25 June 2010

Rand Paul, self-certified physician

I had meant to write about this, but Bob Wachter got there before I did, and, let's be honest, does a much better job than I could have.  For those not following the drama, Rand Paul, MD, son of nutjob libertarian Congressman Ron Paul is running for (and likely to win) the US Senate seat in Kentucky.  He's gone the full Palin in not speaking to the media after he stumbled by suggesting that he would have opposed the Civil Rights Act.  But one tidbit I had noticed but has received little media attention is this:

Enter into this arcane but important debate one Dr. Rand Paul, libertarian, Tea Party heartthrob, son of presidential candidate Ron Paul, and (gulp) perhaps the future U.S. Senator from Kentucky. Paul, an ophthalmologist, has long claimed that he is board certified.

But it turns out that the American Board of Ophthalmology (ABO), the official ABMS board for the field, hasn’t heard from Dr. Paul since 2005, which was when his initial certification lapsed. As the Louisville Courier-Journal reported this week, Dr. Paul is now certified by an organization called the National Board of Ophthalmology (NBO).

Which is convenient, since when the NBO incorporated in 1999, the documents list one Rand Paul as both its founding president and director. The NBO went out of business in 2000, but Paul resurrected it in 2005, just in time to revive his lapsed board certification. In contrast to the ABO, which has a staff of 11 in its Philadelphia office, the NBO’s address is a UPS box in Bowling Green. Rented by, well, you know.

Yeah.  Convenient.  Whatever you think of Paul's politics, this is a pretty concerning matter from a point of view of professional integrity. Dr Paul claims some some bogus "protest" over some policy of the ABO, but it doesn't change the fact that Paul just invented a board certification out of whole cloth and essentially lied about his certification status to his patients and hospital affiliates. I'm on record as opposing back-door "alternate" Board Certifications like the AAPS, but they at least pass the sniff test -- there is an external standard, an exam, and the AAPS was not created by one individual for the sole purpose of certifying said individual.  I actually wonder whether it might rise to the level of criminal fraud: I know nothing about the law in KY, but I believe some states have statutes which criminalize misrepresenting one's professional credentials.  My experience with our state's medical quality assurance board also makes me wonder whether the KY medical board would approve of this sort of chicanery.

Ultimately, it will be up to the voters of Kentucky to decide if Dr Paul is the sort of person they want representing them in the Senate.  It's dishearening that the media may not have adequately informed them of this issue, but I can hope that come November the choose wisely and reject him.


  1. You gotta love all the republicans in Kentucky who voted for Rand Paul and brought him to national exposure, priceless. Lets face it they will try to vote this liar in but we can only wait and see if there is other skeltons in hs closet, oh yeah he is not a racist, I repeat, he is not a racist. Great thing is we are talking about Kentucky, so being a racist may be a positive, we will see.

  2. I'm still trying to figure out how he got credentialed to practice eye surgery when he's not, you know, really board certified. doesn't CMS/JCAHO have a pretty distinct policy on this?

  3. Rand Paul is the Ralph Nader of the right. They have a philosophy and they stick to it, god damnit, no matter how crazy they have to act. He's an individual! He'll compete in the marketplace according to his talents! He doesn't need no stinkin' organization! I always have a little soft spot for people who are consistent to a fault.

  4. Dr. Paul might have well just gotten his certification from a diploma mill or a crackerjack box.

    The worst of all is that people like that make the rest of us health care professionals look bad.

  5. I'm not defending what Dr Paul has done with respect to the phony board by any means, but to correct some misconceptions:

    Apparently Dr Paul was originally certified by the American Board of Ophthalmology at one time. That means that he graduated from med school (at justly famed Duke U. medical school), did 5 years of residency, and went through the certifying process at least once. He could not get it from "a diploma mill or crackerjack box." At one time, board certification was good forever, but in the 1980s, that policy changed, and now every board requires retesting every 8 or 10 years to maintain certification.

    CMS and JCAHO have no policy on board certification. One of the (many) things that practicing physicians resent about Medicare is that a doc who barely scrapes through training and stays one step ahead of the licensing authorities is paid the same for a particular encounter as one who excels and maintains the highest standards. At least with private insurers, most do require board certification, and require it to be maintained.
    I question whether he "lied to his patients and hospital affiliates." Hospitals, in my experience, do not just take a doc's word for such things- they do their due diligence and perform primary verification by directly contacting the appropriate boards.

    I also know nothing about the particulars of Kentucky medical practice, but in most states the state licensing board would look very closely at this type of misrepresentation. He would not lose his license for such a transgression, but would be issued a reprimand and told to stop it now.

    You may dislike Dr. Rand's politics, but don't fall into the trap of therefore believing that everything he does is evil.

  6. The voters won't care one iota. They will vote for him because they are obsessed with the concept of "less government" as they somehow think this will benefit them.

  7. The American Board of Ophthalmology changed from issuing time-unlimited board certifications to term certifications during the early 1990s. There are still many practicing ophthalmologists who have the earlier certificates that never expire, but Dr. Rand Paul (and this poster also) are not among them. We are required to recertify in a multi-step and expensive maintenance of certification process prescribed by the ABO.

    It is true that many carriers as well as most hospitals require board certification for membership, and they commonly ask which board issued the certification, but I have never seen any application that specified which board qualified as a valid certificate; I suspect that much of that is left to credentialing committee discretion, and which might also be subject to legal challenge if a particular credential was rejected.

    The press is trying to make more of this than the issue merits. I am no Rand Paul supporter, but the truth is that Dr. Paul's board certification status never lapsed, only his certification by a particular private voluntary certifying organization was lapsed which was apparently deliberate and done out of protest against the very obvious double standards the ABO did in fact have in grandfathering older members with lifetime certifications while imposing time-limited certifications on all later members.

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  9. Neveri said he was "evil," just deceitful in claiming certification from a board consisting only of himself.

    As for whether the ABO's grandfather clause merits such objection, it's a universal thing in ALL the boards that certification is now time limited and needs renewal. Regular readers of this blog know what I think of the implementation of this policy, but it doesn't justify lying and claiming certification which you have allowed to lapse, even if you did so out of protest.


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