Tuesday, April 14, 2015

Why Journalists Need Maintenance of Certification

Well, well, well, this little blog got a mention in the New York Times Well health care blog last evening in a post entitled "Board Certification and Fees Anger Doctors" by Joshua Krisch.  Too bad what really upsets doctors is not certification, but the proprietary RE-certification monopoly known as the ABMS "Maintenance of Certification" (MOC) program. At least the post includes a dashing public relations photo of Richard Baron, MD, the president and CEO of the American Board of Internal Medicine (ABIM) sporting a neatly-pressed casual sport coat with a hipster purple shirt while he appears to be earnestly conversing with a "board service" representative. 


While the article fairly disclosed some of the issues that bothers physicians, it was remarkably devoid of what really irks physicians, especially the egregious and corrupt financial transactions of the ABIM uncovered on this blog in December 2014.  Follow-up investigations have found that the ABIM repeatedly funneled $30.6 million to their separate non-profit, the ABIM Foundation that is lead by the same officers between 1998 and 2007.  It appeared this transfer of "grants" was used to supplement an investment portfolio that had already exceeding $55 million and included a $2.3 million condominium complete with a chauffeur-driven Mercedes S-class town car, and leadership conferences at 5-star hotels.  All while the ABIM was bleeding cash and growing a deficit from negative $10 million to negative $43 million.

More recently, even more concerning allegations regarding the ABIM's financial and tax disclosures were revealed by veteran journalist, Kurt Eichenwald of Newsweek. So it goes without saying that I was disappointed that Mr. Krisch failed to mention or investigate any of these financial dealings of the ABIM in his reporting.

Clearly, it appears journalists need Maintenance of Journalism Certification, too.

You see, the public demands such certification. After all, an Institute of Journalism Report published in 1999 showed that journalism errors contribute to 999,000 over-treatments and approximately 5000 deaths each year.  Beyond quality, subscribers need to be assured they're getting "value" from their costly annual New York Times subscription.

Fortunately, a new American Board of Journalism Specialties (ABJS) exists to assure quality journalism that not only meets, but exceeds, societal standards. The ABJS has assembled a whole host of subspecialty member boards with salaries commensurate with the medical subspecialty board executives to establish credentials for each category of US journalism.  These include the American Board of Health Care Journalism (ABHCJ), the American Board of Finance Journalism (ABFJ), The American Board of Business Journalism (ABBJ), the American Board of Entertainment Journalism (ABEJ) , the American Board of Sports Section Journalism (ABSSJ), and the American Board of Weather Reporting Journalism (ABWRJ) and the American Board of Style Journalism (ABSJ).   Each member board nominate speciality advisors who provide content for the once-every-ten-year high-stakes secure examination that assures quality reporting in each journalism category.  Literature supporting the benefits for Maintenance of Journalism Certification is second to none. While the costs are different for each category of journalism, they harmonize well with prices set by the American Board of Internal Medicine's MOC program. Furthermore, the examination occurs in industry-standard computerized Pearson Vue Testing Centers that promise comfort and security with the finest of palm reads and cavity searches prior to testing.

Our most recent Maintenance of Journalism Certification (MOJC) results shows that only 78% of journalists pass the ABJS's recertification test on their first try, demonstrating the rigorous nature of the testing.  Don't worry, though, 96% of journalists ultimately pass their examination. Journalists who fail just have to attend a Board Review course developed by their respective ABJS member board to assure they are fed the correct answers for a just a few thousand dollars more.  Once completed, repeat testing fees are kept at a reasonable $750. And for those who fail?  Well, we're really not sure what happens to them.

The secure exam tests mastery of mathematics through calculus, statistics, English Literature, and Written Composition.  Strunck and White's "Elements of Style" are extensively utilized to assure the highest of testing standards. Journalists undergoing this mandatory evaluation every ten years can rest assured that each of the secure examination questions have been carefully vetted using psychometric testing techniques.  Because of the time, energy, and golf games missed to create these questions, paired with the need to maintain the utmost secrecy in fairness to all, divulging test questions to other journalists is strictly forbidden. In the event of such a breach, the ANJS will have no choice but to use every legal means to punish the journalist, resulting in suspension or revocation of the journalist's writing credentials and ability to practice their trade. Freedom of the press in such a circumstance means nothing.

With the explosion of online content of varying quality, the public has demanded that continuous learning take place.  Beginning in January, 2014, a new, even more rigorous continuous certification process has been developed that incorporates Practice Improvement Modules (PIM) in addition to the secure examination.  With this program, journalist will have the option to "pay-as-you go" every two years or cough up the full re-certification fee up front to assure they will be listed on CertificationMatters.org as "Meeting Journalism Standards." PIM will require that journalists participate in survey collection of colleagues' assessment of their workplace and worth to society. Questions concerning quality of their fax machine, computer power, and diversity of reporting to avoid racial, gender, or age bias will be included. Survey results are transmitted non-securely to the ABJS website so the information can then be purchased by concerned stakeholders like ABC, CBS, NBC, CNN, HBO, Huffington Post, Style Magazine, Cosmopolitan, the New York Times, and the Leapfrog Journalism group to censor stories that might not meet journalistic professionalism standards. In addition, a portion of journalist's testing fees will help fund the Choosing Wisely Investment Club that has been looking for a really nice condominium in SoHo.

