Sunday, October 07, 2018

The MOC Fight

From Medical Economics:
“Physicians are pushing legislation on the state level because they don’t trust the ABMS [American Board of Medical Specialties] and its financial conflicts of interest,” says Paul Mathew, MD, a volunteer board member of the NBPAS in Cambridge, Mass. “Many feel the only way to declaw the tiger is legislative action due to insurance companies and academic institutions having no reason to change their pro-MOC policies.” The ABMS oversees MOC for its 24 boards.
-Wes

Friday, October 05, 2018

For Whom MOC Tolls

He saw me in the hall between cases and our eyes connected, however briefly. I probably looked a bit tired, hair askew, and rushed after a long ablation case as I scurried to grab a quick bite to eat before my next case started. He was one of our best fellows in cardiology - hard working, innovative, never one to skip a clinical detail or shirk a responsibility, who clearly wanted to chat. He approached respectfully, smiling timidly, and said quietly:

"Dr. Fisher, is it true that I have to pay ABIM $155 to maintain my certification even though I passed my boards? And do I have to do this for life? I went to the ABIM website and it really isn't clear what we have to do."

I explained the ABIM's current iteration of fees and testing as best I could in the brief time we crossed paths. The ever-shifting sands of the ABIM parsed fee and "point" structures, "discounts," programs, credits, and value of participating (or not) in Maintenance of Certification have lead, I believe intentionally, to the current chaotic state of US physician Board certification. I felt sorry for him but was not surprised he was confused, especially since explaining the board process was equally difficult. I sensed he knew that speaking candidly about his concerns with others in positions of leadership might compromise his reputation as a hard-working, reliable cardiology trainee and was grateful he felt he could approach me with his concerns.

This is what US physician board certification has become: little more than a shakedown of our best and brightest to fund a bloated bureaucratic credentialing system that adds little to no value to our trainees' learning experience. After our conversation, I grabbed a salad and returned to do my pre-operative checklist for my next patient. My phone received a text message:

""They also included a discount on multi-year payment."



"$155 is my annual savings during fellowship..."

-Wes

Tuesday, September 25, 2018

ABMS and ABU Spin on DOJ Letter

Board certification of US physicians continued on its path of deceptive and misleading propaganda following the Department of Justice's (DOJ) letter issued on behalf of a request by the National Board of Physicians and Surgeons (NBPAS) in its effort to thwart the monopoly practices of the American Board of Medical Specialties (ABMS) and its 24 member boards. Despite that letter, the ongoing collusion between the member boards and the ABMS was particularly evident in the email circulated two days ago by the Executive Secretary of the American Board of Urology (ABU), Gerald H. Jordan, MD. The ABU's email attempts to spin the ABMS position as the same as what is stated in the DOJ letter by conflating initial lifetime ABMS Board Certification with the self-created separate time-limited Board certification market product (called Maintenance of Certification®):
The ABMS position that legislative interference which limits the use of physician certification is inappropriate is consistent with the position set forth in the DOJ letter. The ABMS and the ABU have always supported a fair and competitive marketplace for physician specialty certification and continue to do so, encouraging accurate comparison of our programs with other certification programs available.

ABMS agrees with the DOJ’s support of the right of patients and health systems to determine which certification programs best meet their expectations for providing information about high quality specialty care. The ABMS and ABU promote communications practices that allow the public to easily identify and compare the program standards used to certify that a physician has demonstrated, through training and assessment, that he or she in fact has demonstrated the knowledge, skill and judgment to practice in a medical specialty or subspecialty.
This continued deception of the ABMS and its member boards by conflating lifetime certification with time-limited "continuous" certification will not go unchallenged. I encourage all physicians adversely affect by their member boards complicit in this ruse to consider contributing to our ongoing legal challenge against the ABMS board certification monopoly.

-Wes

Sunday, September 16, 2018

Resident Recall - "Cheating" or Part of Free Speech?

