Monday, March 30, 2015

As ABIM Struggles to Find Itself, Doctors are Moving On

After its initial public humiliation, the American Board of Internal Medicine (ABIM) had to re-group and admit they "got it wrong." But as far as the practicing physician community was concerned, the apology was lukewarm at best.  Instead of taking full responsibility for their financial transgressions, the organization continues to deflect and pretend the problem is their Maintenance of Certification (MOC) program. Friday they issued an update asking for more "feedback" as they recruit new "specialty advisers" to appear more clinically relevant. I've had a chance to discuss my concerns with Yul Ejnes, MD, one of their specialty advisors for internal medicine, by phone. After speaking for nearly an hour, it was clear to me that the ABIM is rightfully concerned. It was also clear to me that "specialty advisors" are far down the governance food chain of the ABIM.

The Deeper Problem

Unfortunately feedback and recruiting efforts won't fix what ails the ABIM and the MOC program in general. There is a much deeper problem. On October 6, 1998, the ABIM, the certification body that overseas approximately one quarter of practicing US physicians, revised their bylaws. Since then, the ABIM has allowed unlimited financial and business conflicts of interest to exist with their board members.  One only has to see the effects of those conflicts after Christine Cassel, MD, supposedly a full-time member of the ABIM for 10 years, was forced to divest herself from those long-standing cozy relationships when she transferred jobs to the National Quality Forum, an agency that receives the bulk of its revenues from government contracts.  That change also made their own ABIM Foundation the sole voting member of the board as a corporate entity after January 1, 2002, a troubling conflict itself. (Other board members are individuals, but the conduct and management of the affairs of the Board is vested solely in the Board of Directors and the Staff Members of the Board.)

Then, from 1998 through 2007 for reasons that are unclear, the ABIM repeatedly funneled physician testing fees in the form of "grants" to their Foundation to the tune of $30,600,000 (1998 - $5,000,000; 1999 - $5,000,000; 2000 - $3,300,000; 2001 - $1,600,000; 2002 - $1,000,000; 2003 - $1,760,000; 2006 - $7,000,000; 2007 - $6,000,000).

And the ABIM's spending didn't end there.  Because the ABIM has no obligation to disclose their relationships to the public or their diplomats they have spent without oversight. In 2007 alone they helped purchase a $2.3 million luxury condominium, and spent $5.2 million to outsource testing centers while they held posh "meetings" at fancy hotels like the Four Seasons, Philadelphia and the Ritz-Carlton, Laguna Niguel.  They also occasionally give themselves a bonus.  It is this problem of feeding their constituents over their practicing physician consumers that lies at the core of the problems at the ABIM, irrespective of their efforts to change the MOC program.

Ethical Double-Standards

In 2010 while the annual multimillion dollar physician fee transfers were well underway, the ABIM decided to sue five physicians and sanctioned 134 others who allegedly participated in the Arora Board Review Course that allegedly copied paraphrased questions from the ABIM's high-stakes secure examination.  Many physician careers were ruined as a result. No doubt many of their patients were affected too. Christine Cassel, MD, the President and CEO of the ABIM at the time, published a press release that admonished the physicians' behavior saying: "Ethics are critical to the practice of medicine and are the foundation of a successful doctor-patient relationship. We will not tolerate unethical behavior from physicians seeking board certification" while conveniently failing to mention the physician testing fee fund transfers to their Foundation.  Likewise, they've amassed millions for themselves and their political agendas in their Foundation, while demanding that physicians to skimp on necessary tests for their patients in the name of "public good," lest they be labeled "unprofessional."

We can only ponder what the ABIM has to say about their own ethics now.

Next Steps

What the ABIM fails to grasp is that all of the MOC "modifications" in the world won't change these facts. As a result, the ABIM has officially been rendered irrelevant to the practicing physician community.  Doctors are moving on and hospitals and insurers will need to adapt. If physicians lose their credentials or ability to practice because of MOC, they will sue.  And given these many transgressions, I'm betting they'll win.

