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Fwd: Re: NRC Information Notice 2002-28




Date: Fri, 04 Oct 2002 08:39:09 -0700
To: William V Lipton <liptonw@dteenergy.com>
From: "Carol S. Marcus" <csmarcus@ucla.edu>
Subject: Re: NRC Information Notice 2002-28

At 09:14 AM 10/4/02 -0400, you wrote:
 

"Carol S. Marcus" wrote:
 
Dear Mr. Lipton:

You need to learn to make a distinction between board certified physicians in Nuclear Medicine, as opposed to other groups of physicians who have little education or training in Nuclear Medicine, but who manage to buy licenses to practice some or all of it because NRC is desperate for the money from the User Fees.  The United States has the lowest requirements for practicing Nuclear Medicine among first world countries, and has lower requirements than many third world countries as well, such as India.  I think that you will find that the poor quality professional behavior "discovered" by the NRC is not occurring to any extent, or certainly any significant extent, among the board certified Nuclear Medicine physicians, but among others with lesser qualifications.  This is certainly the case with NRC's "misadministrations", nearly all of which occurred in practices of non-board certified Nuclear Medicine physicians.  The few that occurred with board-certified Nuclear Medicine physicians were almost invariably caused by techs who disobeyed procedures put in place by the physicians.  The real lesson is that NRC is inflicting poor quality Nuclear Medicine on members of the public because (1) NRC needs the money and (2) NRC advertises medical shortcomings and errors perpetrated by such poorly educated and trained individuals as evidence for the need of its regulation of the field, fooling naive members of the public, Congress, and apparently you as well.  One could easily look at NRC's "discoveries" and come to quite another conclusion, namely, that NRC has caused a problem by selling licenses to poorly qualified individuals, and that it should proceed to require the education, training, and experience of physicians for its own licensing that the American Board of Nuclear Medicine requires for its Diplomates.  That is what NRC has done with Radiation Oncology.  Why not Nuclear Medicine?

That would solve most of NRC's "problems", but the drop in User Fee income would cause NRC to have to unbudget many of its staff and management, all of whom are completely incompetent in Nuclear Medicine, or any kind of medicine, and Nuclear Pharmacy, or any kind of pharmacy, not to mention its pathetic competence in medical physics and mathematics.

When the National Academy of Sciences-Institute of Medicine studied NRC's "medical" program, the NAS-IOM found that it was so dysfunctional and without value that it recommended that Congress remove NRC's statutory authority in all medical and medical research areas. Way to go, guys...............

If you need a Nuclear Medicine procedure, what do you look for?  A physician board certified in Nuclear Medicine, or any old physician who has bought a license to practice it from a greedy, medically incompetent regulator?

Ciao,

Carol S. Marcus, Ph.D., M.D., ABNM, FACNP

<csmarcus@ucla.edu>


Dear Dr. Marcus,

Many thanx for supporting my opinion that medical licensees need to improve their self -regulation.  It seems, however, that you are confusing the practice of nuclear medicine with the practice of health physics.  A  hospital RSO's responsibilities are quite different from those of  a nuclear medicine physician, even though they could be the same individual.  I find it difficult to understand how a hospital RSO, even if board certified in nuclear medicine, could fulfill his responsibilities if he's not even aware that he's the RSO.

The opinions expressed are strictly mine.
It's not about dose, it's about trust.
Curies forever.

Bill Lipton, Sc.D., CHP, CHMM, MBA
liptonw@dteenergy.com
 
 
 


Dear Bill:

You missed the point.  These are not board-certified nukes who are made RSO's without their knowledge.  These are generally diagnostic radiologists.

In addition, the non-medical job of an RSO in a community hospital that does some nuclear medicine is largely secretarial, and has no safety significance at all.  The job is to produce paper for inspectors to inspect.  The real job is nuclear medicine practice, which is often poor, practiced by techs who are incompetent to practice any kind of medicine. 

In medicine, as in anything else, there is a whole spectrum of quality of practice.  Only the real outliers on the bottom end are not tolerated.  NRC purports to keep things to a higher standard, and chop off the low end.  This was the case for many years.  However, when NRC started having to raise all its operating expenses with User Fees, around 1990, it got onto this racket of licensing docs to do pieces of nuclear medicine, chopping up a practice so as to leave little for a board certified nuke, and the specialty is shrinking thanks to NRC.  However the number of licenses stays artificially high.  It tried to do this with Radiation Oncology at the last rulemaking, but was politically fought down. 

The NRC is not succeeding in making the quality of Nuclear Medicine better.  It is making it worse.  If we had no NRC regulation, Nuclear Medicine would be practiced like any other kind of medicine, and patients would choose board-certified Nuclear Medicine docs for good quality studies or procedures.  Most members of the public are fooled into thinking that if you have an NRC (or Agreement State) license, that is equivalent to "competence".  Totally untrue.

As to your allegation that medicine needs to reform itself, you obviously have no idea what is going on.  Due to HCFA (now CMS) reimbursement fraud, happily picked up by many third party payors, many hospitals and medical practices are going under.  The economic underpinning of a healthy medical profession has had the bottom fall out.  Hospitals and medical practices are doing what they need to do to survive.  Getting rid of specialists and telling other docs to pick up that work is going on all over medicine for survival.  Endocrinologists are kicked out and internists and family practice guys are told to take over the endocrine cases.  Dermatologists are cut out and family practice docs are told to take it over.   In some HMO's, getting to see a specialist takes an act of Congress.  University medical centers at medical schools, which used to provide highly complex, specialized care for small numbers of patients, and acted as a professional resource for physicians in a geographic area, are now vying with physicians in private practice to grab up insured patients, and screwing the private docs.  Without this, medical schools would go under because the increased reimbursement that contributed significantly to medical teaching institutions largely disappeared.

This situation is not medicine's problem.  It is the nation's problem, because our government created the mess in an attempt to decrease the cost of medical care. 

You can always make something cheaper by making it crummier.  If you think that there should be some minimum standards in some fields, such as medicine, and teaching, and engineering, etc., I assure you that government is the last place to do this.  You only generate a bunch of bureaucrats who care only about job preservation.  NRC adds huge costs to Nuclear Medicine, adds NO safety, and decreases the quality.  At the last Part 35 rulemaking meeting at White Flint when this abortion started a few years ago, two representatives from CMS came to the meeting and told NRC flat out that they would not reimburse for costs generated by the rulemaking.  NRC did not give a rat's ass.   NRC is now contributing to the cost problem by making it more and more expensive to practice Nuclear medicine in an environment of decreasing reimbursement, and most nuclear medicine today is practiced as part of a general radiology practice and the nuclear medicine "losses" are balanced by huge profits in other parts of Radiology.  Other docs choose to do only the nuclear medicine procedures that pay reasonably well, "cherry picking" from the panoply of over a hundred possible procedures, many of which lose money for the practitioner.  In many cases, your drugs are not even reimbursed, and your hospital will not permit you to even perform the procedure, and patient be damned.

Ciao, Carol