Read the opinion piece referenced below carefully. It discusses the widespread use of "resident recall" to study for the American Board of Radiology's board certification examinations by both residents AND faculty/senior physicians:

https://pubs.rsna.org/doi/full/10.1148/radiol.12120251

Then read the back story on how the American Board of Medicine threatened internists in 2010 on the basis of the threat to their training monopoly:

http://drwes.blogspot.com/2016/06/maintenance-of-certification-medicines.html

Then ask yourself: who has "cheated" whom?

It is clear that the American Board of Medical Specialties, who continues to promote its lavish ABMS Conferences with "stakeholders" in Las Vegas (full schedule here), has a serious problem on its hands. This problem is exacerbated when it claims to work collectively with "500 professionals from across the health care community who, working together, will accelerate the transformation of Board Certification and the delivery of quality patient care."

Where's the data a computer test and secret data collection scheme does anything except raise prices and stroke the egos/bank accounts of the boards' leadership?

What do these Las Vegas boondoggles do to reestablish trust in the ABMS board certification process?

The answer is quite simple:

Nothing.

-Wes



Friday, September 14, 2018

When the Walls Start Crumbling Down

From the Department of Justice via the NBPAS website:
'The DOJ explained that the ABMS Program on MOC may have the effect of “harming competition and increasing the cost of healthcare services to customers.” ABMS may do so “by imposing overly burdensome conditions on physicians who wish to maintain their certification.” The DOJ added, with respect to ABMS, “[the] vast majority of [its] board members are medical doctors”—i.e., “active market participants”—who may have incentives to limit competition through “industry self-regulation.” As a result, the DOJ warned, “there would be competition concerns, if dominant certifying bodies [like ABMS] set de facto participation requirements that did not sufficiently correspond to health, safety, or other procompetitive justifications.”'
While this letter is very helpful to the National Board of Physicians and Surgeons (NBPAS) and detrimental to the efforts of the American Board of Medical Specialties and their subsidiary boards to monopolize the physician continuous credentialing system in states' legislation accross the country, it might not be entirely advantageous to employed physicians because of this paragraph on page 14:
"At the same time, the Division discourages the legislature from interfering with unilateral business decisions—such as an individual hospital’s decision about what criteria to use for granting hospital privileges or an individual insurance carrier’s decision about what criteria to use for allowing participation in the insurer’s network, as restricted in the Workgroup’s Bill—unless a restriction is determined to be necessary and narrowly tailored to redress well- founded consumer harms or risks. ... The Division encourages the Maryland legislature to consider whether other tools, such as facilitating entry by competitive certifying bodies, can address concerns with certification without imposing restrictions on the unilateral business decisions of hospitals and carriers."
Still, this letter represents a significant blow to ABMS in their efforts to prevent NBPAS's entry into the physician maintenance of certification (or "continuous certification") market as 30 states have some form of anti-MOC legislation either pending or passed.

-Wes

Friday, September 07, 2018

Thank You, Colleagues

I would be remiss if I did not thank my friends and colleagues nationwide who contributed to our GoFundMe page to initiate our pre-litigation investigation of the American Board of Internal Medicine and the ABIM Foundation. While I was upgrading a DDDR pacemaker to a biventricular ICD today, I received a text from a colleague that we had reached our funding goal for this initial phase.

I cannot express my gratitude enough. Thank you all.

It is very reaffirming to know that others feel as I do about Maintenance of Certification and what it has done to physician autonomy, morale, and even our right to work. I know that the dollars contributed could have been used for so many other things. I hope you will soon see that it your money was well spent.

But as Winston Churchill famously said:

"Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning."

Thanks again -

-Wes

Thursday, September 06, 2018

Video: 7007 US Physicians Weigh In on US Board Certification

From January through March 2018, a voluntary Internet-based survey of US physicians and surgeons was conducted by Practicing Physicians of America concerning ABMS Board Certification. 7007 completed surveys were available for analysis. Here is a brief video summary of many of the survey's findings as promised:



-Wes

Reference: pdf file of PPA Physician survey questions that formed the basis of this report.