Wednesday, June 11, 2014

Damage Control

When you shine light on cockroaches, they scatter.

But we should not think for a minute that the cockroaches are eradicated.

That takes an exterminator.  And sadly, there are very few exterminators who deal in the shady cracks and crevices of the multi-billion dollar non-profit organizational world these people have created for themselves.  There are very few ways to hold individuals who hide behind this altruistic-sounding corporate facades that have been erected by the American Medical Association/American Board of Medical Specialty mothership and their flotilla of member organizations accountable.

But we should acknowledge the tremendous efforts put forth by these "key stakeholders:"
Internationally regarded leaders in medical education discussed data on the value of knowledge examinations. Members of multiple ABMS member boards presented proposed and in-place innovations that will impact these examinations. These innovations included use of evaluations taken at home, short segment continuous evaluation strategies and multiple strategies that provide important formative feedback to physicians as they mature in their careers while also providing the necessary summative data to meet their professional requirements of monitoring and ensuring the public good. 
Note how there are no attempts to rid doctors of this menace. And the conversations must have been remarkably short, since there are few objective data to support their tactics.  Instead, we see self-aggrandizing platitudes like "internationally regarded leaders."  We see fervent efforts being made to rearrange the deck chairs on the Titanic.   Bullying doctors and making them less available for patient care is not insuring the public good.  Making my profession more untenable is not for the public good.  Suggesting that organizational sycophants (payees) are the only ones who are concerned about physician quality and physician education is hubris and surely not ensuring the public good.

A real general does not turn around and open fire on his groups.

What these "stakeholders" don't realize is that US physicians are already doing their overwrought busywork at home.  Doctors are already performing "short-segment continuous evaluation strategies" called knowledge assessment "modules" and "practice improvement modules" that take months to complete on top of an already overwhelming clinical load.  And because eyes must remain on a computer screen as a means of providing  "important formative feedback," we see the hopium for effective clinical teaching perpetuated.   We also see how deeply these individuals have permeated the halls of Congress as the Physician Quality Reporting System incentive payments with CMS are still tied to this unproven and potentially destructive program to physician retention and morale.

It is one thing to sit inside a self-proclaimed ivory tower and preach.

It is another thing entirely to lead.


1 comment:

Paul Kempen said...

Agree with WES! However, the backers of MOC include not only ABMS and its cronies, but the insurance companies and government as well, who will use this to control/cull physicians and by that token limit the CMS budget as the baby boomers retire, who KNOW BETTER.
I am a boomer and close enough to retirement that I can bail on my medical practice and survive, if necessary. But I would like to continue to practice for the foreseeable future. However, if the court in Chicago (where the AAPS suit was transferred to that venue from NJ) supports ABIM/ABMS case, my plan will be to find a job where board certification is not required and/or insure my bylaws stipulate no recertification requirements. No way I plan to knuckle under and do the ABIM EXTORTION MOC-kery. .
Illegitimi non carborundum.
It is time for all state medical societies to issue Amicus Brief Support to the AAPS lawsuit. This is an inexpensive and tactful way to support the right path!