Monday, April 21, 2014

Paid NEJM Subscriptions: There's No Such Thing As A Free Lunch

My hospital system, like many hospital and academic medical centers in America, provides an open-access journal subscription to the New England Journal of Medicine (NEJM) for it's doctors on their private intranet. While I do not know the price of this subscription (I'm sure it's substantial), in the past I have thought it was a nice gesture by our hospital staff to keep doctors current with the latest medical information from the medical journal with the highest impact factor.

Now, I'm not so sure.

New conflict of interests between the NEJM and my hospital have arisen that make me question the wisdom of this policy of free subscriptions provided to doctors, not only our institution, but all other medical centers that offer such an free subscriptions to their medical staff.  As they say, there's no such thing as a free lunch.

Especially when the lunch being served supports tying Maintenance of Certification to maintaining doctors'  hospital privileges.

On 7 April 2014, the New England Journal of Medicine launched their NEJM Knowledge+ website, a product of the NEJM Group, a division of the Massachusetts Medical Society, that breathlessly markets their own costly version of preparing for the ABIM's MOC process to their readership.  A tiny sliver of their exhaustive marketing even promotes the use of their product during the few remaining non-medical hours of a physician's day:
"Whenever you’ve got a moment to lean back and reflect, Internal Medicine Board Review is there with you — whether it’s in line at the supermarket, in the parking lot while waiting for your child’s soccer practice to let out, or during an unplanned minute between patients."

Never is there a mention what NOT passing the ABIM MOC testing means to doctors and their families.   Never is mentioned that since the advent of MOC re-certification, the financial reserves of the ABIM and ABIM Foundation have increased substantially; in 2006 and 2007, the ABIM transferred $13 million to its "foundation."  Never is there a mention that reserves of this magnitude demand accountability to physicians upon which their system has been foisted without any unbiased scientific evidence of its merits.  Never is there a mention of the cozy financial relationship that exists between Area9 Labs (the manufacturer of the NEJM Group's new Knowledge+ website), McGraw-Hill publishing, and the NEJM. Never is mentioned how Area9 distributes and markets the web-based physician learning data it collects on the Knowledge+ website.

Most of all, there is never a mention of the ABIM's unrelenting efforts to link their MOC process to doctors' hospital privileges and their ability to practice their trade - hence where my concern with the conflict of interest exists when hospitals and medical centers purchase the NEJM free of charge for their physicians. Hospitals don't need to buy into this manipulation of their staff.  Almost every medical group has mechanisms to acquire continuing medical education for their staff that are open and not restricted to the ABIM's costs and onorous re-certification process.  By purchasing paid subscriptions to the NEJM, are our hospitals supporting the ABIM's proprietary, self-mandated and scientifically unproven educational process that ties passing a test to the maintenance of hospital privileges?

It is very troubling that the NEJM Group has decided to ally with the ABIM in its MOC efforts.  The ABIM leadership continues to exist under a non-transparent and unethical conflict of interest policy.   The ramifications of the conflicts that existed with former and current members of the ABIM leadership are only now coming to light. This leaves the ABIM's professional credibility seriously in question with physicians.  Is the money that the NEJM Group receives from doctors of all levels of training on their Knowledge+ website worth the damage to their credibility as they ally with the ABIM?

It seems so.  After all, the NEJM seems more concerned about its educational subscription fees than the ethics and scientific integrity of the training process they're promoting.

Because of the clear and present danger that the promotion of the ABIM's MOC process presents to physicians' reputations and their ability to practice sound medicine, I recommend immediate termination of free paid subscriptions to the NEJM for physicians at our institution and others like it until the NEJM Group abandons its support of the ABIM's highly-flawed and manipulative MOC process.

After all, the conflict of interest problems inherent to this cozy institutional arrangement between the ABIM, NEJM Group, and the nation's hospitals far exceed anything that existed when pharmaceutical representatives supplied doctors with free pens.


Sunday, April 20, 2014

Smile Because She Happened

“Don’t cry because it’s over, smile because it happened.”

