Regulation of health care professionals, Part 2: Validation of continued competence.

Today's demand for professional accountability regarding patient outcomes of care stems from two principle concerns: (1) the risks associated with health care services and their delivery, and (2) health care cost-containment and wanting to get the best care with the best patient outcomes at the best cost. Whereas patient outcomes are a function of multiple factors, health care professionals and their practice are considered key to those outcomes. Today's society and particularly the payers for health care services, have grown skeptical of professions and their willingness to do a good job of self-policing their own members, incompetent performers. In the 1970s, this early skepticism and the concurrent malpractice crisis led professionals and state regulators over time to move beyond the one-time testing for a lifelong credential so long as you didn't get into major problems, to considering alternatives for assuring continued competency in practice. The first efforts focused on voluntary or mandatory requirements for continuing education as a basis of attesting to continuing or recredentialing (licensure or certification). Unfortunately, this continuing education process has never been validated, demonstrating its efficacy in assuring continued professional competence and currency of knowledge as it plays out in practice and patient outcomes. Reasonable assumptions are no longer publicly acceptable; evidence is being demanded. Also, a problem that has plagued private credentialers has been the legal concept of a license or certification as a lifelong property right based on the such conditions when it was awarded. Credentialing bodies have been at legal risk in removing a license or certification for failure to comply with new criteria, particularly if the criteria has not been validated as making a difference. Rather than looking solely at currency of knowledge and competence in its utilization (including the associated technology), it is now being recommended that a multifaceted methodology be used in assessing those professional attributes deemed essential for achieving quality patient outcomes.