Dr. Elizabeth P. Maxwell-Schmidt is an emergency medicine specialist based in Annapolis, Maryland.
It has been a long time coming, but one of the darkest sides of our physician care system has been exposed. The American Board of Medical Specialties has long been working with the Accreditation Council on Graduate Medical Education to corner the market in physician board certification. This has all resulted in limiting access to physician care. Their collusive activities can be considered the root cause of physician shortages in key specialties where the ABMS does not board-certify physicians.
This can be seen through every aspect of our health care system, creating shortages in such specialties within primary care, especially access to much-needed specialties in “21st-century” medicine throughout rural America. Physician board certification in specialties not offered by ABMS but by their competitors — in areas such as family medicine, obstetrics, disaster, integrative and emergency medicine — are where our nation sees the largest strain and where it sees its greatest need. Much of the reason for this strain is the collusion to keep all competitors out, allowing them to build an image that the ABMS is the only one to certify.
Last year, a report by the American Medical Association was released in response to news by the Centers for Disease Control and Prevention that rural Americans get sick more often and die at a younger age than people living in urban communities do. The association showed that 136 rural hospitals closed their doors between 2010-21. Roughly 65% of rural America has a shortage of primary care physicians. Between 2002-17, there was a 28% drop in medical school graduates in rural areas, on top of only 4%-5% of incoming U.S. medical students coming from rural locales.
Most recently, the U.S. House of Representatives’ Judiciary Committee launched an investigation into the shortages and have not yet even scratched the surface. The first place it needs to look is the Accreditation Council on Graduate Medical Education, which is controlling every residency program in this country, and its collusion with the American Board of Medical Specialties to filter all residents into ABMS-only boards of certification — leading to control of specialties and who gets to practice what.
On the surface, many may ask, “What’s wrong with that?” Is it not important to maintain the highest standard in medicine? The answer is yes, but it is wrong when it lowers access to care, raises costs and limits advancement in care because there is only one way of thinking. All these reasons — combined with suppressing competition, using federal dollars — not only lower innovation in medicine but are a violation of U.S. antitrust law for so many reasons.
As a nation, could we imagine if we were told that we could only buy one manufacturer’s vehicles? And then, that we must gas up at Shell only? How would the nation react? How would our legislators and regulators react?
It’s insane to think that it would be acceptable. Why, then, are we allowing one organization, colluding with the other, to control our access to physician care? Denying our military and our citizens access to specialties sorely needed, and in areas of the country where access is already so limited, is unacceptable. All this needs to be stopped by those with the power to do so.
Reader reactions, pro or con, are welcomed at civiltalk@iniusa.org.
