Politico.Com Reveals Why Rand Paul's Opthamology "Issue" Makes Him "The Kind Of Guy You Want Working [For] You In Washington, D. C. ."
Rand Paul's ophthalmological crusade
In 1997, the monopolist power prepared a new set of regulations to burden ordinary, hardworking citizens, and one man stood up against them. It was “the kind of hypocritical power play that I despise and have always fought against,” recalled the leader of the dissidents.
And so he led what his enemies saw as a “rump group of malcontents” out of the stodgy old institution, to form his own, rebel organization of … ophthalmologists.
The Death Star, in this parable, was the American Board of Ophthalmology, ABO for short. Luke Skywalker was Bowling Green, Ky. opthamologist Rand Paul, who cut his political teeth working for the Libertarian Party presidential campaign of his father, Ron Paul, and is now the Republican nominee for Senate in Kentucky.
The issue was recertification, the requirement – introduced for most medical professions in the last two decades – that physicians take classes and past tests every ten years to retain their medical licenses. Paul’s campaign against the way the ABO board wanted to institute it for ophthalmologists extended beyond his harsh letters: He put his own medical career on the line, allowing his professionally valuable certification to lapse in 2005 in favor of the unrecognized certification of a small new organization he started.
Sunday’s Louisville Courier-Journal led with the news that Paul – contrary to an earlier assertion – is a not a “board-certified” physician. But while his opponent played gotcha, and while Paul worried, his spokesman said, of the damage to his medical practice, the episode revealed more about Paul’s non-conformist character and his appetite for quixotic conflicts than it did about his competence in removing cataracts.
At the heart of his long, largely failed war against ABO was its decision to grandfather in older physicians while forcing younger ones to face recertification every decade.
“Is it fair that the ophthalmologist down the street can claim board certification, without renewing it, but that a younger ophthalmologist, who passed the same boards, is disallowed?” Paul asked in a statement to reporters Monday, calling the ABO’s decade-old decision “hypocritical and unjust.”
The ophthalmological civil war began in the early 1990s, when the American Board of Medical Specialties – a non-governmental group of which ABO, founded in 1916, is the oldest member – began pushing its member organizations representing the various medical specialties to change the way they certified doctors. In the past, most specialists passed a single certification examination after medical school and received a certificate that was good for life. Under the new “maintenance of certification” process, doctors would have to retake their tests each decade.
“This was upsetting to the younger ophthalmologists who had to participate when older ophthalmologists did not have to,” said ABO’s current executive director, Dr. John Clarkson of Miami’s Bascom Palmer Eye Institute.
Particularly infuriating to Paul was ABO’s decision to allow physicians who had been certified in 1992 and before to keep their certifications for life. Many other specialties follow the same practice.
The board’s leaders said they had no choice, however, and no leeway to change the rules on doctors who had already been certified. “It’s strictly a legal situation,” said Dr. Charles Wilkinson, the Chairman of the Department of Ophthalmology at the Greater Baltimore Medical Center and former chairman of the ABO board. “You couldn’t force them -- you’d be a dead duck and you’d end up spending all that money and getting nowhere.”
Paul didn’t buy it.
The group “claims it is illegal to call for recertification of all ophthalmologists. This is untrue,” he said in his statement.
The certification fight had no obvious ideological charge – the board is not a government organization, and state medical licenses don’t currently depend on board certification. But other opthamologists saw at work some of the same impulses that would later motivate Paul's political career.
"Randy" Paul had been a "friendly pleasant good resident - nothing special, but nothing negative," recalled Dr. Bruce Shields, who had been a professor and mentor of Paul's at Duke University, and then served on the ABO board. Suddenly he was writing "militant" letters to the board, threatening secession, and "challenging the establishment of medicine."
Paul invoked the same deep belief in the freedom of private organizations that nearly derailed his campaign when, soon after winning the nomination, he briefly defended the rights of private businesses to discriminate by race.
“ABO is a private group and creates any rules they wish (even discriminatory policies based on age),” he said. “Having all its members recertify is not illegal -- just impractical, because the older ophthalmologists will vote against it.”
Paul wasn’t the only one to object.
