06.15.10

The Biggest Rand Paul Outrage Yet

The eye doctor isn’t properly certified? Dr. Kent Sepkowitz on Paul’s slick end-run around the profession’s licensing rules—and what it tells you about the kind of politician he is.

Scarcely a day passes that we don’t find out something new and objectionable about Dr. Rand Paul. The risk in the pile-on is that a real doozie will get missed, lost in the daily torrent. The recent news—his lack of standard certification as an ophthalmologist and its relationship to his self-anointing and self-created National Board of Ophthalmology—is just such a Big Deal. Its specifics, however, are so complicated and unrewarding to follow as to threaten to place it on the endangered scandal list.

I am here to make certain that we don’t let this one slide. His decision to sidestep the standard way doctors are certified in America is—even by summer politician standards—slimy, lazy, self-serving, and, important to remember as we sink deeper into his muck, revealing of the real reason for his me-against-the-Man shtick. (Hint: He’s not looking out for you, Mr. Little Guy). But before we read from the latest entry of the Randiad, let me guide you through the mind-numbing world of American physician credentialing.

Trying to gin up a moral issue out of the selfish power play is reminiscent of Nixon’s view of the law as something to try to outsmart. It’s also disrespectful to the oddball but often courageous stances of his father and other giants of the right willing to fight on principle.

Here’s how it works: To practice medicine legally requires a license issued by the state. Eligibility for licensure is granted after graduating medical school and after passing a series of difficult standardized exams prepared by the National Board of Medical Examiners. Once completed, licensure is forever (assuming a person behaves and isn’t a total disaster). Rand is a licensed physician.

But a guy's got to practice medicine somewhere—an eye specialist like Dr. Paul, for example, needs a hospital's operating rooms to ply his trade. And that's where certification comes in. Whereas licensure is a one-size-fits-all blanket of general adequacy, certification is granted by a specialty board to indicate competency in a specific field such as ophthalmology (or medicine or surgery or psychiatry). Certification tests long have been administered by venerable, apolitical groups such as the American Board of Ophthalmology (or Internal Medicine or whatever). The certificate is a national credential that, although not absolutely necessary to practice medicine, is more or less required for any doctor seeking an affiliation with a hospital.

It gets even more complicated, but hang in there; Rand is hoping the distinctions are just too subtle for anyone to really care about. In the 1980s, American medicine decided that it should police itself. A little. So the Grand Old Men of the various fields decided that already certified specialists should recertify once a decade. Rand initially did the right thing and became certified; but when his 10 years were up, he decided he’d had enough and chose not to recertify. Rather, he organized his own certifying program for ophthalmology based right there in his hometown of Bowling Green. He then appointed himself president of the group, which he named the National Board of Ophthalmologists, and better yet, declared his wife (not a doctor) VP and his father-in-law secretary. Talk about convenient! It remains unclear what the NBO criteria for certification are; the organization appears to have no website or easily located documents (though it is registered with the state of Kentucky as a nonprofit and claims to have certified a few hundred eye doctors).

All of this would be OK with me; I just took the frigging recertification test in my field and I hated every minute of it. It is humiliating and infuriating and insulting and a waste of time and money. Indeed, I applaud Rand’s sticking his tongue out at the gasbags who insist on teenage procedures (multiple-choice tests proctored now by cybersecurity) to assure that a doctor is certified in his field.

But Rand lost me when he articulated the reason why he resisted. Being a conscientious objector or pissed off adult simply wasn’t good enough. No, he decided to cast it as a high-end moral stance against groups that discriminate—groups like the American Board of Ophthalmology. And what exactly was their discriminatory practice? Opposing civil rights maybe? Nope—much, much worse. The old geezers who made up the test requirements built a nice little loophole for themselves: They excluded themselves from having to recertify—instead they were “grandfathered” in. And in so doing they discriminated against poor Rand and me and thousands of other of victimized doctors. Thank goodness someone had the strength to make a stand against the nefarious two-tiered system. Ah the pure horseshit—true Kentucky thoroughbred stuff.

Trying to gin up a moral issue out of the selfish power play is reminiscent of Nixon’s view of the law as something to try to outsmart. It’s also disrespectful to the oddball but often courageous stances of his father and other giants of the right willing to fight on principle. With his creation of a ludicrous home-brew “certifying board,” he has shown his dedication not to a movement but to the single goal of making life a little bit more convenient for Rand Paul. And here Paul does appear to speak for his generation: He has given us the finest example yet of yuppie selfishness in senescence.

Correction: An earlier version of this story incorrectly said that the National Board of Medical Examiners was roughly the equivalent of the American Bar Association.


Kent Sepkowitz is an infectious-disease specialist in New York City. He has contributed to The New York Times, Slate, and, oh-so-briefly, O Magazine. He also writes academic medical articles that are at times pretty tough sledding.