Actions speak louder than words.
Imagine, a piece about unsavory financial practices and possible corruption is published about one of the members of your flotilla. That member of the flotilla responds, but the response it met with pushback by the practicing physician community.
The Mothership, already nervous, gets more nervous.
The Mothership calls her public relations firm to ask what to do. Things must be neat and tidy, just like their "new and improved" webpage. "We can't be lost on our messaging to the public," they say to the PR firm. "We need to have 'alignment' with our core values and motives."
So, the public relations firm proposes a strategy. It is reviewed by the leadership of the Mothership. They like how it sounds. So they send a boilerplate press release to each member of the Mothership's flotilla.
And this is what happens.
No, there's no collusion going on among professional societies. None at all. Nothing to see here folks.
Now, can we move along and just ask doctors to keep paying those high re-certification fees?
They like to say 'no margin, no mission'. The truth is closer to 'more missions, more margins'.
Board Certification is a scam.
Part 1: Letter to HRS:
For many HRS physician members, “Board Certification” has been a laudable goal. It is disappointing that the costs in terms of both time and money, have grown substantially, and the requirements have increased in the setting of declining compensation and the absence of validated outcomes data. As HRS members know, actual survival data (SCD-HeFT) was required before we put in preventive ICDs. Excessive charges by the ABIM for examination and MOC, coupled with costs of review materials, courses, and time away from patient care culminate in unreasonable costs for recertification. For computer based educational and testing modules administered in the internet era, current ABIM costs are excessive. It does not make any sense why this could not be done for under $100. Given the longevity and staff composition of the ABIM, it is also very surprising that there is such a paucity of validation of their methods.
Given the “non-profit” nature of ABIM, and their essentially “monopolistic” control of certification costs and standards, the officers, directors, and governors of ABIM should be held to a high standard of disclosure, performance and ethics. Highlighting the concerns of practicing physicians, the disclosure of the compensation arrangements of both ABIM and ABMS physician executives were disappointing. Who ever knew a geriatrician could earn almost three quarters of a million dollars a year over a decade? When our triple certified colleagues in the “trenches” of medical practice struggle with excessive workloads and hours, these “leading” physicians, who are in positions of trust and responsibility, seem to have had no problem enriching themselves. Examining non-physician compensation, one wonders if the ABIM and ABMS purposes have been hijacked from physician control through extraordinary compensation of a few, leading to self-dealing.
Having practiced in academic, private practice, and my current government role, I can attest that generating those levels of value and compensation providing actual patient care require substantial amounts of time and effort. Of note, the VA pay scale (attached), only provides high compensation to physicians who provide direct patient care. And the majority of VA physicians are not paid near the top of the pay ranges allowed. In fact in 2013, of the 694 fulltime VA physicians earning above $300,000, only 15 were paid above $375,000; the maximum being $401,000. Compensation for those at the VA Central Office and in Administrative positions does not exceed those who actually provide patient care. ABIM physician executive compensation should be no greater than a VA executive, or the mean salary of an ABIM certified physician. It is appropriate to call for an investigation of both ABIM and ABMS. This type of excess has opened these previously blindly trusted organizations up to closer scrutiny. As purported public policy organizations, leadership compensation should be commensurate with public servants.
Part 2. Letter to HRS
Physician concerns about the recertification changes created by the MOC process are widespread and reasonable. As I am sure you are aware, numerous concise statements have been made on multiple internet based discussions. Rather than restate many of the valid statements, I refer you to some of them:
Paramount concerns and proposed solutions include:
1) Excessive cost – Fees should be capped at a rate commensurate with the value of work RVUs. For example, should recertification be as risky/time-consuming/difficult/costly as atrial fibrillation ablation? (20 wRVU for CPT code 93656. 2013 Conversion Factor of $34. Under $700.)
2) Multiple certifications – Given the requirement of laddered certification (e.g. IM=>Cardiology=>EP), completion of recertification in the top-most “Board” should be all that is necessary.
3) CME sources – Any ACGME or CME organization accepted on a state level, should suffice. Not mandating ABIM branded CME.
4) Practice Improvement and Patient Care Modules - These should be eliminated. Criminal background checks, Medicare fraud complaints, and malpractice matters can be adjudicated.
5) Lack of validation – ABIM could offer members the opportunity to enroll in IRB approved randomized controlled out comes trials. This could be funded by those interested, or better yet by clawing back the excessive charges levied in the past several years and the disbursements to the ABIM Foundation.
While there are many potential and theoretic approaches to ensuring high quality patient care, the MOC process is not one of them. Physicians today are routinely faced with both cost and time constraints. It is not surprising physicians would seek board certifying organizations following justifiably appropriate guidelines and requirements leading to high quality outcomes. Utilization of the NASPExAM comes to mind, however IBHRE seems to be pursuing the targets set by ABIM/ABMS.
Feel free to edit.
It would have taken about an hour to scrub the template to hide the obvious similarities but these people are so lazy and arrogant.
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