackson (I watched last night) the reporter who filmed the program cited his concern for MJ because he was there when MJ dangled his baby over that balcony in Germany. He said in the film that it was evident that MJ was "pretty manic" during that incident. The film also showed MJ feeding his baby and he was jittery and at intervals made little sense cognitively.

    Add to this "manic" type behavior, his indifference toward "consequences," his inability to sleep even with prescribed sedatives and subsequent requests for Diprivan drip coupled with his bizarre (at times) behavior, his creative and "out there" genious, and his recklessness would seem to point toward undiagnosed Bipolar Disorder. Body Dismorphic/OCD and PTSD also certainly fit with this profile. It certainly looks like mental illness that went undiagnosed! Shame on the professionals!

    Why in Heaven's name wasn't someone in that circle alert to this possibility? What do you think? Perhaps a psych Bipolar Disorder or Dual Diagnosis expert might examine this theory?

    July 3, 2009 at 17:12 | Report abuse | Reply
  6. Wolfsky

    Those "doctors" all had stars in their eyes and a boat note to pay. I mean how cool would you feel to be able to say "I'm Michael Jackson's personal live in physician"...you get drawn into that ego thing of your own. It is a shame...and these pharmacisits and pharmacies should be called to the carpet as well. Do you think for one moment my local Walgreens or Rite Aid would give me a $10 line of credit much less what $100,000.00 crap no...

    July 7, 2009 at 11:29 | Report abuse | Reply
  7. J. Georgino

    Always assure any doc I see is Board Certified....a major requirement!

    July 8, 2009 at 16:19 | Report abuse | Reply

    There should be central authority to regulate the professional qualifications of doctors.

    July 10, 2009 at 20:25 | Report abuse | Reply
    • Richard

      说:Tim its to point out that they have no actual thigns in common, other than the fact that you think both are wrong. When pressed for something that they have on common you end up admitting that my objection was correct (hiding behind calling it a technicality notwithstanding), and you resorted to saying that bans on interracial marriage on the one hand, and a male/female definition of marriage on the other are similar because they're both laughable reasons at best, and they both rely on claims of unsupported e2€œimmoralitye2€9d to get the point across. According to you, naturally.

      October 14, 2012 at 01:55 | Report abuse |
  9. Ted Bonebrake

    I am writing to suggest that the approach being taken toward healthcare reform is wrong. It does not make economic sense. Here is why:

    There are three problems that will prevent us from solving all others. These are private insurance, high costs, and the demise of hospitals. Until those are addressed, we will not be able to improve access or quality. The first two problems are closely related. What we now have in the United States is not health insurance; it really amounts to "prepaid" healthcare. This gives those who have private insurance unprecedented access to a multitude of services at an extremely low out of pocket cost. It also has the effect of removing healthcare from the free market, because the majority of costs are paid by "third-party payors", rather than the consumer. The free-market system has historically been the best method of cost control known, but if the consumer is not spending their own money, that control is lost.

    Imagine if employers offered auto insurance that not only covered accidents, but routine maintenance, oil and service, gas, car washes, cup holders, even a new stereo. What would happen if some drivers could obtain all of these items for a small fraction of the actual cost, but others had to pay full price? The price of automobile parts and products would increase dramatically, employer costs would increase, and people who had this type of auto insurance would tend to “over-use” these services. This results in an “artificial” increase in demand. These products and services would become unobtainable for drivers who did not have this type of insurance, which would create increased demand, and a higher price, for insurance. It then becomes a vicious economic circle.

    This is why healthcare costs are so high today. It is also why the uninsured cannot afford healthcare – they are the only ones who pay full price. Universal healthcare will only make the problem worse. It would completely remove healthcare from the free market, allowing for unchecked inflation.

    Dictionary.com defines insurance:
    "The act, system, or business of insuring property, life, one's person, etc., against loss or harm arising in specified contingencies, as fire, accident, death, disablement, or the like, in consideration of a payment proportionate to the risk involved."

