|Robert C. Schumacher, MD|
After a long and expensive search, the radiology management group of which I am a medical director, recently was able to persuade two radiologists to join a practice we manage in southwest Louisiana. Both of these physicians are from Arizona, and both were excited about coming to the Sportsman’s Paradise. That was not their initial reaction, however, when we first approached them about our opportunity. On the contrary, they had reservations about both the lifestyle and the quality of medicine in Louisiana. Through discussions and site visits we were able to persuade them that Louisiana offers a diverse and unique lifestyle and the latest in diagnostic and surgical technology.
The real problem came when these physicians applied for licensure in Louisiana. Both were rejected. The reason? Louisiana is one of eleven states where the “10-year” rule is in effect (the others: Texas, Alabama, Arizona, Minnesota, Mississippi, North Carolina, Nevada, Oregon, South Carolina, and Utah.) If a physician seeks a license to practice radiology in one of these states, he or she must have taken a licensing or recertifying examination within the past ten years to qualify. The catch is that there is no recertifying examination in radiology. In lieu of such an examination, most states with 10-year rules in effect will accept the radiology board certification examination, or one of the other challenge examinations.
Unfortunately, few veteran physicians are going to accept a position in another state if it means taking a general medical knowledge test (indeed, our two candidates chose to go elsewhere). Imagine highly trained, seasoned specialists such as radiologists taking an examination that asks about the best methods for treating children with the measles.
Demand for radiologists has spiked: A national physician search firm notes that the number of searches it conducts for radiologists has increased from just seven in 1997 to 233 in 2000. It now conducts more searches for radiologists than for physicians in any other specialty. Simultaneously, supply has diminished. The number of medical graduates entering radiology residencies declined sharply in the mid- to late-1990s, while the number of radiologists retiring has increased, the American College of Radiology reports. I recently met with the partners of two radiology groups here in Louisiana who were concerned about pending physician retirements in their groups. They have been looking for replacements for two years without success.
The problem will get only worse this year. Thanks to the fifth-year clinical rotation mandated for radiologists in 1997 by the American Board of Radiology, very few radiologists will be available for recruitment in 2001. Instead of joining radiology groups, they will be busy completing their rotations. This creates a particular problem for states like Louisiana where the 10-year rule is in effect. Because we have a hard time attracting experienced physicians, we have had to rely on recently licensed, younger physicians. There will be fewer of these to choose from this year.
There is a way to confirm the competence of physicians who have not taken a challenge examination in more than ten years. These physicians have an established record for providing care in their specialties. Examine the record. If it is lacking, licensure should be denied. If it is not, no barrier should be erected to keep physicians out of a particular state, especially a state that physicians are not exactly beating down the door to get into. This policy should be resumed in those states where the 10-year rule applies, until such time as the American Board of Radiology develops and appropriate recertifying examination.
The 10-year rule may have been designed to enhance patient care, but it is doing just the opposite. It is exacerbating dangerous shortages and putting states at a competitive disadvantage. Physicians and administrators should join forces to change that rule.
Robert C. Schumacher, MD Medical Director, US Radiology Partners, Dallas.