Finally, such a journalism certification process will harmonize nicely with the unproven ABMS Maintenance of Certification program that is slated to be incorporated as a medical registry in the Medicare SGR Repeal Bill, H.R. 2.

Same concept.  Same money. All for the "public good."

"Ridiculous," you say?  "Outrageous?"

Now you know why doctors are angry.



Gary Levin said...

This issue also attached to MOC s forother specialtlies. Was and why is the ABIM the only board included in the legislation?

Anonymous said...

Based on the accuracy of many news stories about clinical trials this is badly needed.

Anonymous said...

Based on the accuracy of many news stories about clinical trials this is badly needed.

DrWes said...

@Gary Levin -

The ABIM is NOT the only board included in the legislation. In fact, the American Board of Medical Specialties and ALL of their 24 member boards "harmonize" with each other to report Maintenance of Certification results as one form of "medical registry reporting" as part of the Affordable Care Act's passage in 2010. The new Medicare SGR Replacement legislation (H.R. 2) does not remove this reporting requirement, but consolidates it with others.

Scott Sinner said...

Fantastic job, Wes! I needed a smile at the end of a long day. I had the image of that purple-shirted crook stuck in my head since I saw it earlier today.

W.O.R.M. said...

Once again, it’s time to play "Deconstructing Dr. Richard Baron", as recently quoted in the New York Times...

As pictured in the article, Dr. Baron notes that the board certification process is “an ongoing and evolving professional articulation of what the good doctor looks like, what the good doctor knows and what the good doctor does”.
-Dick, you really struck a pose for that comment. I see the archetype of ‘the good doctor’ in a business office setting wearing fancy threads, quite a few parsecs away from anything remotely resembling a clinic. I have no doubt ‘the good doctor’ knows a lot too. Like how to come across as the latest ABIM incarnation of a self-annointed Saint of High Medical Standards, while leading an ethically challenged organization at the salary level of a CEO. And just what does ‘the good doctor” do? I can only assume anything other than being a physician proletariat.

As for the MOC rollout, Dr. Baron proclaimed that “We launched the new program and told all 200,000 of our diplomates that the rules were changing”. In addition, ‘the good doctor’ noted, “We committed to report publicly whether doctors were engaged in this program.”
-Dick, that was rather heavy handed of you. Stalin also had that pesky habit of launching programs without regard to any feedback from the commoners who would be most negatively affected. And if that weren’t enough, the threat of public shaming would force the little people into subordination.

In a seeming attempt to justify the recertification exams vis-a-vis the nature of the questions themselves, Dr. Baron suggest that the exam material “would be best described as clinical simulations, the sorts of things that most people don’t look up in practice”.
-Dick, let me get this straight. A multiple choice test resembles a critical real-time clinical decision making process? Sounds like the ‘good doctor’ needs to get out of his ABIM cloister for a while, breathe some oxygenated air, and check in with reality. Any actual clinical situation that has the same catecholamine release induced heart pounding effect as a multiple choice test can best be dealt with in a calm, reasoned manner. And that includes, if God forbid needed, looking something up. In our wired world, it has never been easier.

The financial burden of recertification was also addressed by Dr. Baron, who said, “it costs money to produce and deliver the exam, and we also have the costs of running a business and paying salaries.”
-Seriously Dick, you have to work on your standup routine during improv night at the ABIM. ‘We also have the costs of running a business and paying salaries’. Great punch line, but what was the joke?

Finally, Dr. Baron reminds us of the healthcare cost savings attributable to ABIM’s maintenance of certification program. “They dismiss that as marginal, but if you’re spending $545 billion on Medicare every year, 2.5 percent is anything but marginal.”
-Dick, assuming these results are valid and not a result of the well known causality/causation conundrum, just why do you suppose it to be the case? The word passed down from on high in the hallowed halls of the ABIM must surely invoke the mantra that ‘good tests’ make ‘good doctors’. Before you pop the champagne and spread the caviar, consider another explanation. The average physician works 54 hours a week. Perhaps the burden of MOC, review courses, exams, etc results in a physician being available to care for their patients 2.5 percent less which averages out to a little more than an hour a week. And of course, less patient care means less patient billing. Not so farfetched. But the party must go on. And let the rest of them eat cake.

Anonymous said...