- Ted Geisel (Dr. Seuss)

It seems just yesterday she came to us, quiet, silky, trusting, needing just a finger to rest her head upon.  Unwavering trust.  Unconditional love.  There in the morning yearning to go with us.  There in the evening, excited to greet us at the end of our day.  She was there before the iPhone and stayed true to us after.  She was the only dog my kids have ever known.

Dogs are a wonderful addition to a young family.  Ours taught us the meaning of devotion.  She taught our young kids the meaning of love.  She knew what we were thinking before we said a word.  When sad, she'd offer her head upon our lap; when happy, she'd show her unbounded joy by quivering her adorable stunted tail at a rate that none of us could fathom.  She would defend us against cement lawn ornaments that startled her, and threaten cats and squirrels fearlessly, as if we shouldn't put up with their misbehavior.

Her black tender nose saved the day more than once.  Perhaps her greatest moment was the day the family hedgehog was lost in the back yard during a brief moment of inattention.  The anxiety and family search party, despite their best efforts could not find the little creature.  But there, wagging happily, was a little dog pointing at a spot in the ground cover.  Beneath her, a hedgehog.  And with that, tears of joy and another family crisis averted.

Her love of tennis balls, like life itself, evolved over the years.  At first she'd chase them darting across the lawn in a burst of enthusiasm.  Who knew such a simple toy could engender such joy?  Then, as the years went by and her cataracts took her sight from her, she'd find their scent buried deep amongst thick bushes or hostas, wagging victoriously as she spirited them back home like treasures to store in our living room.  Once there, she'd lie on the floor with the ball between her legs, then shove the ball forward with her nose as if to say, 'Come play!"  We roll it back between her legs, and she'd shove the ball back to us over and over again in a game of blind dog catch.

Slowly, gradually, her hearing left her too, but her trusty nose would allow her to find her way, tail wagging all along.  We'd come home, the head would raise, the tail would wag, and our presence would be acknowledged as she had so many times before - quietly, graciously, and with a tender heart.

Now we are gathered for Easter, seeing her breathing quicken, even at rest.  We have to lift her to her favorite spot on our couch on occasion.  She's not as hungry at mealtimes now.  We know our time with her is short, but our lessons from her will last a lifetime.

And we can be happy.  Really happy.

That she happened to our grateful family.

Happy Easter.


Friday, April 04, 2014

The Business of Testing Physicians

If you want to understand the world of professional board certification, it is important to understand the business and politics of testing professionals. Such testing is big business. So big in fact, that huge international media and education companies that trade on the New York Stock Exchange have been created to service this need. According to one article on Reuters from 2012, "the entire education sector, including college and mid-career training, represents nearly 9 percent of U.S. gross domestic product, more than the energy or technology sectors."

Part of the expense of "maintaining" one's professional board certification goes for fees for the testing center where the computerized testing occurs.  Because cardiac electrophysiologists must hold two board certificates (Cardiac EP and Cardiology), we must pay for two rounds of test-taking fees: the first is included with our cardiology maintenance of certification (MOC), then we must pay a second $750 testing fee for the second EP test.  (Each test contained 180 questions - $4.17 per question).  I am assuming almost all of this goes to the company that administered my test: Pearson VUE.

ABIM holds a contract with Pearson VUE, a professional testing subsidiary of Pearson Education, the North American subsidiary of Pearson, PLC (NYSE: PSO) - an 9 billion dollar British corporation that claims it is the largest commercial testing company and education publisher in the world. It boasts Penguin Random House publishing and the Financial Times Group as some of its other far-reaching subsidiaries. Mr. John Fallon is the 52 year-old Chief Executive Officer of Pearson, PLC and earns a cool $2.55 million dollars annually while holding 282,147 shares of Pearson stock and plently of stock options.  He is joined by Mr. William T. Ethridge, age 62, who serves as "advisor" currently, but was previously responsible for the North American Educational Division of Pearson.  According to one source, William Ethridge was once chief executive of Pearson's North American Education division in 2008. According to Forbes, his total compensation in 2011 was $1,390,000 and he held a half million shares of Pearson stock at that time.

