Tuesday, September 15, 2015

Pulling the Plug on ABIM; Pulling the Plug on MOC

Kurt Eichenwald in Newsweek strikes again:
Dr. Jones has been a physician for decades. His hundreds of online patient reviews are consistently positive, with an average of just under five stars and raves that he is caring and attentive. Based on those assessments, it’s clear he is the kind of physician who focuses on quality patient care and eases America’s critical shortage of internists.

Unfortunately, as a single father with a disabled child, Dr. Jones can’t manage his practice, care for his family and study for the certification exams administered by the American Board of Internal Medicine. The tests purportedly insure doctors’ competence, but, like many physicians, Dr. Jones says the questions often have nothing to with what he sees in his practice and are little more than a game of medical Trivial Pursuit. Dr. Jones can’t afford the thousands of dollars for study guides and classes to learn obscure, often irrelevant information, and has no time to review the material every night for months. He failed the test, so his hospital will no longer allow him to admit patients because he couldn’t answer questions about diseases he will never encounter.

And so, Dr. Jones—who asked me not to use his real name out of fear the ABIM will somehow block him from ever treating patients again—has closed his practice. The patients who love him will have to find someone else, and America’s shortage of primary care physicians has become just a little bit worse. “I’m hoping that maybe I can find a job as a high school science teacher,” he told me.

It’s a horror story that has played out for years throughout the U.S. as the ABIM abuses its monopoly power to force doctors to do whatever it decrees, while ignoring the many doctors who have demanded for years that independent researchers conduct comprehensive studies to determine if ABIM’s requirements do anything to improve patient care. This medical protection racket has made millionaires of ABIM top officers, financed a ritzy condominium, limousines, and first-class travel, all while sucking huge sums of cash out of the health care system.

But now, after decades of unchecked rule by ABIM, cracks are appearing in the organization’s facade of power. Thousands of doctors began a widespread revolt months ago and, in the last few weeks, evidence that their efforts are succeeding has started rolling in. ABIM officials have proclaimed that they are rushing to make changes—and indeed have announced some changes—but it seems they waited too long and are changing too little.
Read the whole thing.

Then ask yourself the real question: why have all of us practicing physicians allowed the American Board of Specialties and it's 24 member boards (including the ABIM) to be unaccountable to us when we pay all the fees?

It is time to change that model and insist out specialty boards have elected officials and not act as a membership society.

It's also time to end the ABMS MOC program - every bit of it. It is hurting doctors and, in turn, hurting patients without any credible proof it improves patient care or quality. When will our professional organizations quit this insanity and return to physicians maintaining continuing medical education credits like before? No other country in the world wastes this much time and money on such an unproven metric.

Not one.



Anonymous said...

If Physicians Walked Away from the ABMS, What Would Happen?

First of all, nothing would happen. Their is no void to fill. There is no danger of tearing the safety walls down with no ability to build back up for the public's protection. This is utter hog slop served up to make you excited and afraid.

On the other hand, physicians and patients would immediately benefit.
Because all the medical specialty boards serve only three basic function; unfortunately these functions have negative consequences and nothing to do with enhancing the quality of medical care or improving clinical outcomes.

What are the three basic functions the ABMS indulges in at the expense of indentured physicians?

The Three Problematic Faces of ABMS Corruption

1. Self-inurement of officials who claim their professional abilities are worth the exorbitant salaries. Horse sense or common intelligence we all share reveals their negligence and incompetence. Yet officials demand this big fat money without providing proof that the services they invent work. They don't dare try to prove anything, because the outcome of any fair, broad and inclusive scientific investigation would certainly conclude that the ABMS only produces heaviness and stressful burdens with time-consuming mental gymnastics. These are the real bases for their unfounded financial demands.

In fact when physicians make claims that ABMS officials have been corrupted or state that the umbrella organization turns a blind eye toward fraud or corruption they stick to the party line that no such corruption has appeared across the decades of the increased focus from the public or medical community's magnifying glass.

Yet corruption is a fact.

Lying to clients is a fact. Misstatements on tax filings is a fact. Lobbying in secret to secure their dominant legal position which harms physicians and patients in the name of "federally mandated quality measures" is a fact. They do this clandestinely by creating policies that become law.

Illegal transfer of money.

This is a fact, though few will dare say it plainly, because they fear they lack the umbrella of facts to defend such a position.

Their illegal inurement, which ABMS's own head Nora claims is normal, leads to power and the need to keep hold of that power with Machiavellian techniques. This has been obvious, especially if you were one of the many crushed under the weight of that power.

