Competence versus Territoriality

In order to assure the public that they will obtain safe and effective care in a hospital, it is the Chair's responsibility to assure that the surgeon is competent to perform a procedure - i.e., the essence of procedural credentialing. One highly effective evolution of American medicine has been increasing specialization in various disciplines. Such narrowing of focus may become counterproductive, losing the forest for the trees - but that is the subject of another day.

The mantra of specialist can also be used to protect patient volume with economic motivation. Obviously any physician with such a motivation will usually be less than forthcoming, and it becomes rather difficult to challenge the Mom and Apple Pie cry of expertise through specialization.

The underpinning of that cry will frequently relate back to numerosity. Dr. David Leach, the recent head of the ACGME was often heard to relate the axiom "we are what we repeatedly do." Yet as a surgical educator I have seen trainees exhibit masterful conduct of an operation after seeing a mere few, and others on their hundredth attempt remain tentative. It ain't just the numbers.

Assuring competence is a difficult job - to have it complicated by various specialists (medical and surgical) crying quality concerns when protectionism is the underpinning certainly obscures the issue further.