It's a new day now. Practicing doctors are watching. Practicing doctors are feeling the squeeze from all the forces that are being placed upon them. So practicing doctors are starting to act. While it is uncertain how far-reaching their actions will become, one thing that is clear is this:

… a sleeping bear has awakened.



Paul Kempen said...

The time has come to abandon the whole ABMS extortion mafia and admit that a license from the state medical board documents your lifelong learning. If you need a special document to this effect go to and see what the NBPAS.ORG has to offer at much lower rates. attesting to relevant CME and without the force of extortion!

gur. said...

the biggest reality with medical education related scam is that it has been affecting the lowest ranks of medical food chain -residents, students, fellows. it has been only lately that it has affected the physicians who have already paid their loans and thus they could fight back. let us please not promote nbpas for now as we do not know what will nbpas end up as once we all becum busy with our practices after giving initial blows on abim.
it is the time to convert this fight into a tactical war and free the future of medicine from our its enemies.
i request all the medicine residency program directors to sit together and declare an alternate exam with questions set by them (even if each program gives 3 questions) it can enough to repleace abim exam.
the exam should be held a month prior to the completion of medicine residency and the results should be acceptable by all. failures should be asked to repeat exam on a yearly basis. failures can be asked to pay 10-15% higher fees to encourage better compliance. programs already have experience with in service exam, and last in service like exam can replace abim exam. same should be done with all fellowship programs.

Joel Silverman said...

I'm done. After 18 years in medicine - I will not be giving any more gratuitous fees to the ABIM. I study. I take CME. I go to conferences. I learn. I am a doctor. I am proud of keeping up in my field. I, however, am also not a patsy. How does the ABIM justify mandating an MOC exam for some of its internists but not all? How do you state this is a pursuit of excellence in internal medicine, but you grandfather in older internists that are exempt? Either we all take the exam because it has merit - or we don't. The scamming of internists in the USA is over.

Anonymous said...

How dare you question the infinite wisdom of Dr. Christine Cassel--bureaucrat extraordinaire! She was the genius behind the choose wisely campaign designed to please the insurance companies who would propel her to the next echelon of bureaucratic valhalla.
The careful scrutiny of private practice cardiologists is critical given the avarice of the profession. Shall we examine Dr. Cassel's success?
In 2012, she posted her FIVE written in STONE commandments for cardiology. Each one was specifically targeting excessive tests or procedures. As if to say, "you damn cardiologists are doing too much testing and procedures."

Fast forward two scant years and we find out that one of the five was flat out WRONG. How many patients were harmed by Dr. Cassel's recommendations? Why is the ABIM giving out medical advice and who is ultimately responsible for those who have been harmed? What else are they getting wrong or just plain fabricating to curry favor with the insurance companies?

Sharon said...

Thank you for your ongoing update on this issue... I appreciate your efforts!

Anonymous said...

Class action suit against ABIM! Go for it!!

keith said...

This is what happens when a non profit organization loses site of it's true mission and becomes more focused on the dollars. Looks like they are generating so much loot from their plundering of physicians that they needed somewhere to hide it. Why not create a foundation dedicated to what ????

gur. said...

i was not surprised to know that ABIM is not giving up. just today figured out that while ABIM is classically making physicians feel relaxed by talking about potential changes in the moc etc and even their chief dr baron is try to pretend that he is in the interactive mode with physicians, using his newly found blog (although he has already closed the comments section in new days) there is a parallel onslaught which has been started by FSMB in the name of FSMB compact trying to legalize the MOC. actually it is a more dangerous Trozan horse as now FSMB is legally trying to get the definition of physician changed by law. you will be surprsed to know fsmb has already manged to pull it thru 6 state legislatures.
read page 4 clause 4

sneezerdoc said...

Actually there needs to be a class action suit given how they mishandled our $$

Randy said...

I have recently re-certified for the second time. The Practice Improvement Module was a ridiculous waste of time. I spent so much time trying to understand the requirements and collecting questionnaires from my patients that I failed the exam the first time. I simply had very little time to study - I studied less than usual and read fewer journals while I completed these onerous tasks. It's hard to forgive someone for wasting what little time we have.