ABIM Placates Physician Anti-MOC Sentiment with "Commitments"

From the 5 Aug 2014 issue of the Journal of the American College of Cardiology (JACC):

"Note: There is evidence that the ABIM has heard the concerns of its diplomats and is acting responsively. In a July 10, 2014 letter to the internal medicine community, and in a face-to-face meeting in Philadelphia on July 15, 2014, which was attended by 26 internal medicine subspecialty societies including the ACC, the ABIM committed to:

• •Provide a 1-year grace period for those who have attempted but failed to pass the secure examination.
• •Update its governance and financial information on its website.
• •Ensure a broader range of CME options for medical knowledge and skills self-assessment (Part II).
• •Provide more feedback regarding test scores.
• •Evolve the “patient survey” requirement to a “patient voice” requirement and increase the number of ways this requirement can be met.
• •Reduce the data collection requirement for the practice assessment requirement; utilizing performance improvement activities already in place and minimizing the time and complexity of data input.
• •Investigate changes in the secure examination to increase relevance with specific attention to exploring applications for practice focus areas (“modular examinations”) and open-book examinations.

For its part, the ACC has recently:

• •Released a special video that catalogs the suite of ACC resources available to help members meet the MOC Part IV requirements.
• •Determined that free-standing MOC modules will be offered to ACC members at no charge.
• •Posted online (CardioSource.org/MOC) a comprehensive list of ACC MOC Part II offerings. New modules will be added as they become available."

It is concerning that the ACC leadership feels the ABIM is "acting responsively" and continues to market the MOC proess so aggressively.   Let's critically review the list of proposed ABIM "commitments" outlined above:

Provide a 1-year grace period for those who have attempted but failed to pass the secure examination.
We can only imagine what this means.  Does it mean your name won't be posted on the ABMS's Wall of Shame for a year so you can attempt to take the test twice more?   Nowhere is there a concern for the lost revenue, additional hours of study, psychological stress, and damage to a physician's professional reputation created by this unproven process.  While the ABIM acknowledges the increasing failure rate of their examinations in their "letter" to the Internal Medicine community, they provide no evidence of critical self-apprraisal nor a viable rationale for this.  Instead, the spin is that doctors should feel grateful they were granted a 1-year grace period to complete the MOC testing.

Update its governance and financial information on its website.
Updating a website does not mean change in governance will occur at the ABIM.  All ABIM members should be elected by physician peers, not selected by ABIM members themselves.  Is this what they mean?  Of course not.  Do we really think these back-slapping chums will change their self-serving ways? The fact that ABIM members "exercise ultimate fiduciary responsibility and authority" is not acceptable to professionals whose livelihoods are placed at risk by ABIM members who remain unaccountable to those they regulate.  Until physicians have an active voice in the ABIM's "governance," this organization's professional credibility will remain suspect.

Regarding the financial information they will disclose:   How will they justify the high salaries of the executives of the member boards that exceed the salaries of the doctors they pretend to represent by many times? Will they insist on the disclosure of all conflicts of interest and income gained as consultants? So far, the ABIM has failed to list the transfers of funds between organizations like the ABIM and it's separate "ABIM Foundation" publicly. Shouldn't all financial and societal relationships with the ABMS, AMA, ACP, CMS, National Quality Forum, AMA's legal team, academic centers, the American Hospital Association, insurers and other "stakeholders" eager to use the ABIM's data trove be disclosed as well?  Will the ABIM disclose how the survey and test data collected on their server is protected, sold and/or shared?  Why is this unproven MOC process being promoted as a measure of physician "quality?"  Why has it been allowed to continue as a Medicare physician payment incentive?   Given these problems with fiscal transparency, why does our government collude with this private entity?  If the ABIM's "governance and financial information" fails to change sufficiently or mention these specifics, physicians and the public have gained very little from any "commitments" promised by the ABIM.

Ensure a broader range of CME options for medical knowledge and skills self-assessment (Part II).
This is really not a concern, so why it was included as an "action item" for the ABIM is uncertain.  Physicians have always had many ways to earn continuing medical education (CME) credits that do NOT involve the ABIM's MOC process and these MUST be preserved.  Physicians to not want the ABIM to monopolize their ability to gain CME from other sources or methods, especially when the ABIM commands repeated  high payments from physicians for their products.

Provide more feedback regarding test scores.
"Feedback" can come in many ways: statistics, providing answers, or maybe even disclosing a passing level.  But let's be honest.  Why do we care?  Especially when failing still has significant employment, credentialing and social ramifications.  Isn't the point to of life-long-learning to educate?  Isn't the point to learn?  Is forcing doctors to take a computerized test in a secure prison-like environment really beneficial to patients, or just a means of making subordinates of clinical professionals?    Why do we physicians continue to allow such a punitive means for assessment to take hold when there is no independently validated evidence that MOC does anything to improve patient care? 

Evolve the “patient survey” requirement to a “patient voice” requirement and increase the number of ways this requirement can be met.
Oh my goodness.  Really?  A "patient voice" requirement rather than a "patient survey?" The ABIM really has no idea whom they are serving.  They have a Utopian vision for themselves: as one Great Overseer of All Things Perfect and to define for both doctors and "the Public" (whoever they feel that comprises) what "voice" we should all hear.  I can see it now: patient's flying in a horrible thunderstorm with their doctor piloting the plane and the ABIM's answer to improving the safety of the flight?  Make sure the patient's have a "voice" or let's pass out a "survey!"  The reality today is that patients have a voice in their health care: they can go elsewhere, they can sue, they can critique their doctors publicly.  To suggest that patients need a "voice" in assuring physician competency, courtesy of the ABIM's expensive MOC requirement, is not only patronizing, but insulting to both patients and doctors.

Reduce the data collection requirement for the practice assessment requirement; utilizing performance improvement activities already in place and minimizing the time and complexity of data input.
This is nothing new.  It already existed and is exactly what I did recently in my recent recertification process in 2013.

Investigate changes in the secure examination to increase relevance with specific attention to exploring applications for practice focus areas (“modular examinations”) and open-book examinations.
This sounds like a Carte Blanche idea to expand the ABIM's reach and costs without oversight.  Who will fund such an initiative?  Who will regulate the spending of these self-imposed regulators?  How can we control costs of this whole process when the process is continually expanded with such unrealistic and grandiose ideas?   Isn't medicine and real life already an "open book test" for today's physicians?  Why do we need  the pleasure of paying $750 or even more for a another secure exam in a videotaped office building that prides itself on cavity searches? This whole process is already out of hand.  Cut it back and make it manageable, don't expand it.

Why should anyone care about all of this?  Yesterday morning, my good friend John Mandrola, MD sent a prescient tweet my way:

Yet another of Louisville's finest docs sends letter of resignation. Experienced docs are leaving in droves. No one is secure. @doctorwes
— John Mandrola, MD (@drjohnm) August 5, 2014

Senior doctors are getting tired of all the nonsense in medicine these days. And nowhere is there more nonsense that the ABIM's complicated Maintenance of Certification program.  Their continuing education program is far too cumbersome, onerous, and expensive and supplies little to no marginal utility for patients relative to the care that their physicians provide.  As a result, the ABIM's MOC process is causing more harm than good to patient care while also compromising physician retention.    Unless this is horrible mess is greatly simplified or stopped all together, look for more and more doctors to move on to other less hostile work environments or to simply retire.

After all, actions speak louder than words.

-Wes

Addendum: If you've failed a recent Maintenance of Certification examination, I am still confidentially collecting stories from affected physicians.  Please consider contributing yours.