A Good Example of Bad Medicine

The New York Times reported on a recent decision by the American Board of Obstetrics and Gynecology to severely restrict the practice of their members. One of the key restrictions covers the ability of board-certified doctors to see male patients. This anti-competitive act should draw the immediate attention of antitrust officials and state licensing offices.

Although the Board recently backed off of a similar restriction on seeing males who are at a high risk of anal cancer, its broader determination to limit the practice of its members and thereby limit both competition among doctors and care for their patients should call into question the role of medical boards in licensing doctors.

The Board’s decision is not motivated by any evidence that doctors are delivering sub-standard care. There is no allegation that seeing male patients in any way detracts from the care that female patients receive. Rather, the decision seems to be driven by a desire to further separate the specialty from other areas of medicine. Why such as separation would benefit anyone but the leadership of the Board itself is unclear.

It is also not clear why private boards should possess such influence over licensing decisions, especially if the motivating factor in is self-interest rather than public welfare. Private boards may have an advantage in testing professionals for specific knowledge and then certifying the acquisition of that knowledge so that hospitals and patients can rely on it. Government agencies still need to oversee these standards to make sure that they are not hidden attempts to limit entry into a field. But boards should have absolutely no right to restrict doctors’ practice of that knowledge within arbitrary limits. The question of whether a given doctor possesses the somewhat arbitrary minimum amount of knowledge and experience needed to obtain board certification is totally unrelated to the question of whether the doctor should be allowed to use that and other knowledge to help any given patient. In fact, to be consistent with the ethical standards of medicine, the Board should encourage doctors to apply their knowledge to any patient that they can help.

The medical industry needs to demonstrate much higher productivity over the next two decades. To achieve this it will be necessary to break apart many of the institutional barriers that protect providers from competition to reduce costs and improve care. The Board has just provided an excellent example of the type of restrictions that need to be removed.

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