August 07, 2024 Residency Newsletter

• Ethical Challenges of AI in Medicine

• Custom Exam Builder Helps Track Progress

• Battle of the KevinMD Editorials

• Value of Continuing Certification

(Not Just Premeds) Learn to Navigate Ethical Challenges of AI in Medicine

A good short overview of some of the ethics, privacy, and accuracy issues that will be encountered with AI, particularly as it starts to front-end some of the non-clinical patient interactions or provide patient education. While the article is aimed at students, these are the types of issues that physicians in and out of training will encounter. It doesn’t delve into detail in some areas that need to be considered with AI. For instance, there are two types of bias in medical diagnostics: bias from basing training on a single population group or age, and bias in diagnostics from training sources.

For example, the American Cancer Society, the US Preventive Services Task Force, and the American College of Obstetricians and Gynecologists all have variances in their recommendations for pap smear age and frequency. That’s reasonable because the associations are dealing with different risk groups. The requirements aren’t that different, but what’s a poor AI to do? A clinically trained human will easily make sense of why; an AI has a tougher time of it.

Premeds: Learn to Navigate Ethical Challenges of AI in Medicine - US News

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Battle of the KevinMD Editorials

In battling headlines across editorial pages and sites, physician scope of practice, medical school costs, reimbursement, and international medical graduates are all being pointed to in an attempt to figure out why (1) physician shortages abound and (2) where all this money doctors are supposedly making is going.

While reading this, keep in mind that the cumulative inflation rate, according to CPI numbers, from 2017 to 2024 was a tad over 25%. Many suspect the CPI understates some components of inflation. At the same time, Medicare wasn't just not adjusting for inflation; in many cases, they were actively lowering reimbursement. But on with the fight:

You can start all the way back in 2023.  

Salve Lucrum: The Existential Thread of Greed in US Health Care - JAMA Network

To a June 2024 article blaming excessive physician pay.

Is the Doctor Shortage Intentional? - American Council on Science and Health

To a July 2024 rebuttal in KevinMD:

The Truth Behind the U.S. Doctor Shortage: Is it Intentional or Not? - KevinMD, Charles Dinerstein

Healthcare is around a $4.5 trillion dollar industry in the United States. About 5x higher than a defense budget that occasionally loses a few hundred million here or there in audits. Healthcare is regional, it’s compartmentalized, and it has one major customer which drives all sorts of irrationalities that make sense only when looking at through the lens of that customer. One of those irrationalities is the growth of administrators and non-clinical payroll. 

American Board of Medical Specialties Releases Narrative Review Outlining Evidence of the Value of Continuing Certification 

The PDF is A Narrative Review of the Development and Outcomes of ABMS Member Board Continuing Certification Programs 2000-2024.

Back in the days of yore, which would actually be only about four decades ago for many specialties and five for most, there was no recertification. You boarded in a specialty, fulfilled some CME requirements, and you were in. What prompted recertification to become a thing was the rapid specialization and gain of knowledge that wasn’t being reflected in practice, to the detriment of patients. This was before computers and convenient testing centers. You would travel to some city every 7 or 10 years and retake your certification.

In turn, failure rates began growing, among other problems with the high-stakes recertification exam. Questions common in an academic environment made their way into tests for practicing specialists, and the argument was that recertification exams were not an accurate reflection of practice. Continuous Certification was the answer from the ABMS in the early 2000s. That’s a lot of history for something from the 1970s forward.

Now the question is the cost of implementation for Maintenance of Certification regimes against various indicators of care quality: mortality rates, process of care, cost, screening, management, disciplinary actions, and malpractice, to name a few. There are real studies that link scores on initial certification exams to patient quality measures. There are few that have strong indications for MOC. If you look through the study data in the middle of the PDF, what stands out is MOC improvements in various QI measures when it relates to a large and evolving body of knowledge, i.e., pain management.

American Board of Medical Specialties Releases Narrative Review Outlining Evidence of the Value of Continuing Certification - ABMS