Is your doctor keeping up with the times?

Most patients expect that physicians will keep up with the latest developments in their fields. How does this happen? Does it happen?

Continuing Medical Education

Doctors have to fulfill a certain amount of Continuing Medical Education credits to maintain their state licensure, board certification, and hospital privileges.

Continuing Medical Education requirements can be fulfilled by going to conferences, listening to CME-specific podcasts, or online courses, for example. Most of them require some kind of quiz or learning assessment afterward.

You can imagine, though, how the quality and rigor of the CME might vary widely. CME is offered by private companies and approved by the specialty societies, so they are competing for busy doctors’ time and have an incentive to make it as pain-free as possible.

The CME also doesn’t necessarily have to be within a physician’s specialty. A radiologist could fulfill CME requirements with a Wilderness Medicine course in the middle of the forest learning how to set a broken bone, but it is unlikely that information will improve her clinical practice.

Usually the requirement is around 30 hours per year, though that is also very variable. That’s equivalent to about 4 days per year of required learning.

Clinical practice lags behind the research

It takes an average of 17 years for medical knowledge to trickle down into common practice. That’s a disputed number for some very good reasons, but it does take longer than you would expect for an innovation to make its way into guidelines.

This lag often functions as kind of a real-world trial, in which some doctors start to use that approach and get more experience with it, and then serve as experts to their colleagues.

Luckily, most doctors want to do the right thing for their patients and are self-motivated enough to keep up with changes in practice because 1) they like medicine and learning in general and 2) they want to do the right thing for their patients.

There is a widespread misconception in academic centers that private practice physicians are “out of the loop”. The reality is that there is more variability within groups (private practice vs academic) than between those groups. That’s why the answer is generally not as simple as “go to the academic (or private practice) physician.

So how do you know if your doctor is keeping up with the times?

Ask how the approach to an issue has changed in the past 5-10 years.

Most doctors will love this question. They have all this knowledge about how medicine has evolved over their careers that no one ever asks them about.

If they say “It hasn’t”, that doesn’t mean they’re wrong, but it would be a possible red flag. If absolutely nothing has changed in the past decade, it’s either an incredibly challenging or rare disease, or it’s so simple that an easy, cost-effective approach already exists. That’s probably about 20% of the time. The other 80%, there should be something different.

You want a doctor who keeps up with the medical literature because s/he is interested, not because they are mandated to do so by the state. Curious people tend to be better doctors, and they will know what has changed in their field.

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