ABO “is besieging ophthalmology” and “should be stopped before it sows such terrible disunity that our profession never recovers!” wrote a Florida opthamologist, Stanley Braverman, wrote in 2004.
Braverman, Paul, and others also attacked the organization’s motives. It was more interested, they said, in self-preservation than the quality of medical care.
Paul’s hostility to the change, his uncompromising tone, and his public campaign against his profession’s leaders took them by surprise, and won him abiding enmity at the top of his profession.
Dr. Wilkinson recalled “nasty letters to the board” and a “very very negative tone” from Paul. (ABO accepted a written request for Paul’s letters, but didn’t respond immediately.”
“He attempted to organize a rump group of malcontents to oppose the whole thing and to stick their heads in the sand,” said Wilkinson.
“He was trying to paint the board in a pretty dark light,” recalled Dr. Denis O’Day, an ophthalmologist at the Vanderbilt Eye Institute in Nashville who was its executive director through the recertification battle and recalled being “under attack” from Paul.
“He felt that the position I was taking was wrong and he had no hesitancy in saying that,” O’Day said.
When the young doctor failed to persuade his elders to end the inequality, he took the conflict a step further: In 1997, he organized what he now says were 200 ophthalmologists into the National Board of Ophthalmology, a rival to ABO founded, a Paul aide said Monday, to do essentially the same sort of recertification – but without making distinctions between older and younger doctors. This distinction was academic: The group’s members appear entirely to have been the younger doctors who would be recertified anyway. It was a matter of principle.
To join the rival organization could have real consequences, and Paul’s was a principled stand with real risks: Some hospitals only extend privileges to doctors with board certification, and patients look to ABOP as a stamp of approval. But in 2005, Paul let his ABO certification lapse, recertifying – he says – through his own organization’s process.
Paul’s side in the ophthalmology wars was, in the end, much like his father's presidential campaigns: A near- hopeless battle for what he saw as principle. "It was kind of like fighting City Hall – he was fighting a very well established, well respected agency within our medical profession," said Dr. Shields.
For one lone crusader to hcallenge city hall – it didn’t have much chance of succeeding."
And in the end, Paul lost.
For all Paul’s passion, his National Board remains something like the Libertarian Party of ophthalmology. Registered in Kentucky and governed by Paul and two family members, it continues – Paul spokesman Jesse Benton said – to run a formal, confidential recertification process for ABOP dissidents that is much like that of ABO itself. The group has no website and no public presence, but it most recently recertified a doctor just two weeks ago, Benton said. Paul, in his statement, suggested that the American Board of Medical Specialties had refused to embrace his rival group to protect ABOP, one of it charter members, though there’s no evidence Paul ever seriously sought formal recognition.
The National Board of Ophthalmology “never quite caught fire like Rand and the 200 other ophthalmologists had hoped, but it continues to offer quality, trustworthy certifications for ophthalmologists,” said Benton. (A spokesman for the Bowling Green hospital where Paul practices suggested to the Courier-Journal that his certification isn’t a concern.)
As for the shift to what’s called maintenance of certification, “the debate’s over – we’re in the implementation phase,” said O’Day, Paul’s old antagonist.
Paul's admirers and his critics alike see the war with the ABO as a window into the candidate's deeply anti-Establishment politics.
"It speaks to the kind of person that Rand is," said Benton, the spokesman. "He doesn’t like the arbitrary and unfair use of power. He likes fairness, he likes equality under the law, and when these older opthamologists used their power to turn things in their favor, Rand stood up."
Wilkinson, the former ABOP chairman, said the episode should serve as a warning about Paul.
“He’s going to dig himself a little hole here if he’s not real careful,” he said of Paul’s continued criticism of the board’s certification process. Wilkinson compared opthamologists, who conduct eye surgery, to pilots, who also undergo regular testing.
“All you have to do is think of that pilot metaphor and say, ‘Is this the kind of guy you want working on you?’” he said.
Gabriel Beltrone contributed to this report.
Read more: http://www.politico.com/news/stories/0610/38530_Page3.html#ixzz0r2mXDPQa
Editor's comment: wasn't it Albert Einstein who said that "a foolish faith in authority is the worst enemy of truth"?
