EDITORIAL

Recertification of doctors: SEPAR initiative

Recertificación de médicos: iniciativa SEPAR

Arcadi Gual

Director de la revista FEM-Fundación Educación Médica.
E-mail: agual@fundacioneducacionmedica.cat

Continuing professional development, the processes involved in its accreditation and all the initiatives that the central and autonomic authorities, scientific societies and medical associations have woven around this concept have played a vital role in creating a collective awareness of the fact that the recertification of doctors is the most coherent way to guarantee the quality of the professional actions, as well as bringing us closer to what is already the norm internationally. Moreover, the European Union has passed legislation in this sense. One of the initiatives that deserves special attention is Periodic Membership Validation, not because it is better or worse than any of the others, but because it is the first that has managed to implement the process on a regular basis.

The recertification of doctors is a complex issue that involves a number of different actors: politicians and representatives of the healthcare authorities, medical associations and, of course, scientific-medical societies. But although all these actors are necessary and play a relevant role, none of them are the fundamental elements. When we speak of recertification, there are two central characters: the doctor and the patient or, if you prefer, the medical profession and the general population.

It is not so unusual to hear things like 'doctors are not interested in this recertification thing', 'doctors have already got enough on their plate with the cutbacks in spending' or 'now that they have lost so much purchasing power, do we have to ask them for more sacrifices and exams?' But before it can interest them, it has to be explained properly to them. In most forums, on explaining that recertification is a guarantee of quality for the patient and a safeguard for the physician, there is widespread agreement that it should be favoured. Yet, alongside this unanimity several questions also arise: Who will be responsible for the recertification of doctors? Will it be done by the medical associations? Will scientific societies do it? Will it be carried out by the authorities?

All of you, whether physicians or not, know how important the doctor-patient relationship is. Although this relationship is an unwritten contract, a tacit agreement, it is nonetheless real. The recertification of doctors also ends up with a credential, which is valid for a certain period of time and which in itself is a key component of another contract running parallel to that between doctor and patient. This other contract is also tacit and is the one that exists between the medical profession and the general population. The first and main duty of those that administer the medical profession is to ensure the health of both contracts -between physician and patient, and between the medical profession and the general population. It is their responsibility to do so and this must be carried out with transparency. In English-speaking settings, which are more transparent than ours, they have fostered recertification mechanisms, the reason being to avoid a foreseeable crisis, even a possible breakage, of the contract between the medical profession and society.

Who is responsible for ensuring that the social contract, between the medical profession and society, heads in the right direction? As in all contracts, there are two parties: the profession and the general population. For the profession, the responsibility undoubtedly falls upon the professionals themselves, who are represented by medical associations and by scientific-medical societies. For the general population, on the other hand, the responsibility is seen as belonging to their public representatives, their members of Parliament. In a democratic society, in which it has been proven that health is one of the main assets of the welfare state, our representatives are the ones who will have to ensure we have the best possible welfare states, which includes the smooth implementation (quality and transparency) of the contract between medical profession and society.

And what role do the healthcare authorities play in all this? Indeed, their role is relevant and of vital importance. The authorities, as has always been the case, must ensure that what has to be done is actually done, that it is done by those who know how to do it and that it is done well. All of this is included within the principle of subsidiarity promoted by the European Union to which we must strive to draw a little closer every day. Hence, for the authorities to be able to guarantee their responsibilities in the contract between the medical profession and the general population, they must avoid shying away from or pretending to ignore the processes of recertification of doctors carried out by the other party to the contract, i.e. medical associations and scientific societies. Instead, they need to be aware of and become involved in the mechanisms and processes of recertification implemented by the professionals. Only from within can the authorities offer the legislative powers and society itself a guarantee that the contract between physicians and the general population is treading the path of excellence. And if the path was eventually found not to be headed towards excellence, then it should intervene, because it has the responsibility to do so.

In the first week of May an agreement was signed between the Spanish General Council of Official Medical Associations (CGCOM) and a scientific society, the Spanish Pneumology and Thoracic Surgery Society (SEPAR, from the Spanish), which represents pneumologists and thoracic surgeons, to complement the programme of the medical associations, Periodic Membership Validation, with the recertification of the competences of the specialists belonging to the SEPAR. The agreement, which has been called VPC-R.SEPAR, is the first joint programme to be implemented in a practical manner in Spain for granting a recertification credential. Furthermore, the process is inspired by and complies strictly with the final document approved by the Continuing Education Commission of the Spanish National Health System about continuing professional development and the assessment of professional development. Signing this agreement with SEPAR will make it possible to establish synergies between associations and scientific societies and will somehow open up the way to the recertification of doctors. From the realm of medical education all we can do is to consider such an agreement as the first signs of starting to do things well in the processes involved in the recertification of Spanish doctors: we wish those responsible for this undertaking the best of luck and steadfastness in their dealings.