Pearson VUE states it "is built on a foundation of experience in electronic testing."  My experience with Pearson VUE was parodied in an earlier blog post. As I reflect, it seemed that Peason VUE was more concerned about storing my biometric palm scans and a digital photograph as much as they wanted to assure a fair testing environment. While the ABIM discloses this process on their website, doctors unaccustomed to such paranoid security measures are caught off-guard by these tactics and should be concerned about how this information is stored and used. Are previously-certified doctors really this sketchy?

Pearson VUE earns a pretty penny from its professional testing and its physician testing in particular. According to Pearson's most recent SEC filing:
"Professional testing continued to see good revenue and profit with growth test volumes at Pearson VUE up 25% on 2012 to almost 12 million [pounds] ($19.9 million). Key contract renewals included tests for the American Board of Internal Medicine, the Association of Social Work Boards and the Pharmacy Technician Certification Board. "
But profitting from physician education is a politically hot topic, too. Not surprisingly, Pearson Education seems quite active in this space spending $2,100,000 to lobby Washington during the last presidential election cycle in 2011 and 2012, contributing 7:1 to the Democratic side of the political aisle. Also, 6 of the eight current Pearson lobbyists have previously held government jobs.

Doctors should understand how and where their money and personal information are being used in the ABIM's MOC testing process, since much of those funds seem to support the corporations and political aspirations of those who are doing the testing rather than the needs of patients that the ABIM is pretending to protect.


Thursday, April 03, 2014

Mandrola: A Time-Out for ABIM MOC Mandate

From (registration required), John Mandrola, MD calls for a "time-out" for the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) mandate:
The matter for debate is whether the ABIM method - and to be frank, it's arm-twisting tactics - is the best means to achieve physician quality.

Doctors are taught to be skeptical of evidence. Here, there is simply no evidence to judge. We can't know whether this brand of medical education achieves improved patient outcomes. Maybe it will. Maybe it will not. Or, perhaps it could make it even worse. How could aggressive education and measuring quality make things worse? Think heart-failure metrics and an 89 year old, who, a week later presents with a broken hip from all those evidence-based pills. I have many more examples, but I promised brevity.
Read the whole thing.

Some additional thoughts and suggestions to the ABIM:
  • Given the unproven nature of the MOC process to assure physician quality and the ethical breeches created by the ABIM's proprietary process, "board certification" as defined by the ABIM should revert to a lifelong certification to put the ABMS and its subsidiaries in competition with all the CME sources available.
  • The new ABIM MOC rules that are now set to go into effect 1 May 2014 can cause "sudden and unanticipated" revoking of Board Certification based on failure to completely comply with MOC at ANY TIME. This should not be permitted.
  • Since state medical boards are all headed by physicians, the marketing my the American Board of Medical Specialties and the ABIM that physician perform their MOC process to prevent government agencies from providing an alternative to their MOC process is pure propaganda. There are many many government and private agencies that monitor physician performance including hospitals, insurance companies, CMS, Medicare, Medicaid, trial lawyers, the Better Business Bureau to name a few.
  • The ABIM's "board certification" is based on test-taking ability and not patient care metrics. As such it cannot be considered a patient care quality measure of any kind and should not be tied to CMS Physician Quality Reporting System (PQRS) payments to those who care for Medicare patients.
I believe it would be in the best interest of the ABMS and ABIM to listen the the growing chorus of dissatisfaction that is currently echoing throughout the country. I know many physicians are already boycotting the process. Until the ABIM and ABMS change their policies this boycott will continue, especially since doctors know that the incomes of these societies are being directly paid by their physician fees.

Just sayin'-


Here's a link to an anti-MOC petition underway.

Monday, March 31, 2014

ACC14: The Quickening Pace of Change

I just returned from the American College of Cardiology and wanted to write down a few of my 50,000-foot impressions from the meeting for, as the song goes, the times, they are a-changin'.

First, while I don't know the overall attendance at the meeting, there really appeared to be fewer attendees.  Interestingly, the outside-the-US contingent seemed strong, but by comparison, the US presence at the meeting seemed much lighter (no facts to support this, just my impression).