Go Rand.
In 1997, the monopolist power prepared a new set of regulations to burden ordinary, hardworking citizens, and one man stood up against them. It was “the kind of hypocritical power play that I despise and have always fought against,” recalled the leader of the dissidents.
And so he led what his enemies saw as a “rump group of malcontents” out of the stodgy old institution, to form his own, rebel organization of … ophthalmologists.
The Death Star, in this parable, was the American Board of Ophthalmology, ABO for short. Luke Skywalker was Bowling Green, Ky. opthamologist Rand Paul, who cut his political teeth working for the Libertarian Party presidential campaign of his father, Ron Paul, and is now the Republican nominee for Senate in Kentucky.
The issue was recertification, the requirement – introduced for most medical professions in the last two decades – that physicians take classes and past tests every ten years to retain their medical licenses. Paul’s campaign against the way the ABO board wanted to institute it for ophthalmologists extended beyond his harsh letters: He put his own medical career on the line, allowing his professionally valuable certification to lapse in 2005 in favor of the unrecognized certification of a small new organization he started.
Sunday’s Louisville Courier-Journal led with the news that Paul – contrary to an earlier assertion – is a not a “board-certified” physician. But while his opponent played gotcha, and while Paul worried, his spokesman said, of the damage to his medical practice, the episode revealed more about Paul’s non-conformist character and his appetite for quixotic conflicts than it did about his competence in removing cataracts.
At the heart of his long, largely failed war against ABO was its decision to grandfather in older physicians while forcing younger ones to face recertification every decade.
“Is it fair that the ophthalmologist down the street can claim board certification, without renewing it, but that a younger ophthalmologist, who passed the same boards, is disallowed?” Paul asked in a statement to reporters Monday, calling the ABO’s decade-old decision “hypocritical and unjust.”
The ophthalmological civil war began in the early 1990s, when the American Board of Medical Specialties – a non-governmental group of which ABO, founded in 1916, is the oldest member – began pushing its member organizations representing the various medical specialties to change the way they certified doctors. In the past, most specialists passed a single certification examination after medical school and received a certificate that was good for life. Under the new “maintenance of certification” process, doctors would have to retake their tests each decade.
“This was upsetting to the younger ophthalmologists who had to participate when older ophthalmologists did not have to,” said ABO’s current executive director, Dr. John Clarkson of Miami’s Bascom Palmer Eye Institute.
Particularly infuriating to Paul was ABO’s decision to allow physicians who had been certified in 1992 and before to keep their certifications for life. Many other specialties follow the same practice.
The board’s leaders said they had no choice, however, and no leeway to change the rules on doctors who had already been certified. “It’s strictly a legal situation,” said Dr. Charles Wilkinson, the Chairman of the Department of Ophthalmology at the Greater Baltimore Medical Center and former chairman of the ABO board. “You couldn’t force them -- you’d be a dead duck and you’d end up spending all that money and getting nowhere.”
Paul didn’t buy it.
The group “claims it is illegal to call for recertification of all ophthalmologists. This is untrue,” he said in his statement.
The certification fight had no obvious ideological charge – the board is not a government organization, and state medical licenses don’t currently depend on board certification. But other opthamologists saw at work some of the same impulses that would later motivate Paul's political career.
"Randy" Paul had been a "friendly pleasant good resident - nothing special, but nothing negative," recalled Dr. Bruce Shields, who had been a professor and mentor of Paul's at Duke University, and then served on the ABO board. Suddenly he was writing "militant" letters to the board, threatening secession, and "challenging the establishment of medicine."
Paul invoked the same deep belief in the freedom of private organizations that nearly derailed his campaign when, soon after winning the nomination, he briefly defended the rights of private businesses to discriminate by race.
“ABO is a private group and creates any rules they wish (even discriminatory policies based on age),” he said. “Having all its members recertify is not illegal -- just impractical, because the older ophthalmologists will vote against it.”
Paul wasn’t the only one to object.
ABO “is besieging ophthalmology” and “should be stopped before it sows such terrible disunity that our profession never recovers!” wrote a Florida opthamologist, Stanley Braverman, wrote in 2004.
