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Editorial
Recently, I was impressed with an article authored by Dr. Tim Solberg and published as the Chairman's Report for the ACMP Newsletter. So I asked Dr. Solberg if the JACMP could republish this thought-provoking article. It is reproduced below, and I hope you will consider his thoughts and the need for change in our profession.
Michael D. Mills, PhD
Would you but a car without looking at it? Would
you buy a computer without knowing the price? These seem like
ridiculous questions - of course we would never make a major
purchase decision unless we clearly understood the quality and price
of the item we were about to buy. Yet we are often unwilling, or
more aptly unable, to apply the same level of diligence to decisions
that literally affect our lives, namely, those involving our health.
Our healthcare decisions are largely determined for us, by
employers, by insurers, by referral patterns, by personal and
business relationships among providers, and by word of mouth from
our friends and relatives. Clearly as end consumers we are poorly
informed about the quality of our healthcare product and the price
which we pay for it. This was borne out in a 2004 survey
commissioned by the Henry J. Kaiser Family Foundation, the Agency
for Healthcare Research and Quality, and the Harvard School of
Public Health, in which 55% of respondents stated that they were
currently dissatisfied with the quality of health care. Further, 40%
felt the quality of health care had gotten worse over the past five
years.1 Clearly there is substance to
these concerns; as one of many examples, a frequently cited 1999
study from the Institute of Medicine estimated that nearly 100,000
patients die in hospitals each year due to preventable medical
errors.2 This is more deaths than those
due to breast and prostate cancer combined in 2005.3
In a 2004
Harvard Business Review Research Report, Michael Porter and
Elizabeth Olmsted Teisberg argue that the major challenge facing the
practice of medicine in the U.S. is that the nature of competition
in healthcare is fundamentally different than in most other
industries.4 For example, if a
particular manufacturer is known to produce faulty television sets,
consumers won't buy them. Similarly if the cost of a particular
brand of television set is too high relative to its value, consumers
won't buy those either. In almost every industry, market forces act
to drive up quality while driving simultaneously driving costs down.
As a result, TV sets today are both better and cheaper than
they were ten years ago. The same can be said for computers and
automobiles, cell phone service, fast food, and so on. Market forces
are fundamentally different in health care, in large part because
neither the quality nor the cost is truly transparent to the
consumer. While these arguments may add a different perspective to
the dilemma, it comes as a surprise to no one that our nation is
facing a crisis in healthcare. We hear the gloom and doom stories on
a daily basis. To phrase it in a popular culture term (for those
familiar with the Malcolm Gladwell best seller), healthcare is
rapidly approaching a "tipping point."
So what does this have to do with
the profession and practice of medical physics? Well I believe that
we have an obligation to help to "tip" things in the right
direction. This means that we must do all that we can to raise the
level of our profession. Specifically, we have an obligation to
properly educate and train the next generation of medical
physicists. The present standard for medical physics education is
through CAMPEP accredited graduate and clinical residency programs.
We must take steps to ensure that all practicing medical physicists
hold appropriate credentials, and that healthcare providers
understand the importance of Board Certified medical physicists in
establishing and demonstrating institutional quality standards. We
also have an obligation to engage in life-long learning activities.
The standard for medical physics lifelong learning is the
maintenance of certification (MOC) process. Finally, we must
discourage a one-size-fits-all approach and engage our physics,
physician and administration colleagues in embracing evidence-based
medicine. All medicine is not created equal; differentiation based
on quality and outcomes will provide much needed transparency and
value to the healthcare consumer, transforming the business and the
practice of medicine for the better. Our profession has a unique
opportunity to take a lead role in shaping these changes.
Timothy D. Solberg, PhD
1Kaiser Family
Foundation, Agency for Healthcare Research and Quality, Harvard
School of Public Health. National survey on consumers' experiences
with patient safety and quality information. Menlo Park, Calif.:
Kaiser Family Foundation, July 5, 2004.
2Kohn LT, Corrigan JM, Donaldson MS, eds. To
Err Is Human: Building a Safer Health System (Washington: National
Academy Press, 1999).
3Jemal A,
Murray T, Ward E, et al. Cancer Statistics, CA Cancer J Clin
55:10-30, 2005
4Porter ME and
Teisberg EO. Fixing Competition in U.S. Health Care, Harvard
Business Review Research Report, 2004
The Journal of Applied Clinical Medical Physics
| Editor-in-Chief | Michael Mills |
| Deputy Editor-in-Chief | Timothy Solberg |
| Associate Editor-at-Large | Richard Stark |
| Radiation Oncology Physics | Nzhde Agazaryan, Salahuddin Ahmad |
| B. Gino Fallone, John Gibbons, | |
| Michael Herman, Janelle Molloy, | |
| Matthew Podgorsak, Nikos Papanikolaou, | |
| Mehrdad Sarfaraz, Lu Wang | |
| Medical Imaging | Geoffrey Clarke, William Pavlicek |
| Radiation Measurements | Larry DeWerd |
| Radiation Protection & Regulations | James Deye |
| Nonionizing Topics | Bhudatt Paliwal |
| Other Topics | Timothy Solberg |
| Book/Media Reviews | James Smathers |
| Editorials | John Horton |
| Proofreader | Heather Shand |
| Copy Editor | Betty Robinson |
| Layout Editor | Laura Shand |
| Manuscript Manager | Patricia Walker |
© 2006 Am. Coll. Med. Phys.