Friday, January 30, 2015

Is the ABIM Hiding Something?

Mr. Charles Kroll, a health care non-for-profit accountant, notes a troubling discrepancy this morning in the 2014 consolidated financial statement recently released by the American Board of Internal Medicine (ABIM) and it's Foundation:

The American Board of Internal Medicine (ABIM) recently posted the Consolidated (i.e. including ABIM Foundation) Financial Report for the Year Ending June 30, 2014 (and June 30, 2013) to it’s Revenue and Expenses: Where Does the Money Go? page.

The Financial Report’s Contents page lists 3 Financial Statements and 12 pages of Notes to Consolidated Financial Statements.

The Consolidated Financial Report for the Year Ending June 30, 2013 (and June 30, 2012) filed with the State of Pennsylvania on April 7, 2014 Contents page lists 3 Financial Statements, 12 pages of Notes to Consolidated Financial Statements, and 6 Supplementary Information reports spanning 8 pages.

The 6 Supplementary Information reports listed are as follows: Consolidating Statements of Financial Position (2 pages), Consolidating Statement of Activities (2 pages), Schedule of ABIM Changes in Unrestricted Net Assets (Deficit) from Operations, Consolidating Schedule of Administrative, Program and Project Expenses, Consolidating Schedule of Staff Expenses and Consolidating Schedule of Office Expenses.
So questions must be posed about the ABIM's disclosure policy on their "Where Does the Money Go?" webpage:

Ahem, where, exactly, did the money do? Why aren't supplemental information reports included in the 2014 financial statement? Might the ABIM "not be meeting MOC requirements" for public disclosures themselves?


Monday, January 26, 2015

Questioning the ABIM Leadership Compensation

Compensation amounts for the past President and CEO of the American Board of Internal Medicine (ABIM) were reviewed over the last 10 years of available tax documents.  I have outlined them below.  We should recall that US physicians fund 97% of the ABIM's revenue.

Fiscal Year Compensation Comments
2004 $580,377 Includes $50,000 performance bonus awarded to Dr. Cassel by Compensation Committee of the Board of Directors of ABIM
2005 $593,014
2006 $653,922
2007 $646,510 35 hrs/wk. $2.3 million condo purchased by ABIM Foundation.
2008 $627,472 35 hrs/wk. Spousal travel fees also paid (not itemized).
2009 $865,451 35 hrs/wk. Spousal travel fees also paid (not itemized).
2010 $862,191 35 hrs/wk. Spousal travel fees also paid (not itemized).
2011 $794,852 35 hrs/wk. Spousal travel fees also paid (not itemized).
2012 $786,751 35 hrs/wk. Spousal travel fees also paid (not itemized). Also received $203,500 from Kaiser Health Plans and Hospitals
2013 $838,603 35 hrs/wk. Spousal travel fees also paid (not itemized). Additional compensation earned: $235,000 from Premier, Inc.

Total haul by one physician officer: $7,249,143 over 10 years (or $724,914/yr). This amount does not include the additional consulting fees outlined above.  (Not too bad for a desk job that doesn't involve patient care.)

Which leads practicing US physicians to wonder how much compensation did the current ABIM President and CEO earned in fiscal year 2014. Might it have exceeded $1 million? (We should note the most recent audited financial statement available to date disclosed a $568,000 salary with $131,000 in deferred compensation for a "new key employee" hired effective 7 June 2013, but does not specify the additional compensation this "new employee" will recieve from the ABIM's own Foundation.)

The fiscal year 2014 ABIM Form 990 will be available soon enough.  If the ABIM leadership salaries are indeed this high going forward, there should be little doubt why physicians must now pay the ABIM every two years to "maintain" their board certification status. 

It seems that the salaries of the ABIM leadership demand it.


Addendum: To all concerned physicians: consider signing my petition to stop the marketing of the ABMS/ABIM Maintenenace of Certification program, one professional society at a time.

Wednesday, January 21, 2015

Katz: In Defense of the Annual Physical

David L, Katz, MD, Director of the Yale University Prevention Research Center and President, American College of Lifestyle Medicine, makes aa case in defense of the annual physical examination, once a cornerstone of American medicine.
I would argue, then, that glib dismissal is misguided. Rather, the safest and most promising option in the absence of answers to all relevant questions, is to optimize the annual exam, not discard it. There is no need for a battery of perfunctory procedures or ridiculously low-yield lab tests. But these could be replaced with a review of lifestyle practices and use of relevant preventive services; with time for pertinent, customized lifestyle counseling; and with attention to whatever happens to be on a patient’s mind, building that very thing to which modern, evidence-based medicine may pay all too little attention: a relationship. A fundamental human connection.
Read the whole thing.


Tuesday, January 20, 2015

"Science" Takes ACLS Backwards

Food and Drug Administration (FDA) regulations have become the new pathway to riches for the pharmaceutical industry.

First, there was generic colchicine, used for years and years to treat gout for  pennies a pill.  The only problem was, there wasn't an FDA trial proving colchicine's efficacy in the treatment of gout.  Takeda Pharmaceutical, seeing the opening, performed a trial and rebranded the formerly generic colchicine to Colcrys®, "the only authorized generic indicated to prevent and treat gout attacks."  And how much does Colcrys® cost?  Just $203 for thirty tablets at Costco.