Braverman, Paul, and others also attacked the organization’s motives. It was more interested, they said, in self-preservation than the quality of medical care.
Paul’s hostility to the change, his uncompromising tone, and his public campaign against his profession’s leaders took them by surprise, and won him abiding enmity at the top of his profession.
Dr. Wilkinson recalled “nasty letters to the board” and a “very very negative tone” from Paul. (ABO accepted a written request for Paul’s letters, but didn’t respond immediately.”
“He attempted to organize a rump group of malcontents to oppose the whole thing and to stick their heads in the sand,” said Wilkinson.
“He was trying to paint the board in a pretty dark light,” recalled Dr. Denis O’Day, an ophthalmologist at the Vanderbilt Eye Institute in Nashville who was its executive director through the recertification battle and recalled being “under attack” from Paul.
“He felt that the position I was taking was wrong and he had no hesitancy in saying that,” O’Day said.
When the young doctor failed to persuade his elders to end the inequality, he took the conflict a step further: In 1997, he organized what he now says were 200 ophthalmologists into the National Board of Ophthalmology, a rival to ABO founded, a Paul aide said Monday, to do essentially the same sort of recertification – but without making distinctions between older and younger doctors. This distinction was academic: The group’s members appear entirely to have been the younger doctors who would be recertified anyway. It was a matter of principle.
To join the rival organization could have real consequences, and Paul’s was a principled stand with real risks: Some hospitals only extend privileges to doctors with board certification, and patients look to ABOP as a stamp of approval. But in 2005, Paul let his ABO certification lapse, recertifying – he says – through his own organization’s process.
Paul’s side in the ophthalmology wars was, in the end, much like his father's presidential campaigns: A near- hopeless battle for what he saw as principle. "It was kind of like fighting City Hall – he was fighting a very well established, well respected agency within our medical profession," said Dr. Shields.
For one lone crusader to hcallenge city hall – it didn’t have much chance of succeeding."
And in the end, Paul lost.
For all Paul’s passion, his National Board remains something like the Libertarian Party of ophthalmology. Registered in Kentucky and governed by Paul and two family members, it continues – Paul spokesman Jesse Benton said – to run a formal, confidential recertification process for ABOP dissidents that is much like that of ABO itself. The group has no website and no public presence, but it most recently recertified a doctor just two weeks ago, Benton said. Paul, in his statement, suggested that the American Board of Medical Specialties had refused to embrace his rival group to protect ABOP, one of it charter members, though there’s no evidence Paul ever seriously sought formal recognition.
The National Board of Ophthalmology “never quite caught fire like Rand and the 200 other ophthalmologists had hoped, but it continues to offer quality, trustworthy certifications for ophthalmologists,” said Benton. (A spokesman for the Bowling Green hospital where Paul practices suggested to the Courier-Journal that his certification isn’t a concern.)
As for the shift to what’s called maintenance of certification, “the debate’s over – we’re in the implementation phase,” said O’Day, Paul’s old antagonist.
Paul's admirers and his critics alike see the war with the ABO as a window into the candidate's deeply anti-Establishment politics.
"It speaks to the kind of person that Rand is," said Benton, the spokesman. "He doesn’t like the arbitrary and unfair use of power. He likes fairness, he likes equality under the law, and when these older opthamologists used their power to turn things in their favor, Rand stood up."
Wilkinson, the former ABOP chairman, said the episode should serve as a warning about Paul.
“He’s going to dig himself a little hole here if he’s not real careful,” he said of Paul’s continued criticism of the board’s certification process. Wilkinson compared opthamologists, who conduct eye surgery, to pilots, who also undergo regular testing.
“All you have to do is think of that pilot metaphor and say, ‘Is this the kind of guy you want working on you?’” he said.
Gabriel Beltrone contributed to this report.
Read more: http://www.politico.com/news/stories/0610/38530_Page3.html#ixzz0r2mXDPQa
Editor's comment: wasn't it Albert Einstein who said that "a foolish faith in authority is the worst enemy of truth"?
Go Rand.
Labels: Conservatism, Constitutionalist, GOP, ICONoclast, Rand Paul
posted by KYJurisDoctor at 1:47 PM
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Great article!
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