The pharmaceutical and medical device displays seemed awkwardly overdone.  Gigantic displays, lots of sales people standing around, with really not much to do.  The amount of money these companies spend to attract doctors in an era when doctors really aren't the purchasers of this stuff anymore, seems crazy - like they haven't gotten the memo.  And for goodness sakes, pharma needs to understand how bad it looks when they're charging $6 a pill to our patients on novel oral anticoagulants and they've got these bulls**t displays.  Either tone it down, or cut your price… er, never mind: do both.

Surprisingly, I never saw a single model walking on a regular treadmill - a standard at every cardiology meeting I have ever attended.   What this means, I'm not sure.  Perhaps the ACC has matured to realize that women cardiologists are a growing force, or (more likely) the advertisers understand that no one cared about regular treadmills (they don't make any revenue) and are sick and tired of standing in from of them at work.

RFID tracking seemed larger than ever.  Little scanner doomajiggies were all over the place to track us wherever we went, that is, of course if we agreed to have one in our badge.  (I was happy to see that the ACC respected by wishes not to have the RFID in my badge, and none was there).  One thing that several doctors noticed (and I confirmed): they really didn't care if you had your badge on UNTIL you went to the expo floor, showing what really matters, I guess.

I had the great pleasure of meeting and chatting with a few fellows from across the country and around the world: New York, Massachusetts, North Carolina, California, China, China, and China.  These younger folks were cool, but clearly lamenting that it might not be one they participate in much longer.  For the most part, most of them were there on much of their own nickel.  I quickly polled them to inquire about the annual stipend they receive from their institutions for these things, and the numbers I heard were quite low: from $1500 to $2500.  Between cuts to doctors' income and low expense stipends, it is no wonder more and more physicians are staying away - kind of sad for doctors, sure, but really sad for these bright, eager residents and fellows.  One is starting to wonder how many more years such expensive sessions will continue.

The other big thing that I noticed at this meeting: not much was scientifically new.  It was striking. Think about it: the big trials were a trial on TAVR, a few talks on Mitra-clip, renal denervation, cardiac resynchronization, and pericarditis.  Maybe the PCSK9 inhibitors that drop LDL substantially in folks with familial hypercholesterolemia were novel, but that one's not really my bag…  It just seems that the  of innovation in US medicine has taken a pause.  Even in the posters: meta-analyses of old big trials seemed to outnumber and new big trials.  It's different now.  The cuts are real.

Finally, there was an important first at the meeting.  I was impressed that the topic of social media in medicine was given it's own real, live session with it's own central room at #ACC14.  I was even more amazed they invited me.  After all, I haven't exactly ingratiated myself with the College lately.  To their credit, however, they are giving folks like you and me a place to learn about and a platform to promote what I believe to be an important tool for physicians in the years ahead.  For that, I am truly grateful.   We are, after all, are all professionals all doing this crazy work of medicine together.  We may not agree at times, but I think we all want to improve the system for our patients' sake, and social media is a very powerful way to affect change, act collectively, vet ideas, and improve our health care system for the better.  Industry, too, is learning from doctors and patients as they use social media to critique, explain, and promote ideas and tools for better patient care.  Sure there will be bumps.  Sure there will be disagreements.   And change may not come right away.  But more more often than not, with enough collective voices reaching some compromise, there will be effective change for the better.  Seriously, where else can we get value like that?

So to the ACC leadership and all the great people I had the chance to meet, discuss, learn from, share ideas with, thank you.  It was a blast.


Sunday, March 30, 2014

Is Maintenance of Certification Our Next Tuskegee?

“An experiment is ethical or not at its inception, it does not become ethical post hoc – ends do not justify means. There is no ethical distinction between ends and means.”
-- Henry K. Beecher, MD
 New Engl J Med 274(24) June 16, 1966 pp 1354-1360.

