Neurosurgical credentials: a history and critique.
The author presents a review of the process of peer evaluation in this century, as well as how certification and techniques of evaluation in the practice of medicine and neurosurgery have evolved. The effect of licensure on the workforce, the influence of trade laws on quality of education and training, and the new paradigm of competition and managed medical practices have made a remarkable impact on the nature of the care of patients in the United States. The author also discusses the effect of risk management and litigation on the quality of medical care, the nature of outcomes evaluation and economic credentials in the absence of appropriate instruments for such evaluation, and alternatives for the future of the credentials process.
Tolchin
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La Mesa, California.