2. The ABMS and its members act as ad hoc political action committees pushing cost- savings plans and social reforms consciously or through the use of tactics which condition and control physicians, thereby leaving them passive and afraid--too afraid to speak out or against anything proposed. Even if the ABMS suddenly starts acting like a big collection agency. And they claim you owe, but never provide the proof of debt. They can't.

The ABMS has a profound history of just such control over physicians treating them as cattle or sheep, literally.

3. The power and the inurement of officers has given rise to multi-year plans to corrupt medicine in favor of a medical mono culture, which has nothing to do with standard-setting medical knowledge and practice, but has everything to do with creating an inferior medical practice environment with severe restrictions of patient flow and restraints placed on the medical "tools"--which are needed in the job of healing or comforting. Impotent physicians result from the ABMS affair.

Anonymous said...


EHR is one example of collusion among the ABMS, government and corporate entities to push EHR down physicians throats without having an evolved product. Bottleneck and click syndrome have been the result. One could argue the whole of the present health care condition/crisis has been manipulated not by "quality measurement" companies, but by politically powerful machines that have lobbied to destroy physicians power and mold our country's medical system in selected officials' and government's own political image.

The will of physicians was broken by destroying the spirit of learning in them. This was done to condition physicians to obey and not question. Education and practice fatigue is the norm now created by the ABMS through abusing physicians with outdated educational philosophy and obsolete, broken learning tools--along with idiotic ideas and delivery techniques.

It is time to pull the plug on the ABMS and the MOC(K)ery it makes of the sweet inherent wish to learn inside of us all. The officers have thrown the physician into a brave new world of slavish incarceration where "learning" is made out of old yeast that will never ferment. The onerous activities deprive the patient of needed time and medical encounters with the physician thereby harming and not enhancing outcomes.

Patient encounters are turned into a dry shortbread without the sweet strawberries.

The broken ABMS umbrella consisting of 24 "member societies" is upside down full of filthy murky water. It protects no one. Leave it where it lies in its own cesspool of lies and obfuscation divorced from financial reality and medical fact.

DrWes said...

Anony –

I appreciate your sentiments and agree with most of them. However, we should appreciate that the ABMS is just part of the much larger (and politically-connected) Accreditation Council for Graduate Medical Education (ACGME). The ACGME is comprised of the ABMS and its 24-member boards, the AMA, the American Hospital Association (AHA), the Council of Medical Subspecialty Societies (CMSS), and the two main osteopathic boards. As such, the ABMS has conveniently and covertly insisted (via a change in the definition of what it means to be “board certified”) that hospital-employed physicians (where the vast majority of physicians are now employed thanks to health care reform efforts underway for years) perform the ABMS MOC program to remain "board certified" to maintain their hospital credentials. The change in policy of making board certification time-limited is coercive (and some say even extortion) regulatory capture at its finest. Practicing physicians are all too aware of this catch-22 situation for them to remain employed.

That is why the anti-trust suit against the ABMS by the Association of American Physicians and Surgeons in Federal Court is so important. In the meantime, practicing physicians should work with the medical executive committees of their respective hospitals to insist that they permit the National Board of Physicians and Surgeons (NBPAS.org) credential to be used in lieu of the ABMS MOC credential for ongoing proof of performing continuing medical education and maintaining their hospital privileges. Choking them financially is an appropriate strategy.

OSWJ said...

Excellent reporting and comments . For many ,many years I've heard negative comments about this organization, and some of its umbrella
' societies ' . I'm not a physician, but am steeped in working close with them ( clinical trials , basic research , medical informatics , recall design and execution ). Also , work a bit with the residents ,, I have incredible respect for the profession ( as well as , RN's , techs, staff).
My Questions : Given the assessments and so called ' facts ' ----> Why the heck does it still exist ? Why ? Is it worth a cleaning house and restructuring ? Why do the hospitals even give credence to their ' doc blessings ' ?
Saw a respected , hard working oncologist , yesterday ---- She told me : " she has no time -- I just pay the bill,,, take a test " . She was aware of the various controversies . So, she plugs on : ---seeing her patients , learning the new hippa nuances, EMR, obamaless rules , taking orders from the insurance carriers , trying to stay away from the ambulance carriers , checking out the patient blog reviews,,,,
Who has the time to fix , complain , assess, monitor ?? What is to be done ? Sorry for the rant -- thanks to Dr Wes & and the few caring commenters !!

