On December 8-9, 2005 48 people representing 36 different organizations gathered in Chicago, IL for the second Summit entitled Physician Accountability for Physician Competence. As in the case of the first Summit, this group represents a wide range of experience and practice - including academia, regulatory agencies, payers, the public sector, providers and professional organizations.

The primary question instigating these Summits is: how does the healthcare community determine, measure and assure the public concerning physician competence over the career of the physician?

The first Summit in March 2005 (see the documentation from that summit here) focused on developing a set of scenarios of the future of healthcare over the next 15 to 20 years. These scenarios were then distributed to the participating organizations as a discussion tool – a way for engaging people in a conversation about the future of healthcare in which some system for determining, measuring and assuring physician competence would exist in.

In this Summit, participants initially dove deep into the 5 scenarios as a way to explore the implications of these various future states on specific stakeholder groups (patients/the public, payers, physicians, Health Systems, and Medical Education). Once immersed again into these scenarios, participants then began looking at various ways physician competence might be determined, measured and assured in each of these five different possible future states.

Participants then used a lateral thinking activity called a Take Away to see if they could discover and think differently about the regulatory system. This activity challenged participants to think about the regulatory system as it exists now and to list the components of the current system that are essential for it work. They were then asked to ‘take away’ one or several of the essential parts of the regulatory system and challenged to think about designing a system of regulation that works without that essential part.

Both activities, the Take Away and the previous activity resulted in a handful of possible options for systems to consider – both structure and process – and it allowed all the participants to experience the complexity of the challenge of unifying a large number of medical organizations around a single process. The experience of this complexity lead the participants to explore the idea of creating an Alliance of organizations focused and aligned around the idea that the Healthcare Community can work together to develop the standards by which physicians are educated and practice medicine and by which the public can be assured of physician competence throughout the life of the physician.

This lead to a dialog about defining what competence is – what a good doctor is – and that resulted in several iterations of a statement of competence and a first draft of a table of contents for a document tentatively titled, Good Medical Practice. This document was suggested to be used as a stimulus of further conversation with other members of the organizations present and to begin bringing additional stakeholders into the conversation. To that end, near the end of the session participants developed a list of additional stakeholders to include in the conversation and a plan to hold several additional Summits and invite them to participate.

NOTE: please note that participants acknowledged and know the conversation about physician competence needs to be an honest and open dialog between and among the profession and the public and that this conversation is just beginning. Participants were urged NOT to make decisions about what competence is nor what the process to determine, measure and assure competence will be in the future. They were however urged to explore various options for the defintion of competence, options for how the future might play out and options for what a competence system might look like in any given future. These options, and the results of this summit, are meant to stimulate further conversations with the ultimate goal of developing system wide alignment and agreement.

We would like to acknowledge the following organizations for their contribution to making this conference a success:

Accreditation Council for Continuing Medical Education
Accreditation Council for Graduate Medical Education
American Board of Internal Medicine Foundation
American Board of Medical Specialties
Association of American Medical Colleges
Blue Cross/Blue Shield Association
National Board of Medical Examiners
The Robert Wood Johnson Foundation