But that's not all.

Today I learned that generic vasopressin (which can be stored at room temperature in stable form on crash carts), must be switched to the FDA-approved brand called Vasostrict® that requires dilution and refrigeration.  It seems the generic form of vasopressin will no longer be available to be kept on crash carts since it's not "FDA-approved" for the indication of "increasing blood pressure in adults with vasodilatory shock (post-cardiotomy or sepsis) who remain hypotensive despite fluids and catecholamines." Vasostrict®, on the other hand, is "now the first and only vasopressin injection, USP, product with an NDA approved by the FDA." The catch is, it must diluted before use and discarded after 18 hrs (or after 24 hrs if refrigerated). This little regulatory quirk is a big deal for America's hospitals looking to save costs.

But hey, why should we worry about costs in health care?  After all, you can never be too safe.


Monday, January 19, 2015

The Cancer of Our Profession

  229. Unity and friendship in the medical society is important.

The first, and in some respects the most important, function is that mentioned by the wise founders of your parent society - to lay a foundation for that unity and friendship which is essential to the dignity and usefulness of the profession. Unity and friendship! How we all long for them, but how difficult to attain! Strife seems to be the very life of the practitioner, whose warfare is incessant against disease and against ignorance and prejudice, and, sad to have to admit, he too often lets his angry passions rise against his professional brother. The quarrels of doctors make a pretty chapter in the history of medicine.

Sir William Osler
On the Educational Value of the Medical Society, In Aequanimitas, 335-6.
Never has the divide between the practicing work-a-day physician and the non-practicing ivory tower elite physician been greater. It is the cancer of our profession: quick to spread, difficult to contain.

But this should not surprise us. It is a recurrent theme in history, just as Osler was quick to remind us. But the ideal that Osler advocated for has disintegrated under political, financial and partisan agendas that covertly operate without transparency.

If nothing else, social media is helping expose this divide and its corrosive effects on our profession.


Friday, January 16, 2015

Grass Roots: It's Time To Take Action on MOC

As many long-term readers of this blog are aware, because of concerns over its coercive nature, I have been investigating the American Board of Medical Specialties (ABMS) Maintenance of Certification (MOC) program implemented in large part by the American Board of Internal Medicine (ABIM) since studying for my third round of re-certification.  As part of that investigation, I have uncovered what appears to be a carefully crafted propaganda campaign using poor scientific methods, non-practicing authors from think-tanks, the veterinary profession, and the ABMS/ABIM hierarchy to serve as "evidence" of the program's legitimacy, as well as much more troubling financial dealings of the ABIM and the ABIM Foundation.

I brought these concerns to the leadership at the Heart Rhythm Society via an email left on their website on 2 January 2015 that included a link to my investigation of the ABIM's tax records.  The Heart Rhythm Society's office as closed at that time (they returned 5 January 2015), but I never received a response to that email initially.  So I called the Heart Rhythm Society on the 14th of January and asked to speak with Mr. James Youngblood, their President and CEO, about my concerns regarding the ABIM. I seems he was unavailable at the time but I was assured they had found the email and that I would receive a response  "in 24-48 hours." Yesterday I received the email and this is what he said:

"Sorry for the delay in responding to your email request. We appreciate the information you shared and your opinion in this matter.  Regarding your follow-up voice message inquiring about what the HRS offers in support of ABIM-MOC, HRS provides the opportunity for members to earn up to 42 MOC medical knowledge points on a complementary basis. (Opportunity for MOC points expires 10/15/15)

We have extensive additional information provided at

We have provided ongoing feedback to the ABIM around our concerns with their approach to the MOC program. We will continue that dialogue.

With regard to an financial concerns with ABIM, we will continue to monitor the situation closely and inform our members should any action be required.

Thanks, J

James H. Youngblood
Chief Executive Officer
Heart Rhythm Society
1325 G St. NW, Suite 400
Washington, DC 20005
(Phone numbers redacted)
It seems the very public outcry by practicing physicians over the entire ABMS/ABIM-MOC program is being met with little action despite the evidence of its corrosive effects on our profession of medicine. Therefore, I have decided to begin a grass roots effort to ask my own professional medical society, the Heart Rhythm Society, to immediately cease their promotion and marketing of the ABMS/ABIM MOC program and instead to turn their considerable resources to removing the corrupt ABMS MOC program from the Affordable Care Act. To that end, I am now circulating a petition for Heart Rhythm Society members (and other interested practicing physicians) to sign to send a clear message to our society's leadership that we need more than words, we need action, to stop the use of this unproven and unethical MOC program that has been foisted without evidence of its effectiveness for improving patient care upon practicing US physicians. Anything less is unacceptable, given what we now know about the program.

I would ask that Heart Rhythm Society members who agree with this petition to sign it and designate their membership status with the Heart Rhythm Society in the "Notes" section and then send it on to your colleagues. 

It is time we send a strong message to our professional organizations that we demand more than words in response to our deep concerns with the ABMS/ABIM MOC program.

Thank you -