Anonymous said...

Good points from above!

Yes, Wes, this is not a unilateral action on the part of the ABMS. That should be well understood by anyone who has experienced the strong biting clamps of the almighty ACGME and the caustic synthetic glues of its many co-conspirators.

Physicians are like a piece of molded wood clamped in place for life by these organizations and MOC is just one of the cutting clamps of their torturous unyielding yoke.

Can you feel the pain and at the same time taste that there is a possibility of freedom from the whip of "pharaoh"!

We prize the notion that we are modern and civilized today, yet nothing has changed. There are still masters and slaves; the masters are seldom held to account for any of the evil they do to others.

The antitrust lawsuit against the ABMS, which was moved to Illinois from New Jersey, is not just a relevant issue for the AAPS but for all physicians fighting to have some voice in their profession. The case is clearly strong against the ABMS.
The only question is how fair and honest is our judicial system and how effective is the legal representation.

You know, Kurt Eichenwald should take an interest in this trial. It may be more significant than any for decades. This is more than a movie for physicians. It is real life and we need to have a victory. To insure fairness in the judicial process often takes scrutiny of the free press. I would pray for that free press to ride into town again to save the day, but it seems we have some severe conflicts of interest when a few corporations own the lot.

That is what I admire about Kurt Eichenwald. It is his ability to state facts based on that old fashioned type of investigative reporting that gave passion to the profession.

Let the new monkey trials begin without the judicial process failing the American public. The faith and health of America is in the noose of the ABMS and its co-conspirators. We are waiting for informed politicians to assist and insist on serving the public again. All too often politicians and the legal system have served the likes of "Big Tobacco", as Eichenwald pointed out when he mentioned ABIM Chairman Thomas Brem and Big Tobacco's cancerous slush fund #4 paying to influence medicine and the fate of millions of lives around the world with obfuscation of facts.

What other hidden money is out there? Chris Cassel did not disclose to the ABMS her conflicts of interest and recuse herself from the position of CEO and President of the most influential organization within the ABMS umbrella. No accountability. Protection for the elite few is the norm. Shame on America!

Have we become so corrupt as a nation as to accept the fact that "bribes" are now "standard payday" with a system of lies to support that elite class of "carpet baggers", as someone called them here on this site.

What about the laundering of money by the ABIM! It is a fact, not fiction. Yet we accept a plausible fiction invented by the elite who govern physicians by putting them through a gauntlet of torturous misdirected mandates that have led to systemic breakdown.

Now "we the people" stand before the crushing weight of "Big Corporate Bureaucratic Medicine" (free of Big Tobacco's lie, I hope) and it is clear this medical industrial complex and web of professional medical politicians do not have the public's best interests in mind.

Where is the free press?


Ned Radich said...

The Anesthesiolgy Board just announced that they are doing away with the test every 10 years and will do weekly question which will need to be answered to demonstrate "ongoing learning." Not ideal, but beats the heck out of the old system. Hopefully other Boards will follow suit.

Anonymous said...

ABIM has spoken !!! OMG !!
Assessment 2020 Task Force Findings to Focus Discussion of Changes to ABIM Certification and Maintenance of Certification

Philadelphia, PA, September 16, 2015 – The American Board of Internal Medicine (ABIM) today released a report from the Assessment 2020 Task Force that envisions a variety of potential directions for the future of assessments in ABIM's Certification and Maintenance of Certification (MOC) programs.

The Assessment 2020 Task Force was convened in 2013 to develop a vision for the future of assessment in internal medicine and associated subspecialties. The independent Task Force included representatives from a diverse group of stakeholders, including ABIM leadership, experts in assessment, education, health care and consumer advocacy.

The report, A Vision for Certification in Internal Medicine in 2020, is intended to inform ongoing redesign of ABIM's Certification and MOC programs, guided by the needs of patients and society while also increasing the value to and decreasing the burden on physicians.

“Feedback collected by the Assessment 2020 Task Force is very consistent with feedback ABIM is hearing from the community regarding the MOC program,” said Richard J. Baron, MD, President and CEO of ABIM. “These recommendations are meant to be a catalyst for further discussion and can ultimately lead to an improved MOC program for diplomates.”
ABIM has started actively exploring the implementation of the recommendations through a subcommittee that consists of members of both the ABIM Council and Board of Directors, led by ABIM Council member Naomi O'Grady, MD. Key recommendations from the report include:
Change the MOC exam.
The Task Force recommends replacing the 10-year MOC exam with more meaningful, less burdensome assessments.
Focus assessments on cognitive and technical skills.
Assessment of cognitive skills assures the public that physicians are staying current with the clinical knowledge relevant to patient care. Assessment of technical skills ensures that physicians can apply that knowledge to adequately perform the technical procedures appropriate to the discipline.
Recognize specialization.
The Task Force recommends exploring the need for certification in specialized areas, without the requirement to maintain underlying certificates, while being transparent about specialization to the public.

