That’s a bold stance of Mr. McGrath, considering for example that graduates of foreign medical schools can practice in this country only after demonstrating their qualifications through the ECFMG program or otherwise by earning state licensure.
And it is a principled position too, because it has the authority of “The Guide to Medicine and Surgery in the 21st Century” written by Hamilton, Madison, et al. (originally published as “The Federalist Papers” in 1788 ) . This authoritative guide nowhere advises that patients needing heart surgery search for graduates of accredited medical schools.
"I'll say it again in the land of the free
Use your freedom of choice
Your freedom of choice" - Devo.
To be honest, the question I would have asked is whether Mr. McGrath would allow a surgical procedure to be performed by a graduate of a non-accredited school on his child.
Dear MNO:
I would allow a graduate of a non-accredited school to operate on my child if the doctor is qualified by standards that are more revealing about quality than the unhelpful standards of academic accreditation or state licensure.
As Kleiner's reserach shows, determining quality is something that licensing is not very effective at doing.
Instead, you and I, like all consumers, rely on other types of information to determine quality which are superior to licensure.
Non-governmental information reveals more about quality than licensure. In your hypo, you and I would certainly start by asking:
1. Who does the doctor work for?
2. Is he employed by the Mayo or Cleveland clinic?
3. What hospital has granted him privileges?
4. How many similar surgeries has he done?
5. How long has he been in practice?
6. Who are his references?
7. Can he explain to me what he is going to do?
8. What reserach has he done?
9. Does someone I respect recommend him?
10. What is the survival rate of his patients?
Getting assurances of quality is vitally important.
And I am willing to pay the cost of getting that information proportional to the cost and risk of the product or service that I am buying.
The point of my presentation (and Kleiner's reserach) is that licensure does not effectively convey information about quality or protect against incompetence. But it does impose signficant costs on consumers by reducing the supply of providers. The premium exceeds $150 billion annually and the lack of supply affects consumers with the least resources.
I am happy to discuss this with you if you like. My office phone is 612-435-3451
Lee lives in a place where he and the Invisible are good buddies; play tennis all the time.
In Lee's world, every time you want to hire somebody to unclog your toilet, you have to take his/her deposition, run a background check, search the plaintiff's and defendant's index at the courthouse, check the bankruptcy records and do a Google search before you hire the plumber.
Now, as gifted a cross examiner as Lee is, he might actually get a better plumber, but most people won't.
It's an absurd way to even think about running a railroad, so to speak.
This should remind you, boys and girls, of Lee's foolish fellow traveler, Captain Fishsticks.
I am dying to know re this statement: “And I am willing to pay the cost of getting that information proportional to the cost and risk of the product or service that I am buying.” – what proportionality would you pay? For a $20K surgery, would you pay 2% out of your own pocket?
Speaking as a person who worked at a medical device firm, McGrath’s list is perverse:
How the heck does a hospital like Mayo or the Cleveland Clinic decide to hire someone? Licensure is a threshold test. How does an MD get privileges? Licensure is a threshold test. How many “similar” surgeries has he done? Again, ditto, ditto, ditto.
Is licensure the most perfect marker for quality – obviously not. But in a field as complex as medicine or surgery, measuring outcomes isn’t so easy. Measuring success rates requires big statistical samples. Measuring survival rates can take years. McGrath’s measures might work for some – he is probably two phone calls away from speaking to the chairperson of any surgery department, but for most people that source of information is not available.
Lee, the point you're missing is that the licensing is the place to start to get that info.
And as for "graduate of nonaccredited school."
So....you would allow a graduate of Liberty University to operate on your child? Or to represent you in a legal case? How about Bob Jones U?
Mr. McGrath's questions do make sense for what he and I might want in a physician, but let's not kid ourselves that those are the kind of questions Daniel Hauser's parents would ask.
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