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Calvin Freiburger

Rand Paul Tries to Skirt Medical Bureaucracy (In Which I Defend Dr. Paul … Sort Of)

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Posted on June 16 2010 10:00 pm
Hailing from Fond du Lac, Wisconsin, Calvin Freiburger is a political science major at Hillsdale College. He also writes for the Hillsdale Forum and his personal website, Calvin Freiburger Online.

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Scarcely a day passes that we don’t find out something new and objectionable about Dr. Rand Paul. The risk in the pile-on is that a real doozie will get missed, lost in the daily torrent.

Truer words have rarely been spoken. On the Daily Beast, Kent Sepkowitz tackles a new scandal concerning whether or not Dr. Crank’s ophthalmology credentials are in order:

To practice medicine legally requires a license issued by the state. Eligibility for licensure is granted after graduating medical school and after passing a series of difficult standardized exams prepared by the National Board of Medical Examiners. Once completed, licensure is forever (assuming a person behaves and isn’t a total disaster). Rand is a licensed physician.

But a guy’s got to practice medicine somewhere—an eye specialist like Dr. Paul, for example, needs a hospital’s operating rooms to ply his trade. And that’s where certification comes in. Whereas licensure is a one-size-fits-all blanket of general adequacy, certification is granted by a specialty board to indicate competency in a specific field such as ophthalmology (or medicine or surgery or psychiatry). Certification tests long have been administered by venerable, apolitical groups such as the American Board of Ophthalmology (or Internal Medicine or whatever). The certificate is a national credential that, although not absolutely necessary to practice medicine, is more or less required for any doctor seeking an affiliation with a hospital.

It gets even more complicated, but hang in there; Rand is hoping the distinctions are just too subtle for anyone to really care about. In the 1980s, American medicine decided that it should police itself. A little. So the Grand Old Men of the various fields decided that already certified specialists should recertify once a decade. Rand initially did the right thing and became certified; but when his 10 years were up, he decided he’d had enough and chose not to recertify. Rather, he organized his own certifying program for ophthalmology based right there in his hometown of Bowling Green. He then appointed himself president of the group, which he named the National Board of Ophthalmologists, and better yet, declared his wife (not a doctor) VP and his father-in-law secretary. Talk about convenient!

The NBO is not recognized by the AMA-approved American Board of Medical Specialties. To be clear, the scandal is not about whether or not Paul knows what he’s doing. Every media account I’ve seen indicates he’s a fine doctor.  The question is a bureaucratic one, but that doesn’t make it irrelevant.  Sepkowitz continues by applauding Paul’s dissent from “gasbags who insist on” overrated recertification standards in the form of “multiple-choice tests proctored now by cybersecurity.” But he can’t buy Paul’s reasoning:

Being a conscientious objector or pissed off adult simply wasn’t good enough. No, he decided to cast it as a high-end moral stance against groups that discriminate—groups like the American Board of Ophthalmology. And what exactly was their discriminatory practice? Opposing civil rights maybe? Nope—much, much worse. The old geezers who made up the test requirements built a nice little loophole for themselves: They excluded themselves from having to recertify—instead they were “grandfathered” in. And in so doing they discriminated against poor Rand and me and thousands of other of victimized doctors.

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