Immunity from prosecution for defamation confers absolute power to destroy, a vehicle without brakes. Unbiased peer review is the goal. One way to approach it is for each side's judges to agree on a third party. Then, all three hear the case. Immunity under these circumstances protects the interests of all parties. Whom to trust--that is the question.

Novermber, 2001 update on immunity: Click here.

Peer review is not guaranteed to be impartial under these provisions...

Isn't it possible to conduct non-punitive, educational peer review as a routine part of our work, much as airlines try to reduce risk across their system? Can't the piloting be improved without throwing the pilot out of the plane? Some doctors would welcome impartial peer review, corrective and non-punitive, perhaps with cases selected at random and discussed by impartial outsiders under a plan adopted via their county medical society. Others will want to do it on a state or a national basis--if we have national exams, why not have national peer reviewers, not as part of the government, but elected by physicians?

(For that matter, why not have national credentials, or state-wide credentials?) What are the best ways to conduct impartial peer review without making it an impartial witch hunt? By specialty? By geography? If the decision is left up to each medical community, will the judges be impartial? There is no reason to impose a single system, as long as adjudication is impartial.

As you seek employment, which places will you prefer, given the particulars occasionally associated with managed care (coercion, gag clauses) in a system not under physicians' control? For example, during interviews who would ever worry about being blacklisted into one of the national data banks by a bogus peer review? Or, of having to leave practice after 'economic credentialing or de-credentialing'? Welcome to the X-rated film in which you will star: "Medicine--The Business". Without being too 'confrontational' for some people's taste, it is fair to say that there is no legal requirement for fair peer review, and that unfair peer review can destroy careers. Until laws are changed, you must fend for yourself. This situtation is explained on this web site. It is worth noting that doctors locate after working in many states for college, medical school, internship, residency, fellowship. After meeting national examination standards and working ~100 hours per week in violation of the labor laws, they find themselves confronting entrenched local power in the person controlling a committee or two in a place they would like to work. There is unavoidable competition. This is a 'free country'? The inevitable struggle ensues. Innuendo and defamation sometimes play a key role; sometimes they do not appear at all. If we need doctors at all, perhaps there is a better way; perhaps due process is that better way. If so, why do not the AMA and the Joint Commission say so? Why, indeed?

We will publish By-Laws and Contracts for comparison, as well as replies which decline requests for this material, to encourage re-consideration. Institutions accepting public money such as Medicare are public. Officers have an obligation to meet public standards of disclosure and accountability. Remember 'The Enron'. If American medicine is to change from a profession into an Agribusiness with physicians electronically penned like poultry, "providers in a Product Line"--don't we need a Medical RICO Act to protect patients from future 'Enrons'? If cutting care to cut costs while claiming to be giving more care isn't racketeering, what is? Every time you hear the stock quote of the health care 'industry', remember that it is blood money that is being paid. Is it important to conduct fair peer review? You decide. There is no point in prolonging this brief diatribe. The trend is for people to choose professions other than this one. The surgical internships failed to fill for 2000 and 2001. Perhaps the missing applicants know something we have forgotten.

Things to consider during your job search are discussed on links within this site, including:

1: Impartial peer review, independent of HMO's, hospitals, insurance companies, governments. Peer review is a professional activity, and should be paid by doctors. Fair peer review is performed by independent doctors.

2. No restrictive covenant (non-competition clause). You are free to move into your own practice with copies of your patients' charts.

3. Incentive. Extra pay for extra work or liability.

4. No enticements from hospitals to admit preferentially to one hospital over another. Such practices are another form of fee-splitting.

5. Flexibility: Are doctors harassed by paperwork, insurance approvals, responsibility without the needed authority, lack of autonomy or cooperation, or a fixed schedule?

If you wish to see other aspects of practice included on this site, please call Dr. Waite at 714-995-7242 or email SteveWSmith@pol.net or HButler@pol.net.