On any subject, presidents can handpick experts from the best and the brightest to give them advice, and many have dipped into America's deep well of intellectual talent throughout our history. But there was a telling moment during the final presidential election debate, when President Trump was asked about a recent report when he called infectious disease expert Anthony Fauci, MD, and those like him, "idiots": "If you're not listening to them, who are you listening to?"
Much public reporting suggests that the most influential medical advisor the president is listening to right now is Scott Atlas, MD. To those without medical training, Atlas might seem like the right choice.
He is on the faculty at Stanford and is a fellow at the well-known Hoover Institution. Such a distinguished resume might presumptively qualify him to advise the president on how to guide the country through the COVID-19 pandemic, the worst public health crisis in over a century, which has already taken more than 225,000 American lives and had a devastating impact on our economy. The public would reasonably expect that the president was getting the best available advice and that the advice was coming from people known to be experts.
But the issue of Atlas's expertise goes directly to the core value proposition of board certification: it's about verified expertise, not just self-declared expertise.
An early published history of the American Board of Internal Medicine (of which this author is the CEO) locates the beginning of the "board movement" to the 1865 meeting of the American Medical Association (AMA) where the New York delegation brought forward a complaint that there were local doctors advertising that they had special expertise in heart disease. But, said the New York delegation, they did not have not such expertise; it was, in their words, a "naked attempt to grab patients."
The remedy requested by the New York delegates? They asked the AMA to declare specialization "unprofessional," requesting that any doctor who claimed to be a specialist should be kicked out of the AMA.
Doing what organizations do in this situation, the AMA appointed a committee to study it, and the committee came back three years later with the conclusion that specialization was not itself the problem: that could advance scientific knowledge and lead to better patient care. But self-declared expertise was, in their view, a risk to the profession, and it should be looked at very skeptically.
The idea of board certification is rooted in the concept that the public deserves to be served by physician experts whose training, competence, and ability in a field have been independently verified by a body of their peers, not simply self-declared.
At a time when the public is confused about whose advice to follow, how to keep themselves safe, and what steps we should be taking as a country to protect ourselves, verified expertise is critically important. This is especially true at a time when anyone can say anything they want about themselves on the internet or on TV. It is also critically important for those physicians who actually have that expertise to be able to distinguish themselves from those who just say they do.
Atlas is publicly reported as certified as a diagnostic radiologist by the American Board of Radiology, an independent private organization composed of expert physicians deeply familiar through training and practice with the field of radiology. That certification means that a group of independent experts has attested to Atlas's ability in radiology.
Any licensed doctor in the country could claim that they were an expert in interpreting MRIs of the brain and they could bill Medicare for reading one. Atlas's certification through the American Board of Radiology demonstrates he has verified expertise in his ability to do that.
The American Board of Radiology has not, however, verified any expertise he might have in the field of infectious disease or public health. Any expertise Atlas may have in infectious diseases or public health is entirely self-declared, unverified by anyone with actual expertise in the field.
Anthony Fauci, MD, on the other hand, is certified in internal medicine and in infectious disease by the American Board of Internal Medicine, which I lead. ABIM is composed of doctors experienced in the practice, teaching, and research of internal medicine and its subspecialties.
In other words, Fauci's expertise to advise the president and public about the coronavirus pandemic is not just self-declared: it has been fully and amply demonstrated to expert peers.
Why does any of this matter? Because, as any physician knows, being an expert in one field doesn't assure that one is an expert in another. Many of us have driver's licenses, but that doesn't mean we can safely drive 18-wheelers or motorcycles.
At a time when the public is deeply confused about whom to trust, it is prudent to be skeptical of those that simply self-declare their expertise. And those in the profession who put in the hard work of doing accredited training and passing a comprehensive certification exam in their field, working hard every day to stay current, deserve to differentiate themselves from the increasing number of doctors who claim all kinds of things on the internet or TV but don't have the credentials to back it up.
The average member of the public, confronted with a whirlwind of conflicting information about how to stay safe and how to behave, should not be having to independently verify the skills and abilities of those they seek out to care for them in their time of need. That's our role as the medical profession, and this is a time when having a recognizable credential independently verifying experts is of huge value to the profession and to the public.
Expertise matters and many people would like to claim it, but knowledge and experience are hard-won and acquired by years of labor. The public deserves no less than to be served, both in the leadership of our response to the pandemic and in those who care for them in their communities, by physicians who have had their expertise verified by independent bodies of experts in the relevant field, not just those who say "trust me, I'm a doctor."
We wouldn't rely on Fauci to interpret an MRI of the brain; we shouldn't be relying on Atlas to guide the country through a pandemic.
Richard J. Baron, MD, is a geriatrician and internist and CEO of the American Board of Internal Medicine and the ABIM Foundation.
Last Updated November 02, 2020
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