It is inconsistent to claim that the ABIM's methods and practices are corrupt in general and that therefore its recertification program is invalid, and yet recognize that its certification program is valid. The fees paid by graduating residents and practicing physicians are mingled together and thus we all fund this organization's operations. Why might it be inappropriate for practicing physicians to have to feed this organization, but okay for residents to have to pay to fund the same organizational practices you find so objectionable? Fees collected from both initial certifiers and re-certifiers perpetuate the problem.

James OBrien said...

Nicely done.

I might add that Dr. Nora the quisling at ABMS is also a J.D.

How come lawyers don't need recertification?

Why doesn't she bring it up at an ABA meeting?

Because she knows they would sue her and her organization out of existence.

So why don't we?

g. said...

it is very important for doctors that they recognise the "frankenstein group"
which we created and have truned to be our greatest nemensis. abms/abim/acp/ama/fsmb etc and every other organisation who is working to destroy the independence of physicians. we need to call their offices, cancel our subscriptions of all their services and spread the word of civil withdrawl of our monetary support which is helping their survival. a strong marketing campaign reaching the residency programs and fellowships is very important for putting a final nail in the coffin of these bigots. residency programs directors should seize this opportunity to regain the independece of medicine back into their own hands. abim and all these cronies should go.. i mean be thrown away..

g. said...

i started reading aafp jurnal a couple of days back and i was shocked to the alternate side of medicine about which i was never aware about.. how blind i was during my residency! then i pondered how come i did not read all these stuff including the intricacies of obama care, pharma lobbies, hospital billing frauds etc etc.. i kept reading for many days, till i just tired of reality.
i feel the only reason i did not read this further is because it is not attahced to CMEs/MOCs etc etc.. is this is a way that the industry/govt is using sponsored eduction to filter what it wants to reach us? even in this age of one click web search it is a massive feat they have been successful in acheiving.. now thanks to the frankensteins that we created in our own quest for perfection, we are trapped in our self created web..

Anonymous said...

From the perspective of an attorney who has worked in healthcare for many years, I am puzzled by the hold that the ABIM and ABMS have achieved over the practice of medicine. Physicians' intelligence and skills are under a microscope even before they enter medical school, and in order to earn their professional license they must pass a series of rigorous exams and successfully complete an accredited residency. The cross-checks on physicians continue throughout their career, with peers, patients, state medical boards, and attorneys constantly monitoring the quality of their care. And now, EHRs are enabling even more real-time physician quality metrics to be easily observed. This process seems like ample vetting to allow a physician to practice basic medicine either in an office or in the hospital. Other healthcare providers are doing physicians' jobs with far less training and vetting. Currently, NPs and physician assistants are essentially functioning as general practitioners, and healthcare thought leaders want them to assume even more responsibilities that were traditionally the GP's scope of practice. So why must physicians pass through yet another hoop- a very expensive and time consuming hoop with very questionable value- just to be able to practice the same medicine now being practiced by NPs and physician assistants? In law, any attorney who has passed the state bar may practice general law in that state. To my knowledge, there are only two well-known specialty bars: patent and tax. Other than those distinctions, attorneys develop their own niche and succeed or fail based on the quality of their work. So why should a duly-licensed physician be denied basic privileges to practice at a GP level at any hospital or be denied full participation in Medicare/insurance payments solely because they have not either certified or re-certified with the ABMS or ABIM? There is a place for sub-specialty testing and recognition, but the ABIM has ceased to be relevant, and no physician willing and wanting to practice general medicine should be denied a right to earn a living (and pay off their expensive medical school loans) simply because the ABIM has been allowed to violate well-established antitrust laws.

Anonymous said...

Great piece. However, you missed several important factors such as the over-utilization of journalism. This is clearly demonstrated by the number of news stories and outlets. The 'fee-for-service' model of journalism is encouraging excessive/unnecessary writing. Rather, I propose a burdensome, iron fisted, pugilistic oversight committee with yet to be appointed bureaucrats who decide what writing is appropriate. Failure to comply will be met with harsh civil and in some cases criminal penalties levied and enforced by the DOJ.
There will be exceptions for the most egregious violators who have access to powerful senators as long as they are willing to donate to their PACs.

Anonymous said...

Mr. Anonymous Health Care Attorney,

If what you say is true, What recourse do we have?

Does extortion, collusion, antitrust activity, and tax fraud equate to RICO misbehavior?

What Calvary can we call for help?

Anonymous said...

The new alternative board has an opportunity to reach out to residents and practicing physicians and expand its membership, by granting basic general practitioner or IM certification to any practicing physician who has completed an accredited residency in the U.S., who holds a valid, active state license to practice medicine, and who demonstrates motivation to engage in meaningful continuing education activities. This would enable any licensed physician to at least practice at the level of mid-level providers who are now being permitted to function within the traditional GP/IM scope of practice. The new board could then continue to develop realistic criteria for sub-specialty certifications. Any move by a competing board to quash the activities of this new board would simply highlight the anti-competitive practices of the former. In other words, offer a better product, more docs will buy into it, and hospitals and the govt will have to recognize it.