The sole agency recognized by the federal government to accredit U.S. medical schools suffers from an "inerent conflict of interest" that could lead to artificial limits on the future supply of doctors, the staff of the Federal Trade Commission has warned.
In a series of letters and formal statements to the Office of Education, the FTC's Bureau of Competition has suggested that it reconsider confering that authority on the Liaison Committee on Medical Education, which has had the accrediting job for the last 35 years.
"Basically, we are concerned that LCME, an organization tied to and heavily influenced by the American Medical Association, has sole authority over the accreditation of United States medical schools - and hence over the supply of physicians," Daniel C. Schwartz, acting director of the Bureau of Competition, wrote Ernest L. Boyer, commissioner of education, recently.
LCME, which accredits schools, which then are eligible for federal financial support, has 15 members - six of whom are picked by the AMA. Another six are selected by the Association of American Medical Colleges, two are selected by prior LCME members, and one is a government representative.
The AMA provides half of LCME's operating funds each year and administers LCME every other year, alternating the medical colleges association. In addition, LCME's legal advice is provided by AMA's attorneys every other year, alternating again with AAMC, LCME has no separate offices but operates, in alternate years, out of the offices of its parent bodies, Schwartz said.
In addition, the AMA has veto power over LCME's accreditation standards because they must be approved by the AMA's House of Delegates. Although Schwartz emphasized that neither LCME nor the AMA was that [WORD ILLEGIBLE] LCME nor the AMA was being accused of acting to limit the supply of doctors in recent years, the agency staff is concerned that the structure of LCME fails to meet the legal standards set up by the government for recognition and could lead to abuse.
"It is our view that because of AMA's significant influence over it. LCME does not protect against conflicts of interest, lacks autonomy, does not adequately reflect the community of interests affected by medical school accreditation and lacks sufficient public representation," Schwartz said.
"Our principal concern is the inherent conflict of interest faced by a professional association such as AMA which largely controls or dominates the accrediting agency whose decisions govern entry into the profession in question.
Although the comments forwarded to the Office of Education were the staffs, the staff was authorized by the commission to do so. The bureau has been investigating possible restrictions on entry into the medical profession as part of its ongoing probe into health-care problems.
The Office of Education is in the process of deciding whether to grant LCME's petition for onctinued acceptance as the nationally recognized agency to accredit medical schools. An advisory committee to the office has recommended that LCME be recognized for a two-year period instead of the customary four years because of "deficiencies," but the FTC staff questioned whether it should even get two more years.
The bureau recommended that, at a minimum LCME be required within a one-year period to make "significant and unmistakeable changes" designed to bring into compliance with the Office of Education's requirements.
The staff suggested that accreditation should be entrusted to autonomous groups composed of representatives of wide range of affected interests, including individual doctors and public representatives.