“The Assessment 2020 Task Force members provided useful insights and recommendations that will be instrumental as we reshape certification to meet physicians' and society's changing needs,” said Clarence H. Braddock III, MD, Chair of the ABIM Board of Directors. “We now need to hear constructive feedback from the internal medicine community on these recommendations, begin to determine their feasibility and develop implementation plans where needed.”

ABIM has made a number of changes to its Certification and MOC programs in partnership with the internal medicine community in recent months, including suspending quality improvement and patient safety requirements in the program until more meaningful requirements are defined, no longer requiring underlying certifications for MOC, offering a one-year grace period for physicians who fail the MOC examination in their discipline, a reduction of the first-time examination retake fee in MOC and a new partnership with the Accreditation Council for Continuing Medical Education (ACCME) to accept more forms of continuing medical education (CME) for MOC credit.

In addition, the blueprint for the internal medicine exam was recently updated with physician input, and the score reports diplomates receive with their examination results now provide more specific feedback on performance. The Task Force recommendations will inform ABIM’s ongoing collaboration with the internal medicine community to ensure that ABIM Certification and MOC are relevant and meaningful to physicians and patients.

Anonymous said...

Would anyone feel better knowing that the ACC would be charged with your credentialing?

This is the same ACC that proposed a guideline to the Choose Wisely campaign about non-culprit vessel revascularization that was absolutely wrong.

This is the same ACC that opposes targeting LDL cholesterol levels less than 70 in clear opposition of other well respected medical societies. This is in the face of a new 'expensive' treatment (PCSK9 inhibitors) for patients with under-treated risk factors.

This is the same ACC that has adopted rigid guidelines labeling interventions inappropriate based upon a study that screened 30,000 patients, enrolled just 3,000 then had about 50% cross over to intervention from medical therapy,

This is the same ACC that has been ruled over by California physicians tied to Kaiser Permanente. Is anyone surprised that doctors employed by an insurance company promulgate guidelines to limit patient care?

Anonymous said...

Anesthesiology Board Drops 10-Year-Exam for MOC

On September 10, the American Board of Anesthesiology (ABA) unveiled a redesign of its MOC in Anesthesiology (MOCA) program that replaces a dreaded 10-year exam with an online learning tool called the MOCA Minute that will quiz and teach physicians on a continuous, baby-step basis at their convenience. MOCA 2.0, as it is called, also drops a requirement for assessing an anesthesiologist's simulated care of a dummy patient and makes it optional instead. The ABA has been airing these and other changes for months, so they come as no surprise to the physicians it certifies.

MOCA 2.0 has gotten good, if not rave, reviews from anesthesiologists. "The changes are all in the right direction," said John Abenstein, MD, president of the American Society of Anesthesiology, who told Medscape Medical News he was speaking for himself, rather than for his association. "They're being viewed as positive."

A prominent critic of the American Board of Internal Medicine (ABIM) and its controversial MOC program said the idea of replacing his specialty's 10-year-exam with the equivalent of the MOCA Minute holds promise.

"If it can be tailored so that it is relevant to each physician's practice, is truly educational, is not onerous, and can be accomplished at a reduced cost, I think many physicians would embrace it," Paul Teirstein, MD, chief of cardiology at the Scripps Clinic in San Diego, California, told Medscape Medical News. "This kind of program is something the ABIM should seriously explore."


Anonymous said...

No matter how the ABIM re-invents itself and recasts its rules and regulations, a fundamental problem remains: it is a private organization, a closed society, that operates without accountability to its member physicians (who no longer have the option of joining of their own free will). Its lack of accountability has been its undoing. These cosmetic changes won't hide the fact that it is an organization with a 'best use by' date that expired long ago. It needs to be relegated to a footnote in American medical history.

Taxpayer said...

Concerning the ABIM 2020 Task Force. Suggestions for the ABIM Board and Subcommittee.

As you know the board sets the executive pay. Bring that executive compensation back in line with reality; or just do away with the full-time mischief makers altogether. You know very well what I am talking about. And so do others by now!

