Arlington, VA – The Treatment Advocacy
Center today signaled its support of a proposal released last Friday by the Pew Health
Professions Commission to initiate regular competency tests for American health care
providers – especially in the area of psychiatry – to ensure public safety.
Under the current health care system, doctors become licensed when they complete their
training and are never again tested on their skills. Some physicians elect to take
specialty board certification exams, which are usually voluntary and on a one-time basis.
Among psychiatrists, only half have taken the elective specialty board exam, which is one
of the lowest percentages among all medical specialties in the country.
"It is outrageous that half of all practicing psychiatrists in the United States
have never demonstrated their medical and psychiatric skills since originally receiving a
license to practice medicine," said Dr. E. Fuller Torrey, Treatment Advocacy Center
President and leading research psychiatrist specializing in schizophrenia. "Adding to
this scandal are the older psychiatrists who have never been tested on their knowledge
even though they received their diplomas in the 1940s and 1950s, before the introduction
of any antipsychotic or antidepressant drugs.
"The amount of incompetent care being given by psychiatrists is the psychiatric
profession’s dirty little secret," said Torrey. "The American Psychiatric
Association is silent on this issue, as are the National Institute of Mental Health and
the Center for Mental Health Services."
There is abundant evidence that psychiatrists need to become updated in their knowledge
and to demonstrate competency. Earlier this year, the National Institute of Mental Health
released the results of the Schizophrenia Patient Outcomes Research Team study (PORT),
which found that more than half of individuals with schizophrenia today receive
substandard care. Specifically, the study found that only 29 percent of patients with
schizophrenia received the appropriate dose of antipsychotic medication, only half
received appropriate treatment for the side effects of their medications, and fewer than
half who had symptoms of depression were given antidepressant medication.
Another recent indicator of the need for psychiatrists to update their skills and
knowledge was evident in a report issued in June 1998 by Public Citizen Health Research
Group on inappropriate sexual contact between doctors and patients. Among all medical
specialties, it was noted that psychiatrists have one of the highest incidences of such
improper contact.
Torrey said that licensing inadequacies at the state level make the problem of
incompetent care worse. "It has been common knowledge for many years that state
mental health systems employ physicians who not only are not certified in psychiatry, but
are not even capable of passing their basic medical licensing exam," said Torrey.
"States are able to sanction such disreputable practices by issuing permits that
allow the unlicensed physician to work only in the state mental health system. The doctor
can provide care for public patients, but not for private patients."
According to a 1990 study by the National Association of State Mental Health Program
Directors, "Physician Limited Licensure," a total of 21 states issued permits
allowing unlicensed physicians to practice in their state mental health system: Alabama,
California, Colorado, Connecticut, Delaware, the District of Columbia, Florida, Georgia,
Hawaii, Kansas, Kentucky, Massachusetts, Mississippi, Missouri, Nebraska, Nevada, New
Jersey, New York, Ohio, Oregon, and Rhode Island.
The best known and tragic example of incompetent psychiatric care was the highly
publicized 1972 case of an unlicensed physician who was assigned to work at Elgin State
Hospital in Illinois on a state permit. He was originally assigned to perform autopsies,
but according to the Chicago Tribune (March 1, 1972) he "demonstrated total
incompetence in working with corpses, so mental health officials demoted him by
transferring him to the hospital wards where he treated live patients." According to
the newspaper, this doctor was later investigated in connection with 18 patient deaths.
Equally disturbing was the fact that the state-employed physician who was responsible for
approving the first physician’s credentials had himself failed the state licensing
examination 10 times.
In addition, Torrey said there is abundant anecdotal evidence that there are many
incompetent psychiatrists practicing today. "Patients and their families regularly
complain about psychiatrists in both the public and private sectors who are not up-to-date
in their knowledge," said Torrey. "This is an increasing problem because many
advanced medications have been introduced in recent years for the treatment of
schizophrenia, manic-depressive illness, depression, and other psychiatric disorders, and
doctors just aren’t keeping current. It is likely that the amount of incompetent
psychiatric care will only increase as more new medications become available.
The solution is obvious and simple," said Torrey. "We must institute a system
of mandatory certification for psychiatrists, followed by periodic examination and
recertification. The psychiatric profession, unfortunately, is likely to continue to
oppose any movement in this direction." A recent article in the American Journal
of Psychiatry noted that "psychiatrists have generally resisted attempts to
implement recertification."
Both the American Psychiatric Association (APA) and the American Medical Association
(AMA) argue that mandatory recertification is unnecessary because all physicians are
required to undergo a specified number of hours of "continuing medical
education" each year. "What the APA and AMA don’t say, is that many
‘continuing medical education’ courses are nothing more than junket vacations
that psychiatrists write off on their income taxes," Torrey said.
Citing several examples, Torrey said that currently available for "continuing
medical education" for psychiatrists and other physicians are two- to three-week
trips to "Gourmet France," a "Yangtze River Journey," and a
"Kenya and Tanzania Safari" under the Academy for International Medical Studies,
Inc. Torrey said if these adventures do not appeal to doctors there are others. For
example, a psychiatrist may meet the requirement for "continuing medical
education" credits by climbing Mt. Kilimanjaro in Tanzania, hiking the Inca Trail in
Peru, rafting in Chile, or trekking to the base of Mt. Everest in Nepal under an
organization called Seminars in Wilderness Medicine.
"The Northern California Psychiatric Society has even organized its own accredited
sham ‘continuing education’ program by sponsoring an annual trip to the Santa Fe
opera," said Torrey. "This so-called ‘psychiatric education’ includes
lectures such as ‘Reality in Art: Mozart and Puccini and Their Works.’
Psychiatrists are undoubtedly the only professionals who can go to the opera, get credit
as ‘continuing medial education,’ and write it off their taxes."
"Meanwhile, back in the real world, psychiatric patients who cannot go to the
opera and write it off their taxes continue to suffer because of incompetent psychiatric
care," Torrey said. "Individuals with schizophrenia, manic-depressive illness,
and severe depression continue to receive inappropriate and/or inadequate medication and
to experience side effects that are not treated.
"Patients are not rehabilitated or offered the most recent advances in
treatment," said Torrey. "And, the situation appears to be getting worse."
To effectively address the inadequacies of today’s psychiatric health care system
and the incompetence of its doctors, the Treatment Advocacy Center recommends:
- All physicians who wish to practice as psychiatrists in either the public or private
sector should be required to pass an initial psychiatric board certification exam prior to
beginning practice.
- All certified psychiatrists should be required to pass a recertification exam every 10
years. Those failing the exam would be given an opportunity to re-take the exam for each
of the two following years; if they were to fail both of those exams, they would no longer
be allowed to practice psychiatry.
- The system of using state permits to allow unlicensed physicians to practice in state
mental health systems must be immediately abolished.
- All physicians, regardless of the country of origin of their original medical training,
must be required to pass the same licensing and certification exams.
