Dear Dr. Burland
I received a copy of your letter from Joseph Schachter, and so take it to be open to discussion. I felt it to be a very sensitive, even compelling response to Schachter's proposal, and so I wanted to join the conversation if I may.
Although I hold no particular brief for the proposal, I do feel that Schachter is addressing a significant problem that your letter really does not attend to. The undeniable fact is that there are long-standing and severe difficulties with the Certification Committee that simply cannot be chalked up to malcontents, misunderstandings, or problems of meritocracy. I recently became Director of the Chicago Institute. Soon after assuming office, I received a copy of a letter sent by the chair of your committee to one of our graduates who had not been certified. One could only charitably say that the letter was incomprehensible. I showed it to our former dean, who said it was a not untypical, although garbled, letter. I wrote to your chair, who apologized for the letter's lack of clarity and confessed that indeed he had mixed up the cases referred to. The applicant was confused and bewildered inasmuch as her career seemed threatened by a less than competent group of people. To her credit she persevered and in the next go-round passed with flying colors.
Now I confess that all of this is very disconcerting to me, primarily because absolutely nothing happened in the intervening period to qualify that candidate except for a possible change in the committee, either in its make-up or its competence. What does seem evident is that this sort of process is basically an insult to the institute. Do you really feel that the committee's supposed “group wisdom” outweighs the hundreds of hours we have spent teaching and evaluating that applicant? Of course anyone can make a mistake, but just what is the value of your aiming to second guess us? This may all be of little moment, except that now another applicant has called me with a similar story of being reinterviewed, asked to submit another case, etc., etc. Once again we have someone we have devoted a great deal of time and energy to educating, and have graduated, but in this instance one who says she will probably not persevere. We will likely lose her to your committee's peculiarities. Are you really better qualified than our own faculty to judge her “minimal competence”? Can you not see what a depreciation that is of our work?
Our institute recently had a site visit and was passed with a rather glowing commentary. Are we still to feel that your committee is in an even better position to judge our educative efforts? The hard facts are very simple: there simply is no way to develop a fair and standard test of analytic competence, and, failing this, your committee has no right to behave in this essentially slipshod manner, which serves to injure people and insult the educational efforts of our institutes.
I have served on the Board on Professional Standards for a few years now and, among many other things, am impressed with the profusion of committees whose main purpose seems to be to perpetuate themselves. Yours is no exception. The Committee on Institutes, like our college accreditation groups, decides if an educational facility is up to par. When a person graduates from college, the accrediting group does not then decide if the degree is deserved. Certifying groups in other medical specialties seem able to give standardized tests for competence, and they nowhere give rise to the profusion of stories of mistreatment as does your committee, which has not been able to deliver a fair and standard test of competence. Short of that achievement, the Certification Committee cannot ignore the honest feeling behind Schachter's proposal; it is simply that there is no way the committee can justify its continued existence. I say this with due respect for the efforts of the committee, but with an accompanying awareness of its fundamental lack of any raison d'etre.
Arnold Goldberg, M.D.