“For the most part, doctors and civil servants simply did their jobs. Some merely followed orders, others worked for the glory of science."
-- John Heller, Director of the Public Health Service's Division of Venereal Diseases

The Tuskegee syphilis experiment was an infamous clinical study conducted between 1932 and 1972 by the U.S. Public Health Service to study the natural progression of untreated syphilis in rural African American men who thought they were receiving free health care from the U.S. government. The Public Health Service started working with the Tuskegee Institute in 1932. Investigators enrolled in the study a total of 600 impoverished sharecroppers from Macon County Alabama. Three-hundred ninety-nine (399) of those men had previously contracted syphilis before the study began, and 201 did not have the disease. The men were given free medical care, meals, and free burial insurance, for participating in the study. They were never told they had syphilis, nor were they ever treated for it. According to the Centers for Disease Control, the men were told they were being treated for "bad blood", a local term for various illnesses that include syphilis, anemia, and fatigue.

The 40-year study was controversial for reasons related ethical standards, primarily because researchers knowingly failed to treat patients appropriately after the 1940s validation of penicillin as an effective cure for the disease they were studying. Revelation of study failures by a whistleblower led to major changes in U.S. law and regulation on the protection of participants in clinical studies. Now studies require informed consent, communication of diagnosis, and accurate reporting of test results.

The Tuskegee Syphilis Study led to the 1979 Belmont Report and the establishment of the Office for Human Research Protections (OHRP). Importantly, it also led to federal laws and regulations requiring Institutional Review Boards for the protection of human subjects in studies involving human subjects.

Fast forward thirty-five years.

Could the new American Board of Internal Medicine (ABIM) mandate for participating in their Maintenance of Certification (MOC) process unilaterally imposed 1 January 2014 so they can maintain a publicly-reported maintenance of certification "status" be violating ethical standards set forth by the 1979 Belmont Report?

Let me explain why I think it does.

The increasingly complicated test- and survey-taking exercise called "Maintenance of Certification" has never been scientifically proven to improve physician quality.   Our society's inability to agree on a definition of a "quality" physician (and how to measure those qualities) is part of the reason why this issue has never been studied.   For instance, should we define a "quality" physician on the basis of his or her empathy, surgical skill, lack of complications, ability to recall facts or some combination of these or other attributes? The reality is, it is nearly impossible to adequately define a "quality" physician at the outset.

But the issue of maintaining "quality" health care delivery is critical to those paying for health care services (CMS and insurers, aka, "stakeholders"), especially now in this era of health care reform.  Payers want to assure they receive the most value for their dollars spent in health care.  Patients want to be reassured that they are receiving competent care by a physician, especially in a time where cost-cutting, deployment of unproven electronic medical systems, use of non-physician care-givers, and shortened physician training and work hours has occurred.  Seeing an opportunity, the American Board of Medical Specialties (ABMS) and the ABIM stepped in to help the government define physician quality.  Through the assurances of their leadership,  the ABIM led "stakeholders" to believe that (1) quality is easy to measure (after all, they have a thorough testing "process") and (2) the responsibility for determining physician quality should rest with individual physicians. This leap of faith by government officials is similar to the Tuskegee era when government physicians were similarly obsessed with African American sexuality, believing that the responsibility for the acquisition of syphilis rested solely upon the individual.

Because the Maintenance of Certification process imposed by the American Board of Internal Medicine is unproven, it is, at best, an experiment that attempts to assure physician quality on patients without a defined hypothesis (what, really, does the ABIM test with the MOC process?) or informed consent.  The issue of informed consent is critical, in my view, because the psychological, financial, and social consequences of NOT passing the test to doctors and their patients have never been evaluated.

The "MOC Complex" at ACC2014 (click to enlarge)
Yesterday, I attended the session entitled "Changes to ABIM's Maintenance of Certification (MOC) Process" at the American College of Cardiology Scientific Sessions in Washington, DC.  Drs. Richard Baron, MD, President and CEO of the American Board of Internal Medicine (ABIM) and the ABIM Foundation, William Little, MD (who also receives considerable compensation from the ABIM) and Henry Ting, MD  were speakers.  I learned several important things at that session about the 2013 MOC examination results.

First, I learned that the pass rate this year (2013) for internal medicine specialists was 86%, and for cardiac electrophysiologists was 84%.  This means that fourteen percent of internists and sixteen percent of cardiac elecrophysiologists did not pass their test.  (We were assured that 97% "ultimately" pass, however, but no data were supplied to the audience to this effect).

