"Now this is not the end.
It is not even the beginning of the end.
But it is, perhaps, the end of the beginning."
In a widely circulated mea culpa announcement today, the American Board of Internal Medicine (ABIM) deployed some chaff in an attempt to ward off a flurry of incoming Exocet missiles aimed squarely at its years-long history of corrupt and coercive financial dealings, gross mismanagement, and entirely unproven Maintenance of Certification (MOC) program by saying simply, "We got it wrong and sincerely apologize. We are sorry."
In an effort to project an image of sincerity, the ABIM agreed to "immediately suspend the Practice Assessment, Patient Voice and Patient Safety requirements for at least two years" and "hold their pricing at or below 2014 levels until 2017." It was clear that they sense themselves becoming increasingly irrelevant thanks to the efforts of Paul Tierstein, MD and his much cheaper NBPAS.org. To align themselves with the NBPAS, they also promised in their FAQ page "to work toward recognizing most forms of CME as fulfilling ABIM's MOC expectations for knowledge self-assessment." Better yet, they even agreed to set up a Google + community that doctors can join to discuss things!
There now, good working doctor, feeling better? Now can we move along?
But perhaps we should ask first: Why MOC at all?
Contrary to years of propaganda promoted through pseudo-science and journal article citations on the ABIM's website, might MOC have really been created because the ABIM's consolidated fund balance dropped 43.2% from $54,009,086 on June 30. 2001 to $30,691,329 by June 30, 2013 while the Standard and Poors 500 index increased 37.7% over the same period? Said another way, maybe MOC was created because the net assets of the ABIM diminished from negative $10,930,327 to negative $43,150,390 from 30 June 2003 to 30 June 2013 while their leadership and board members did little more than pad their resumes so they could apply to the next insurance company or National Quality Forum job opening.
Or maybe MOC was created because the ABIM ran a bit short on cash because they decided to transfer $17,360,000 of physician testing fees over the seven years ending June 30, 2008 to their own shadow ABIM Foundation (that shares the same leadership) and purchase a $2.3 million condominium for themselves. (Oh, and where and when was that ABIM Foundation created, anyway? Iowa in 1999 (as the tax form says) or Pennsylvania in 1989 (as public record says)? Or should we ask? And how did the Foundation suddenly have $52,811,298 of net assets by June 30, 2002 - less than three years after its creation? Where did those funds come from? Finally, given the hefty balance sheet of the Foundation, why was the Foundation granted those additional $17,360,000 from physician certification fees via the ABIM?)
Or maybe MOC was created to help fund the high salaries and lavish lifestyles of its many officers and administrative staff. Does the President and CEO of ABIM and the ABIM Foundation really need to earn at least $7.2 million over the ten years ending June 30, 2013 while also earning additional cash on the side from multiple consultant positions? Sorry, but for the ABIM to hold fees stable given their self-serving largess is inexcusable. It's time for ABIM to drop its fees and cut their expenses.
And then there's the whole collusion with our professional societies whose non-physician leaders profit handsomely from educational programs that support MOC. Too many ABMS and ABIM sycophants are earning far too much income on the backs of instilling fear amongst young physicians already struggling to pass their tests so they can maintain their job while increasingly drowning in educational debt. To already see ABIM sycophants congratulating "the ABIM staff and board for working to make MOC what it can become" with today's announcement given these realities is unconscionable, even if they are trying to be politically correct.
MOC doesn't need to "become" anything. It is not a legitimate physician quality registry. MOC needs to go away.
To that end, we should recognize that the American Board of Medical Specialties (ABMS) and their 24 member boards (of which ABIM is just one), lobbied Congress hard to etch themselves permanently in to the Affordable Care Act as a physician "quality" registry to affect CMS physician payments as part of our new health care law. But if the MOC program is indeed corrupt, what does that say about this means of paying physicians for the care they provide patients? How corrosive to the doctor-patient relationship might this program become? Recall that the ABIM has never studied the effects that failing a physician during recertification has on the physician or the patients that physician treats. The spin is that MOC assures physician quality. But if a physician can no longer practice because he loses his privileges to practice his art because he failed a computerized test insensitive to the physician's scope of practice, where does that leave his patients? Why has no one ever evaluated this? Might it never have been evaluated because the MOC program was always more about the money than a means of assuring quality patient care?
I'm sorry, but an apology is not enough when there are so many unanswered questions and unethical practices underway by so many for so long - especially by those of our own profession who have turned against practicing physicians for their own benefit.
It is time for a full Congressional investigation into the financial, legal, and ethical dealings of the ABIM, the ABIM Foundation, the legitimacy of the ABMS's entire MOC program, and to question the inclusion of such an irresponsible and corrupt physician quality measure into the Affordable Care Act.
You see the real story today is not about the ABIM's changes to their illegitimate MOC program. Rather it's about how the MOC debacle has finally mobilized practicing physicians to advocate for themselves and their patients for what is right, whether the ABIM and their sycophants like it or not.
Reference (with links to tax form financial data): In the Grasp of the Gang (pdf) via Mr. Charles Kroll