I suggest you make the executive pay a stipend until the board, physicians and the public can assess the executives' possible wrongdoing and likelihood to create more harm to the public in the future. Consider this a kind warning!

Meet to take care of relevant business and maintain a day job like everyone else in the past who served at the ABIM and its subspecialty organizations, before the membership society "sold out" to special interests. The conflicts of interest have been too grave to ignore.

Disclose ALL the conflicts of interest on the website and make it a voluntary tradition of providing for taxpayers your tax returns. (Upon request for public's inspection.) The taxpayer and patient is ultimately supporting the non-profit status; the ABMS and ABIM enjoy the generous fruits thereof. Consider the billions of dollars MOC adds to healthcare costs from the physicians; the burden you create for the taxpayer. This will provide needed transparency. Public trust has been compromised. It is necessary as a test of goodwill to get it back.

End MOC completely, because you cannot prove that it has really made a difference. Evidence mounts that it does harm.

Close the Foundation. Give the money back to physicians who have overpaid. Maybe in the form of credits so it does not break the corporation. Put together a team of specialists to find your clients' names and addresses just as any honest organization would do when caught in inappropriate financial conduct and overbilling.

Give the money back or be prepared to go to court. Physicians will no longer tolerate such irregular accounting practices and tucking profits away to inure your executives and others from your highly suspicious double bank accounts. All this rich pay while you collect from many other overlapping sources at the same time as well.

Task Force 2020 should focus on studying the best way to create a meaningful lifetime test and then act as a politically neutral agency staying out of the cost-savings game completely. End Choosing Wisely initiatives.

It is dishonest and extremely disingenuous to have feigned to teach working physicians anything about professionalism with empty charters that aim to cheat the public with cleverly designed medical propaganda. Political propaganda should not be disseminated from the ABIM or Foundation. Neither should the ABMS engage in such corporate deceit.

One other strong suggestion. Try populating your boards, staff, and executive chairs with some folks who are not democrats.

I am a social democrat myself and I have never seen such a disgraceful bunch of violators and hypocrites in my life. Good God!

Taxpayer (part ii) said...

What kind of message are we sending to the world about the Democratic Party with such lack of ethics. Work immediately to make the organization apolitical, or be prepared for discriminatory lawsuits from past, present and future employees. This political activism on the part of the ABIM is one thing I plan on taking up with my local democratic and republican representatives. Others should follow suit to investigate and correct partisanship and cronyism at the ABIM. It is rampant and has never been addressed through oversight or internally as far as we know.

This political activism is highly irregular behavior for a non-profit with strict bylaws and federal rulings and needs to be reported; plus everything the ABIM has done to undermine our political system's fairness to the public! I mean the voter and not jus the patient. It is fraud to claim to be one thing and really be another!

Get a move on! Or I will personally reach across the aisle to inform key representatives and insist on action. I will make this a campaign issue. You have gotten off easy so far. Don't expect this leniency from physicians, taxpayers, and state and federal authorities to continue.

Anonymous said...

ITs so damn easy for ABIM to end this .

IF ABIM is so MOC-happy , just use the 25 question yearly "Update module" they offer on their website for each specialty. And make it a real update of the previous year.

Once a year -- 25 questions---- on-line---- with immediate answers.
No high pressure. 1-2 hours a year. And everyone passes.

Add CME of your own choice.

No secure exam... GOODBYE.
No pt management, no pt voice.

I can live with the 25 question on-line update module a year.

plus CME.

Anonymous said...

And don't forget that the ABIM Recertification process and later MOC was instituted in 1990. So why does the ABIM need the "2020 Task Force" 30 years later? To prove that MOC is still a waste of time and remains a money making juggernaut for them? Come on people. Their corruption has been exposed. End MOC. All of it. Demand it and do not comply with it.

Anonymous said...

Don't anyone get your hopes up that they'll "get it right" now. The 2020 Task Force has drank the Kool Aid. From the report: "ABIM has consistently produced exams that are rigorous and fair assessments of cognitive skills." Read the report! It is overflowing with ambitious opportunities to "get it wrong" again and again, all the while raking in dollars from your threadbare pockets to pour into their silk pockets. Don't let them continue to muck about and muck up our lives and professions endlessly. Join the alternative board and push your hospital to accept alternative certifications.

Blog Administrator said...

If anyone thinks the ABIM, after all their outrageous nonsense and abject arrogance, will now get it 'right', please contact me ASAP - I have a bridge to sell u in Brooklyn!

