Physicians' assessment and competence: USA and UK.

摘要

The growing evidence of widespread deficiencies in quality of care and the associated rising awareness and concern of policymakers and the public is catalysing physicians' organisations in the USA and the UK to focus their attention on ways to strengthen the profession's role in the quality movement. In both nations, many healthcare stakeholders have put forward strategies to lend support to improvement, including new regulatory approaches, mandates for quality measurement and public reporting, implementation of pay-for-performance programmes, and training in the science of systems improvement.1,2Self-regulation of the medical profession has a long history on both sides of the Atlantic. Longstanding physician-led organisations have been responsible for setting (and maintaining) standards for the profession. However, critics view self-regulation as an implicit social contract between physicians and payers (or the government)-physicians have essential knowledge and provide service to the community in exchange for autonomy and freedom from onerous external regulation. Acts of improper conduct by individual doctors, coupled with a perception that the self-interest of the profession mitigates against self-policing, have caused a crisis of confidence that reliance on professional self-regulation is neither effective nor prudent.