The performance of physicians in their day-to-day clinical practices
has become an area of intense public interest. Both patients and health care
purchasers want more effective means of identifying excellent clinicians,
and a variety of organizations are discussing and implementing plans for assessing
the performance of individual clinicians. In this article, we review the current
state of physician clinical performance assessment with a focus on its usefulness
for competency assessment. We describe recommendations for a physician clinical
performance assessment system for these purposes, and identify ways in which
current methods of performance assessment fall short of these. We conclude
that important technical barriers stand in the way of using physician clinical
performance assessment for evaluating the competency of individual physicians.
Overcoming these barriers will require considerable additional research and
development. Even then, for some uses, physician clinical performance assessment
at the individual physician level may be technically impossible to accomplish
in a valid and fair way.