Doctors' doctors: these are the peers physicians would choose to heal themselves.

• Author: Martin, Edward
• Position: Directory

His behavior had been erratic but never like this. He admired a patient's ring and invited her to go outside to his car, ostensibly so he could show her his ring. She refused. When a man complained of an injured foot, he removed the patient's shoe, slung it across the examination room and told him nothing was wrong with him except laziness. The man had a broken foot.

The N.C. Medical Board stripped the Chapel Hill doctor of his license last year after he was diagnosed with bipolar disorder. But the system set up to protect patients from doctors who could kill them through incompetence does little to help them find the ones who could save their lives.

Private entities try to fill that void with quality ratings. Boston-based Best Doctors Inc., which produced the list that follows, surveys physicians, asking whom they would choose to treat themselves or their families. Some 30,000 doctors nationwide made the cut. About 4% of the 20,000 who practice in North Carolina are on it.

A federal system that grades doctors on how successfully they treat patients could be in place within two years. It would be similar to Hospital Compare, the rating system that became available on the Internet in April. The Centers for Medicare & Medicaid Services, which manages public health-insurance programs, compiles the list. The Department of Health and Human Services agency is evaluating suggestions for a doctor-rating system. State medical authorities say it could supplement ratings such as those compiled by Best Doctors by grading physicians on how well their Medicare patients recover. In many practices, those patients make up more than half the workload.

Gordon DeFriese, president of the North Carolina Institute of Medicine in Durham, says surgeons will be easiest to evaluate. "They can determine if patients were re-hospitalized or suffered complications. But for primary-care doctors and others, they might have to look at the number of patients admitted for care who possibly could have been managed as outpatients."

Regardless of the final form, such a system is likely to be coolly received by doctors, who have long resisted outside attempts to measure quality of care. They argue that individual factors--a heart patient also might be overweight and diabetic--make grading impossible. But patient advocates cite studies that indicate medical accidents alone--not including variations between marginal and excellent care--kill more than 100,000 patients a year.

The Medical Board is the only state agency providing information about doctors for patients, but efforts to beef up its authority long have been thwarted by the General Assembly. The 12-member board monitors about 35,000 professionals--doctors practicing in and out of the state, physician assistants, nurse practitioners and others. "Our attention is on trying to identify those practicing below the standard," Executive Director David Henderson says. "It would be a monumental task to try to rate the best ones."

Best Doctors executives say they fill gaps left by official agencies. The company sells its services to employers, insurers and agencies trying to keep costs down by identifying doctors who excel in their fields. Like the Medical Board, it verifies licenses and board certification but also sends ballots to doctors who appeared on previous year's lists, asking them to nominate and vote for physicians they deem outstanding. "They have to have the confidence of their peers," Research Director Lucienne Stec says, "and we consider that the best measure."

ALLERGY AND IMMUNOLOGY

A. Wesley Burks Jr., Duke University Medical Center, Durham; John W. Georgitis, LaFayette Clinic, Fayetteville; M. Louise Markert, Duke University Medical Center, Durham; Larry W. Williams, Duke University Medical Center, Durham.

ANESTHESIOLOGY

Philip Boysen, UNC School of Medicine, Chapel Hill; John F. Butterworth IV, Wake Forest University Health Sciences Center, Winston-Salem; David Colonna, Piedmont Triad Anesthesia, Winston-Salem; D. Ryan Cook, Duke University Medical Center, Durham; Joseph P. Coyle, Southeast Anesthesiology Consultants, Charlotte; John Ebert, Presbyterian Hospital, Charlotte; Randy C. Efird, Critical Health Systems, Raleigh; James C. Eisenach, Wake Forest University Baptist Medical Center, Winston-Salem; Andrew P. Hart, Asheville Anesthesia Associates, Asheville; Jonathan B. Mark, Durham Veterans Administration Medical Center, Durham; Mark Newman, Duke University Medical Center, Durham; Michael A. Olympio, Wake Forest University Health Sciences Center, Winston-Salem; Patricia Petrozza, Wake Forest University Health Sciences Center, Winston-Salem; Richard Prielipp, Wake Forest University Health Sciences Center, Winston-Salem; Richard L. Rauck, Carolina Pain Institute, Winston-Salem; Douglas Ririe, Wake Forest University Health Sciences Center, Winston-Salem; Roger L. Royster, Wake Forest University Health Sciences Center, Winston-Salem; Debra A. Schwinn, Duke University Medical Center, Durham; Phillip E. Scuderi, Wake Forest University Health Sciences Center, Winston-Salem; Robert E. Seymour, Critical Health Services, Raleigh; Joseph R. Tobin, Wake Forest University Health Sciences Center, Winston-Salem; Mark M. Vogelhut, Presbyterian Hospital, Charlotte; David Samuel Warner, Duke University Medical Center, Durham; Deborah Whelan, Wake Forest University Health Sciences Center, Winston-Salem; David A. Zvara, Wake Forest University Health Sciences Center, Winston-Salem.

CARDIOVASCULAR DISEASE

Thomas M. Bashore, Duke University Medical Center, Durham; Richard C. Becker, Duke Clinical Research Institute, Durham; Robert M. Califf, Duke University Medical Center, Durham; David Fitzgerald, Wake Forest University Baptist Medical Center, Winston-Salem; Joe Ellis Gaddy, Cardiology Specialists of North Carolina, Winston-Salem; Davidson H. Givens, Winston-Salem Cardiology, Winston-Salem; J. Kevin Harrison, Duke Heart Physicians, Durham; Joseph Kisslo, Duke University Medical Center, Durham; J. Tift Mann, Wake Heart Associates, Raleigh; Daniel B. Mark, Duke University Medical Center, Durham; Joseph G. Rogers, Duke University Medical Center, Durham; Marschall S. Runge, UNC School of Medicine, Chapel Hill; Thomas J. Ryan, Duke University Medical Center, Durham; Sidney C. Smith Jr., The Heart Center, Chapel Hill; Franklin C. Wefald, Smithfield Heart Associates, Smithfield; James P. Zidar, Duke Cardiology of Raleigh, Raleigh.

DERMATOLOGY

Charles J. Brown, Dermatologic Laser Center, Charlotte; William Burke, Brody School of Medicine at East Carolina University, Greenville; Claude S. Burton, Duke University Medical Center, Durham; Jonathan Cook, Duke University Medical Center, Durham; Luis A. Diaz, UNC School of Medicine, Chapel Hill; Zoe D. Draelos, High Point; Libby I.E. Edwards, Mid-Charlotte Dermatology and Research, Charlotte; Steven Feldman, Wake Forest University Health Sciences Center, Winston-Salem; Alan Fleischer Jr., Wake Forest University Health Sciences Center, Winston-Salem; W. Ray Gammon, Eastern Dermatology and Pathology, Greenville; Russell P. Hall III, Duke University Medical Center, Durham; W. Dean Henrichs, Winston-Salem Health Care, Winston-Salem; Joseph L. Jorizzo, Wake Forest University Health Sciences Center, Winston-Salem; Barry Leshin, The Skin Surgery Center, Winston-Salem; Stanley B. Levy, Chapel Hill Dermatology, Chapel Hill; Amy J. McMichael, Wake Forest University Health Sciences Center, Winston-Salem; Elise A. Olsen, Duke University Medical Center, Durham; Lawrence H. Pearson, Cleveland Dermatology, Shelby; Neil S. Prose, Duke University Medical Center...