    This suggests that insurance is for unexpected or accidental occurrences. Healthcare insurance today pays for many routine costs that are neither "unexpected" nor "accidental". They consume a large portion of the billions of dollars spent on healthcare each year, yet they produce nothing. They do create higher costs for doctors, hospitals, pharmacies and most other healthcare providers, who must hire extra employees to deal with the paperwork and accept less than full payment for their services.

    I believe that the solution to this problem is to expand Medicaid so that the poor are really covered. Then limit insurance to covering "catastrophic" events, like surgeries, hospitalizations or expensive chronic medical conditions. This would limit both their profit and their involvement in healthcare. A competing government-run plan might not be a bad idea; however it should not cover routine costs either.

    The third problem is the demise of hospitals. It is not here yet, but it is coming. In the 1970's for-profit hospitals took over the healthcare industry. Prior to that, most hospitals were non-profit or county-owned. When profit became the driving force behind running a hospital, care suffered and costs skyrocketed. Then in the 1990's, many surgeons, rich from their inflated costs (which were paid by insurance companies), began to build their own, free-standing surgical centers. This significantly reduced revenue from a hospital's most profitable department yet left it with the responsibility of maintaining an emergency room, usually the most costly department. Today, most indigent healthcare is provided in emergency rooms, increasing overall healthcare costs and draining hospitals' resources. Hospitals have turned to employing physicians as a way to recoup some of these costs. This has its own set of problems.

    I think the other major step that should be taken is to close and eliminate free-standing surgical centers and require all hospitals to be either 501c-3 non-profit organizations, or owned by local governments and run as non-profits. Employment of physicians should also be eliminated, with the exception of traditional hospital employees: pathologists, radiologists, and emergency room doctors.

    The result will be a system that is closer to a true free market, without removing the safety net completely. The government does not need to pay for everyone, only those who need it. Most people, who are healthy and working, would pay out of pocket for visits to private doctors, who would compete on the free market, resulting in lower costs. The same would be true for prescription medicines. No pill costs $12 to make, and in a free market, no one would buy it. It might be worth taking a look at a system like Title X to help fund hospitals.
    As long as providing healthcare in the US is guided by profit, rather than the care of the patient, we will see costs continue to soar. These huge profit “loopholes” must be closed. Currently, these are being exploited by (1) drug companies, who charge as much as they want for drugs, knowing that insurance will pay all but $20 or $40; (2) insurance companies, who simply add an extra layer of paperwork and costs, without really producing anything; (3) some physicians, like surgeons who build their own surgical centers, or ophthalmologists who open their own optical shops; (4) and hospitals, which are driven by profit, and not patient care.

    Again, we DO NOT need to provide “pre-paid healthcare” for those who are generally healthy and can afford to pay for a visit to the doctor if they are sick. Insurance companies should not be allowed to offer this type of insurance – this is what makes costs, and their profits, go up. Most healthy people would be covered for catastrophic events only, similar to today’s $5000 deductible HSA. But rather than the government or insurance paying for routine visits, annual exams, cancer screening and cholesterol checks, why not let people pay for it themselves? Insurance companies could be required to offer discounts to people who get regular health maintenance. We do need to provide for those who cannot pay by expanding Medicaid to cover ALL persons under the federal poverty level.

    I know that some of these ideas are rather radical and I hope they make it to your desk. I can almost guarantee you that this type of plan will not only be less expensive than universal coverage for everything for everyone, it will also dramatically reduce healthcare costs. The burden to taxpayers would also be reduced.

    The interesting thing about my suggestions is that they should have bi-partisan appeal! Republicans love the free market, and reduced government involvement. American citizens may be concerned at first about losing their "pre-paid" healthcare, but they will be better off. Typically, insurance costs several thousand dollars a year, but most Americans spend far less than that on their annual healthcare. It would be a net gain for them, for business, and for overall quality and access.


    Ted A. Bonebrake, M.D.

    July 16, 2009 at 20:26 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.