Resources & Information

Nov 3 2010

Revisiting ‘practice drift’ - Reader response calls for clarification

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In the Summer 2010 issue of the Forum, Dr. Jablonski’s President’s Message discussed the phenomenon of “practice drift” and stated the Board’s intention to look further into this issue. The Board defines practice drift as the outflow of physicians from areas in which they were trained into new areas of practice. Areas into which both primary care and specialty physicians are “drifting” include cosmetic procedures, mental health and pain management.

The article generated an unprecedented response from Forum readers, who posted a record number of comments to the online version of Dr. Jablonski’s article. The Board and, more specifically, the Forum staff are gratified to see licensees engaging in this way, even though many licensees disagreed strongly with Dr. Jablonski’s words! It was also encouraging to see several comments that applauded the Board’s interest in practice drift as prudent and appropriate to its regulatory mission and mandate.

If you have never visited the online version of this newsletter, please go to www.ncmedboard.org and click on “Forum” in the Professional Resources section. Readers may post comments at the end of each article. Comments are screened by the Forum editor. Personal attacks, profanity or other derogatory comments are not posted. Criticism or commentary of the Board and its policies is invited and encouraged, provided it is delivered in a collegial manner.

After reading the many comments posted to Dr. Jablonski’s article on practice drift, it seemed necessary to clarify the Board’s intentions.

Several licensees who commented on the article expressed concern that Board attention to practice drift would lead to a “witch hunt” to identify and sanction licensees practicing outside their areas of formal training. Some opined that a certain amount of “drift” is inevitable in primary care due to numerous factors, including the scarce availability of subspecialists in certain areas, namely psychiatry.

Dr. Jablonski wrote that, bottom line, the Board’s primary concern about drift is about professional competence. He further stated that, if a licensee is practicing competently within an area that falls outside the area they trained in, the Board does not have a problem with their “drift.” Second, the Board is a complaint-driven organization that investigates licensees based on patient complaints or information that comes to it through a variety of other sources. It does not knock down doors looking for misconduct and it does not use its Investigations and Complaints departments to search out cases of a particular type. Fears about witch hunts are simply unfounded.

The Board is pleased to report that Dr. Jablonski did indeed appoint a Special Task Force on Practice Drift, as he indicated he would at the end of his Forum article. The Special Task Force held what is expected to be its only face-to-face session on Oct. 13, with 21 participants, including representatives from primary care, the subspecialties and the liability insurance companies, among other constituencies. With Board Member Thomas H. Hill, MD, presiding, participants engaged in a thorough discussion of practice drift with a goal of reaching mutual agreement on the meat of a to-be-drafted Board position statement on practice drift.

What’s next: The Special Task Force agreed that the Board should adopt a position statement that declares its expectation that licensees practicing outside of areas in which they have received extensive training (e.g. residency and/or fellowship training) must be competent in the new areas of practice. The Board aims to have a draft statement prepared by January 2011.

Selection of comments excerpted from the Web version of Dr. Jablonski’s article:

"This article is right on target and long overdue. It is not “anti-physician.” It is propatient."

"There used to be a phenomenon called physician integrity which, loosely, meant a doctor would do the right thing because it was the only way to practice…"

“Perhaps if compensations were adequate the pressure to seek additional services to offer would be minimized. It is unfortunate that primary care is in such a current sad state of affairs with cuts to the SGR impending every 6months."

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