The second thing I learned directly from Dr. Baron yesterday during the question and answer period was this: the ABIM has never studied the psychological, social, or financial impact that NOT passing the MOC process upon physician test-takers.   This is not a small issue, especially if one considers that many hospitals are beginning to tie the ongoing Maintenance of Certification process to the issuance of hospital privileges to practice medicine.  How could anyone trained in the ethics of scientific study and research permit such an egregious oversight to the protection of physicians?

From the 1979 Belmont Report:
The expression "basic ethical principles" refers to those general judgments that serve as a basic justification for the many particular ethical prescriptions and evaluations of human actions. Three basic principles, among those generally accepted in our cultural tradition, are particularly relevant to the ethics of research involving human subjects: the principles of respect of persons, beneficence and justice.
Let's examine each of these principles described in the Belmont Report in regards to MOC testing.

Regarding respect for persons:
Respect for persons incorporates at least two ethical convictions: first, that individuals should be treated as autonomous agents, and second, that persons with diminished autonomy are entitled to protection.
Today, physicians are "persons with diminished authority" in the certification and licensure discussion. The decision to invoke every-two-year testing was imposed by leadership of several physician organizations whose leadership have had strong ties to government agencies (including the Center for Medicare and Medicaid Services, a la Dr. Baron) without the approval of their membership. Further, the MOC process is already being used by some hospitals as a lever to dispense hospital privileges without proof  that the MOC process assures physician quality, however might have been defined.

Regarding beneficence:
Persons are treated in an ethical manner not only by respecting their decisions and protecting them from harm, but also by making efforts to secure their well-being. Such treatment falls under the principle of beneficence. The term "beneficence" is often understood to cover acts of kindness or charity that go beyond strict obligation. In this document, beneficence is understood in a stronger sense, as an obligation. Two general rules have been formulated as complementary expressions of beneficent actions in this sense: (1) do not harm and (2) maximize possible benefits and minimize possible harms.
Given the fact that the negative consequences of failing to re-certify in medicine are very real for doctors, failing to pass the ABIM's tests may, in fact, harm them.  No attempt to minimize harm to physicians has occurred.  No attempt has been made to warn physicians about the negative consequences of what might happen to them if they fail to maintain their certification in good "status."  Worse still: not allowing physicians to practice medicine may actually harm, rather than benefit, the doctor's patients!  The ABMS and ABIM have clearly turned a blind eye to this possibility.

Finally, in regards to the last critical element of the Belmont Report, justice:
Who ought to receive the benefits of research and bear its burdens? This is a question of justice, in the sense of "fairness in distribution" or "what is deserved." An injustice occurs when some benefit to which a person is entitled is denied without good reason or when some burden is imposed unduly. Another way of conceiving the principle of justice is that equals ought to be treated equally. However, this statement requires explication. Who is equal and who is unequal? What considerations justify departure from equal distribution? Almost all commentators allow that distinctions based on experience, age, deprivation, competence, merit and position do sometimes constitute criteria justifying differential treatment for certain purposes. It is necessary, then, to explain in what respects people should be treated equally. There are several widely accepted formulations of just ways to distribute burdens and benefits. Each formulation mentions some relevant property on the basis of which burdens and benefits should be distributed. These formulations are (1) to each person an equal share, (2) to each person according to individual need, (3) to each person according to individual effort, (4) to each person according to societal contribution, and (5) to each person according to merit.

Questions of justice have long been associated with social practices such as punishment, taxation and political representation. Until recently these questions have not generally been associated with scientific research. However, they are foreshadowed even in the earliest reflections on the ethics of research involving human subjects. For example, during the 19th and early 20th centuries the burdens of serving as research subjects fell largely upon poor ward patients, while the benefits of improved medical care flowed primarily to private patients. Subsequently, the exploitation of unwilling prisoners as research subjects in Nazi concentration camps was condemned as a particularly flagrant injustice. In this country, in the 1940's, the Tuskegee syphilis study used disadvantaged, rural black men to study the untreated course of a disease that is by no means confined to that population. These subjects were deprived of demonstrably effective treatment in order not to interrupt the project, long after such treatment became generally available.
So who is served by the Maintenance of Certification process, really?  Are patients?  Doctors?  Or the leadership of ABIM?

