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November 1, 2000

Deficiencies in US Medical Care

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(17):2184-2185. doi:10.1001/jama.284.17.2184

To the Editor: Dr Starfield1 fails to mention the prevalence of obesity in the US population. I suspect that this is significantly higher than that of the comparison countries and might well account for the differences in health care indices that she cites.

I must also comment on the statistics on iatrogenic morbidity and mortality. In virtually all of the countries mentioned, a specialty board (such as the Royal College of Surgeons) controls who is allowed to practice a specialty. Specialists generally cannot practice unless they complete a residency approved by the College and pass a certification examination given by the College. In the United States, specialists are allowed to practice when "board-eligible" and never need to take a certifying examination. Is it surprising, then, that the United States has a high level of poor outcomes?

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