ATLANTA - The next time you're at the doctor's office, peek at those certificates on the wall. Like gallons of milk, some of them are expiring.
For the first time since leaving medical school, many doctors are having to take tests to renew board certification in their fields - 147 specialties from dermatology to obstetrics.
Any doctor can deliver a baby, treat cancer, or declare himself or herself a cardiologist. Certification means the doctor had special training in that field and passed an exam to prove knowledge of it.
Doctors used to do this once and be certified for life. That changed in the 1990s - doctors certified since then must retest every six to 10 years to prove their skills have not gone stale.
For some specialists, such as those who push tubes into heart arteries to unclog blockages, this is the first year many are getting retested.
Older doctors also are feeling the heat. More than a quarter of a million of them were "grandfathered" with lifetime certificates but are being urged to retest voluntarily to show they still know their stuff.
Most don't want to do this. One who isn't grumbling is Stephen Mester, 52, a cardiologist in Brandon, Fla.
"I am choosing to renew," he said. "It's just an opportunity to maintain my skills and confirm to myself that I can do what I've been trained to do. Most of what I do today didn't exist, and some of it not even thought of, when I was in medical school."
The recent American College of Cardiology conference in Atlanta offered refresher sessions to help doctors prepare. In one, they played "name that tune," listening to tapes to identify various heart murmurs.
In another, they played "beat the clock" to do an artery-opening procedure within 90 minutes of a mock patient's arriving at a hospital. This session, which Mester took, was led by William Hamman, a Michigan cardiologist and United Airlines pilot.
"As an airline captain, everything I do is performance-based," with frequent testing on simulators of landings, takeoffs, and other skills, Hamman said.
Yet most airline accidents are caused by breakdowns in softer skills - communication and teamwork, he said. "Health care has not even touched that subject" in testing proficiency, he said.
Research shows that what doctors think they know does not match what they do and that performance declines with years in practice.
The authors of an opposing essay - a medical-school dean, a professor who teaches primary care, and a practicing physician - complain that testing emphasizes recall of facts rather than making full use of available sources of information, such as electronic references and the Internet, as modern doctors are taught to do.
The recertification tests are a work in progress. In the future, some boards plan to include assessment of a doctor's communication skills with patients. Eventually, testing may include rating a doctor's technical skills and directly observing performance.
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