Climate Change: It's Not About the Weather-Continuing Medical Education and Maintenance of Certification and Licensure.

Abstract

Carol Havens, MD Jeffrey Mallin, MD State of Health Care in the US Many feel that the impending acceleration of global warming is the greatest threat that our species has ever faced. Less arguable but already having an impact is a drastic climate change in health care. Not only is it shaking up health care delivery and insurance, but its effects are visible on the education, training, certification, and accreditation systems of physicians and other health care professionals and organizations throughout the US. The US public is increasingly questioning medical care. Well-publicized cases of poor quality of care, wide variations in practice, embarrassing failures to achieve good patient outcomes (such as routine preventive care, hypertension control, management of chronic disease, and prevention of postsurgical infections), escalating health care costs, and interactions between physicians and commercial entities have led to increasing public outcry and legislative scrutiny. It seems as if Mother Nature’s vengeance is palpable already. In 2001, the Institute of Medicine described US health care in crisis, with 30-40% of patients not getting evidence-based care and with 25% of the care delivered not needed or actually harmful to patients. Evidence demonstrates overuse, underuse, and misuse, even in situations with appropriate access to care. A whole alphabet soup of health care-related organizations and groups has been trying to develop better methods of oversight in their areas of control. Fortunately, all those groups are also now aligning around the common goal of improving patient care and protecting the public through a focus on performance assessment and improvement. They are creating systems that actually support each other rather than generate differing and sometimes bewildering requirements. Realistically, physicians are only one part of the problem, and that means that we’re only one part of the solution. The systems and environments in which we practice, access to care, other health care professionals, and patients themselves play significant roles, too. But the challenge for us as physicians is to see how our role is changing and how the “be all and end all” is “Quality” of care (with a capital Q). There are many factors driving up the Quality of care, and these include respected quality constructs (such as, Plan-Do-Study-Act and Six Sigma), electronic health records (such as, Kaiser Permanente HealthConnect), clinical decision support systems, public reporting, and pay for performance. There is also a relatively new construct called Continuous Professional Development. Think of it as Continuing Medical Education (CME) Version 2.0.