The time has come for the creation of a national system to assess doctors' performance and to expand programs to help those who are found to be deficient, say Harvard physicians Lucian Leape and John Fromson. In an article in the Annals of Internal Medicine (1/17/2006), Leape and Fromson called on the Federation of State Medical Boards, the American Board of Medical Specialties, and the Joint Commission on Accreditation of Healthcare Organizations to take the lead and collaborate with one another to reduce performance failures that could endanger patients.

Leape and Fromson believe that "a routine, formal, proactive system" is needed in every hospital to measure physicians' clinical and behavioral performance. They envision a system that would include explicit standards of performance (developed by a national organization), as well as physician acceptance of these standards and the consequences for failing to abide by them. Adherence to standards would be monitored annually in a formal evaluation using validated measures of competence and behavior. If deficiencies are identified, prompt action would be taken—whether it is evaluative testing, counseling, referral for further assessment and treatment, or even restricting practice while the physician undergoes further assessment or rehabilitation. Their plan also acknowledges that assessment and treatment programs need to be created to manage substandard performance.

"The long-term objective is to enable physicians to continue to practice effectively and safely—not to 'weed them out,'" wrote Leape and Fromson. "If the system works properly, that is, if physicians who perform poorly are identified before serious consequences arise, then one might expect referrals to the state medical board for disciplinary action to decrease."