There are significant financial incentives driving the marketing of the ABIM's ongoing MOC process to America's physicians.  From the ABIM's own 2012 Form 990 that I could retrieve, the ABIM earned $30,661,314 from their members for examination fees, $17,509,141 for Maintenance of Certification, and an additional $970,415 for exam development, supplying duplicate certificates, and re-scores of the examination.  Of the total revenues reported by the ABIM in 2011 ($49,304,645) fully 48.6% ($23,937,881) went to staff salaries, other compensation, and employee benefits.  Christine Cassels, MD alone (who served as President and CEO at the time), earned $786,751 that year and had her spouse's travel fees to meetings thrown in, too.  It goes without saying that the leadership of these organizations have received salaries far higher than most of their physician members.  Justice (as defined by the Belmont Report) can hardly be served when scales are tipped so heavily toward those of our own profession that stand to benefit so handsomely from this certification process.

It is time that doctors and patients understand exactly what has transpired with the foisting of the ongoing MOC process upon America's physicians.   Just as the Tuskegee experiments in Macon County Alabama did years ago, well-meaning members of our profession have represented physician "quality" by their own standards that include the ability to perform a serious of test- and survey-taking exercises without responsibly admitting the harms this process might have on their colleagues and their patients.  Like the serious breaches of ethical standards that occurred when doctors worked "for the glory of science" in the Tuskegee era, this unfortunate unproven experiment of MOC re-certification by the ABIM continues unabated without checks and balances.

It is time for this injustice against physicians to stop.  Responsible physicians and their patients everywhere need to rise up and demand accountability by the ABIM for their ethical breaches that have occurred.  The heavy marketing of the benefit of this process without acknowledging its potential harms is dangerous to both doctors and patients.  Further, it is not okay to entrap physicians by making them pay for an unproven process that could destroy their social status and ability to earn a living.

To believe otherwise is about as unethical as it gets.


P.S.: Here's a link to an anti-MOC petition underway.

Friday, March 28, 2014

Social Media at Scientific Sessions

More and more physicians are entering the social media space - so much so that even our more classic academic physician colleagues are joining in.  But there can be challenges that arise at scientific sessions when the old way of professional discourse meets the new way of social media.

Robert A Harrington, MD (Chair, Dept of Medicine, Stanford University, CA) and Clyde W. Yancy, MD, MSc (Northwestern Medical Center, IL) discuss these challenges nicely at and offer some interesting insights and tips for doctors, both young and old, as they consider entering the social media space.


P.S.: Then again, if you're still unsure how Twitter even works, consider this Twitter primer.

Why Do Most Medical Professional Societies Call Chicago Home?

Professional medical societies "concerned" about physician education, advocacy and quality appear to have multiplied at an alarming rate over the years. Interestingly, it seems many of the professional offices of these societies are based in Chicago.  On my review, no other city in the United States hosts more of them (not even Philadelphia).

Why is this?

First, there is the grand-daddy of all physician professional societies: the American Medial Association based at AMA Plaza, 330 N Wacker Drive, Chicago. 

Next, there's the American Board of Medial Specialties (ABMS) (who boasts its supervisory role over 24 subsidiary specialty medical societies across the nation, including the American Board of Internal Medicine and the American College of Cardiology among others) that has it's home at 222 North LaSalle Street in Chicago, just blocks away from the AMA building.  

Next, there's the little-known Council on Medical Specialty Societies,  who also seemed to be concerned with physician "quality" located just across the Chicago river at 35 E. Wacker Drive.

And let's not forget the Acceditation Council on Graduate Medical Education who oversees all graduate medical education in the United States located at 515 North State Street in Chicago.

Makes you wonder why all of these societies are within blocks of each another in Chicago. 

Maybe it's so they can have lunch together.  Maybe it's because of all of the academic medical centers located here in Chicago who have retiring professors that need a place to land.  Maybe it's because of the state's political leanings.  Or perhaps it's just because of Chicago's fairly central US geographic location? 

One thing's for sure, it certainly isn't because of low real estate prices or low taxes.