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."
Seriously?

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.

-Wes

7 comments:

  1. I'm hoping they'll offer an MOC Rewards MasterCard . :)

    ReplyDelete
  2. Dr Wes Paid NEJMed subscriptions…No …Free Lunch. April 23, 2014.
    Yes, “educational testing” involves many billion dollar test industries which have moved further and further from wisdom, common sense, and truth in many situations. They’re hurting diverse population groups ranging from art students in elementary schools to neurosurgeons in the operating room. What do the public schools, the US Dept of Education, and the American Board of Internal Medicine, ABIM, have in common? They thrive on expensive and eternal testing protocols with no evidence for long term improvements in educational outcomes or community performance.
    As you say, the Area9 company, developers of adaptive technology and “reimaging learning”, was bought by McGraw Hill Education for a cool $1 billion dollars or so, in Euro currency, between January 2013 and February 6, 2014. I welcome the new technology but at what cost? Mass Med Society and NEJM Knowledge+ from the NEJM Group arranged the technology allegedly with the independent arm of Area9 company before closure of the McGraw Hill purchase. This NEJM Knowledge + Internal Medicine Board Review interactive package which Dr Wes challenges was designed and financed by NEJM Group and then NEJM negotiated ABIM acceptance of the new program. As we know, ABIM markets their testing industry monopoly carefully with Green Monster fee schedules. What are the NEJM Knowledge + charges? For about $600 per doctor for the first year, $150 per year annually afterwards, this NEJM program is being marketed only for ABIM Board preparations, not for Family Practice Board preparation. Evidently, the American Board of Family Medicine still retains their own testing monopoly (hopefully at less cost). Doctor fees for the new NEJM Knowledge+ adaptive learning technology questions provide revenue only for MMSociety and the NEJM Group. This is just one among many products marketed and sold for continuing medical education.
    Yes, I am disappointed that the NEJM Group used the ABIM MOC approval as a carrot option in order to justify high fees. Good CME used to be given free or for nominal fees for journal subscribers. At least it would be better if the NEJM Group would give their readers this educational tool at lower prices. I welcome the new technology but not the fees.
    Knowing the commercial and product bias associated with recent MOC materials, I hope that the NEJM Group can produce educational contents of greater clinical relevance, medical sophistication, and medical objectivity than those produced by today’s ABIM MOC program managers. And NEJM Group should work with other physician groups and societies outside of ABIM here and abroad to break if not abolish the ABMS recert (MOC, make others cash “Green Monster”) testing monopoly. This Green Monster ends the hospital and university careers of many fine, conscientious mid career physicians and surgeons in the USA each year. Just as we want our CME to be free of high revenue commercial and product device kickbacks or other undue influence, I hope that the NEJM Group might succeed with new CME packages in the future independent of influence from the powerful, high revenue ABIM MOC testing industry.

    ReplyDelete
  3. Dr Wes Paid NEJMed subscriptions…No …Free Lunch. April 23, 2014.
    Yes, “educational testing” involves many billion dollar test industries which have moved further and further from wisdom, common sense, and truth in many situations. They’re hurting diverse population groups ranging from art students in elementary schools to neurosurgeons in the operating room. What do the public schools, the US Dept of Education, and the American Board of Internal Medicine, ABIM, have in common? They thrive on expensive and eternal testing protocols with no evidence for long term improvements in educational outcomes or community performance.
    As you say, the Area9 company, developers of adaptive technology and “reimaging learning”, was bought by McGraw Hill Education for a cool $1 billion dollars or so, in Euro currency, between January 2013 and February 6, 2014. I welcome the new technology but at what cost? Mass Med Society and NEJM Knowledge+ from the NEJM Group arranged the technology allegedly with the independent arm of Area9 company before closure of the McGraw Hill purchase. This NEJM Knowledge + Internal Medicine Board Review interactive package which Dr Wes challenges was designed and financed by NEJM Group and then NEJM negotiated ABIM acceptance of the new program. As we know, ABIM markets their testing industry monopoly carefully with Green Monster fee schedules. What are the NEJM Knowledge + charges? For about $600 per doctor for the first year, $150 per year annually afterwards, this NEJM program is being marketed only for ABIM Board preparations, not for Family Practice Board preparation. Evidently, the American Board of Family Medicine still retains their own testing monopoly (hopefully at less cost). Doctor fees for the new NEJM Knowledge+ adaptive learning technology questions provide revenue only for MMSociety and the NEJM Group. This is just one among many products marketed and sold for continuing medical education. Yes, I am disappointed that the NEJM Group used the ABIM MOC approval as a carrot option in order to justify high fees. Good CME used to be given free or for nominal fees for journal subscribers. At least it would be better if the NEJM Group would give their readers this educational tool at lower prices. I welcome the new technology but not the fees.
    Knowing the commercial and product bias associated with recent MOC materials, I hope that the NEJM Group can produce educational contents of greater clinical relevance, medical sophistication, and medical objectivity than those produced by today’s ABIM MOC program managers. And NEJM Group should work with other physician groups and societies outside of ABIM here and abroad to break if not abolish the ABMS recert (MOC, make others cash “Green Monster”) testing monopoly. This Green Monster ends the hospital and university careers of many fine, conscientious mid career physicians and surgeons in the USA each year. Just as we want our CME to be free of high revenue commercial and product device kickbacks or other undue influence, I hope that the NEJM Group might succeed with new CME packages in the future independent of influence from the powerful, high revenue ABIM MOC testing industry.

    ReplyDelete
  4. Do you have any suggestions for how to track the money for the ABPN (psychiatrists) and our increasingly onerous MOC? Thank you!

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  5. do you have any idea how to connect the $ for ABPN, which limits most of its MOC to APA/AACAP materials? Thank you,

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  6. Psychiatry had an MOC... but we're supposed to know better...

    http://internationalpsychoanalysis.net/2014/01/13/the-maintenance-of-certification-exam-as-fetish/

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  7. Dear Dr Wes
    Thank you for deleting the
    ABIM corporation logo off your wonderful blog. {you do not need
    the "board certified" in your first sentence either}

    BTW ABIM is creating a NEW postion looking for a senior VP. If you search ABIM and choose past 24 hrs under search tool, you will see the add. I do not want to post the link to avoid advertising for them.
    Baron's answer is NOT acceptable. He wrote many doctors signed up. The truth is that many doctors were forced to sign up.

    ReplyDelete