TIME: Truth In Medical Education

It’s Time for Time

A patient enters a Doctors office after seeing an advertisement on television on hearing. An evaluation is conducted with several tests. Finally, she meets with the doctor and gets her prescription for a new hearing aid. It arrives in one week and fits great but her hearing is not improved. The patient return to the clinic only to find out her doctor was actual a Ph.D. an audiologist and not a doctor of medicine. The staff at the facility tells her to seek out an Otolaryngologist for a more thorough evaluation. Somehow things just do not feel correct. This type of scenario is played out daily at health care providers offices, laser centers and even practitioner offices across our country. The type of misrepresentation with medical advertising can usually be found in most phone books, on billboards and in radio/ television commercials in every community.

So, how did the medical community get to this point in time? A landmark case in the 1970’s set the precedence for today’s predicament. The Federal Trade Commission (FTC) ignored the classic or traditional approach to medical training through residencies and fellowships and ruled that health care providers could perform any service or procedure where they could document appropriate experience, training or background. Certification agencies began to sprout up overnight. The old standard of the American Board of Medical Specialist (ABMS) seemed to be out of vogue. Marketing companies began services that most physicians usually took many years to produce like pre and post operative photographs of procedures, documentation of board certification, and high end advertisements meant to entice the public at large. Buy that laser and for an additional $5,000 and up you got the advertising campaign. So what if those really were not the practitioner’s patients on that billboard?

In my profession of Plastic Surgery we have been dealing with these types of issues for decades. Everyone seems to want to be a Plastic Surgeon. Most practitioners were not willing or able to return to training to obtain the credentials. So, they took an easier path. As a plastic surgeon whose medical education consisted of four years of college, four years of medical school and eight years of surgical training in both general surgeries, burns, hand surgery and plastic surgery I used to be offended by these physicians. In the past our colleges with arguments of turf battles or credentialing issues had pacified our surgical specialist. Now, as many non-physician provider groups are looking to expand their scope of practice to perform medical procedures the concern regarding medical education has moved into the limelight. More than ever, patients are confused about who exactly they are seeing for a medical procedure or service.

Truth in Medical Education or TIME has its origins from the ethics and standards of my national society, the American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgeons (ASAPS). Truth in Medical Education or TIME has already been an essential component of these societies for many decades.

Truth in Medical Education or TIME legislation is an initiative to allow for transparency in advertising by all health care providers. It seeks to assert that medical providers should simply uphold the ethical standards set out by the Federal Trade Commission (FTC); advertising must be truthful and non-deceptive, advertisers must have evidence to back up their claims and advertisements cannot be unfair. TIME does not seek to restrict the types of procedures providers actually perform but requires disclosure of professional liscenser and requires providers to be CLEAR and TRANSPARENT in their communication with the public about their training and education. By FTC and TIME guidelines it would be perfectly fine if any practitioners to perform a breast augmentation. All that is requested by TIME is that the public be openly aware of this surgeon’s medical education, training and certification so an informed decision can be obtained.

The current state of the American health care system and decreased reimbursement for insured procedures has pushed this concern to the forefront. This shift in some physicians’ practice mix is due to the lure of cash payment for services versus reimbursement from a health plan, the prospect of better hours, and the opportunity for significant supplemental or replacement income. It is the easier way. However, just because it is legal for a licensed physician to perform a particular medical procedure, it does not always mean that a physician is qualified to perform that procedure. Sometimes health care providers act in the best interest of their bottom line and not the best interest of their patient. Often these are providers who rely predominately upon advertising as their chief source of referrals or already have a captive audience at their disposal. In the interest of patient safety, and to increase the patient’s awareness about different providers who may offer similar services, it is necessary to establish transparency in the training and qualifications those providers. IT is Time for TIME.

Because of concerns of patient safety and the misrepresentation of facts with deceptive or misleading advertising TIME legislation has already been passed and included in the Medical Practice Acts of the states of California and Florida. Federal initiatives have been introduced. They are supported by the American Medical Association (AMA), the American Dental Association (ADA) and 21 different state and national specialty societies. Truth in Medical Education (TIME) legislation only aims to clarify differences in practitioner qualifications via the disclosure of professional training and education in professional advertising initiatives and in the office setting. Potential provisions in model TIME legislation have included, among other things, disclosure of: 1) degrees conferred; 2) name of ABMS board, or ABMS-equivalent board; 3) prohibition of the use of the term “board-certified” if the physician did not complete and ACGME residency in that specialty; and 4) disclosure of professional liscenser via name tag or other means 5) disclosure of professionally-related commercial interests that may influence clinical decision-making communicated to patients, the public and colleagues.

TIME will allow for the public to make informed decisions regarding the medical health care providers education that are providing services by requiring a full disclosure of their training, background and experience. It will allow for the distinction between the Audiologist and the Otolaryngologist, the orthopedic surgeon and the Podiatrist, and the Optometrist and the Ophthalmologist. It places all health care providers on the same level for ethical advertising and disclosure. IT is Time for TIME.

A Commentary on TIME by
Gary Culbertson, MD, FACS