Ben Smith has written a run-down on the underlying ideology that contributes to Kentucky Senate candidate Rand Paul's crusade against the organization that certifies ophthalmologists like him as proficient in their field. When the American Board of Ophthalmologists began periodically re-certifying doctors once a decade instead of for life, they grandfathered in older doctors, leading Paul, in his telling, to object for reasons of fairness. I explained Paul's decision to found his own certification board -- and that he does not currently have an accredited certification -- a few weeks ago.
While Smith's assessment that Paul's project reflects his libertarian philosophy isn't off-target, the story misses some important points that are worth thinking about:
- Paul's organization went under a year after he founded it, and he only revived it when his accredited certification expired. While Paul founded his certification board in 1999, it was dissolved a year later when Paul failed to file an annual report, according to public documents. Then in 2005, a few months before his accredited certification was due to expire, he restarted the organization, adopting its certification as his own. If Paul's whole objection to the existing certification board was based on principle, what happened to those principles -- and the certification of at least 199 other doctors he claims were involved -- from 2000 to 2005?
- Paul's organization is totally opaque. The point of certification boards is both to ensure physicians are well-trained and to provide patients with independent knowledge about their doctors. Hence, the American Board of Ophthalmologists publicly posts its standards. Paul's organization, run by his own family, does no such thing -- so what's the point of providing a certification if no one but the recipients know what that entails, and they aren't telling? It suggests someone trying to game the system, not create a fairer one.
- Every single medical specialty uses periodic recertification. And there's a reason for that: Medical technology shifts constantly and making sure that physicians understand the latest treatments and best practice is important to patient care. While Smith's story presents Paul's view that this was a question of fairness, neither Paul nor the piece discuss patient welfare. Indeed, Smith notes that Paul's board apparently now performs periodic recertification, so unless there is a disagreement about what certification ought to mean, there's no basis for the organization's existence except as a personal feud.
All that suggests either that this battle isn't all about his libertarian ideology; it's about the desire for special privilege, a dislike of institutions, and self-interest. Well, perhaps this is about libertarian ideology, after all.
-- Tim Fernholz
