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.

-Wes