Paul Drake said...

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For a complete list of beneficiaries and advice talk to your trusted MOC® broker.
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ABIM's communications officer LL makes more than the executive director of APHA

Footnote: APHA is the only non-profit organization of its kind that claims to "influence federal policy"! Read below.

The American Public Health Association (APHA) is a Washington, D.C.-based professional organization for public health professionals in the United States. Founded in 1872 by a group of physicians, including Dr. Stephen Smith, Dr. Henry Hartshorne, APHA has more than 25,000 members worldwide.[1] The Associations defines itself as: "APHA champions the health of all people and all communities. We Strengthen the public health profession. We speak out for public health issues and policies backed by science. We are the only organization that influences federal policy, has a 140-plus year perspective and brings together members from all fields of public health." It defines its mission as: "Improve the health of the public and achieve equity in health status."


x said...

i think it is time for ACGME to step in and dissolve its association with ABIM, declare that it will take one time exam for board certification during the last month of residency or fellowship while the candidates are still in the program and end its association with ABMS. ACP should realise that it is loosing memberships permanently unless it declares its opposition to MOCs/recertification.

very soon ACGME will be the next target of independent physicians unless it understands that its plethora of hydra are now strangling its neck and cut these heads off timely.

ABIM /ABMS has no role to play after initial board exam and there are already a lot of mechanisms in place created by wisdom of ages. Greed has no place in the world of medicine esp when are resources are becoming meagre each passing moment.

congrats dr wes and the physicans like you as it seems u r being heard.

but a word of caution - pls dont give up till this muck of Cassel et al is removed from the corridors of health care.

Anonymous said...

-page 2-

No superficial study such as Taskforce 2020 with its feigned call for "physician input" will bring change to the corrupt culture of personal entitlement and conflict of interests embedded for decades at the ABIM and ABMS. Taskforce 2020 is little more than a sugar-coated placebo that already from the start has a bitter taste in the mouth. It is the decades-long bitter taste of lies and doublespeak.

ABIM must address possible malpractice involving its Choosing Wisely campaign and that program's serious appearance of being profoundly infected with conflicts of interest.

ABIMF's Choosing Wisely "discussion" has been already cited to result in morbidity, prolonged hospitalizations, and increased healthcare costs. To ignore these “preventable adverse events” by officers at the ABMS and other participants is unconscionable and exhibits utter lack of concern for the patients it directly puts in harms way. Medical conscience guided by evidence-based medicine should be the benchmark for any hospital quality and patient safety initiatives. The ABIM has turned two blind eyes toward its own errors in judgment and finical conflicts of interests in respect to serving not the public but corporate and government interests.

Taskforce 2020 presents unrealistic expectations with more unintended consequences to follow for patients and healthcare providers. The ABIM is caught in yet another lie. Patients have been given yet another false sense of security while ABIM officers play "paddy cake" among themselves never growing up morally enough to see all of their unintended consequences. It all stems from a primal existential lie to the physician and the patient; the ABIM and ABMS are neither "of the profession" nor are they "for the patient".

The ABIM and ABMS consist of selfish masters serving only themselves, while putting on the appearance of serving the profession and the public. That is the culpable state they find themselves in.

The ABIM is infected with lies. The ABIM/ABMS cover it up with more words. The surfeit of ABIM-speak never fails to amaze me. But their "surfeit of wind" no longer diverts us from the real injurious facts in hand.

x said...

dr wes

1 can u run a small investigation into the fact how the abms/acp affiliates are incentivising the physicains in administrative roles into its ranks who indirectly force the young physicians into its ranks by asking them to spend money on acitivites which bring money into the ABMS /ACP coffers. many hospitals are now a days asking all physicains to spend the CME moeny into the organisations affilaited with these cronies. why can we use our own money with independenet organisations.

2 also can ACP please publsih a small study calculating the financial damage which young phsycians occur when teh ABMC initial certification exans are scheuled after completion of residency/fellowshop. pphysicains are taking months off to pass these exams. it is the duty of GME progams to given physicains time during the residney /fellowship programs and it is moral imperative of the abms affiliates to give change to all type of branches to scheudle the exam before completion day of GME educatiion in all branches.

Anonymous said...

Selling the ABMS Franchise Globally

Rather than fix the problems in the US system ABMS financial relationships are sought by the ABIM/ABMS overseas. Here is one example: Singapore.

Singapore's Distinguished Lecture Series and ABIM/ABMS (ABIM personal inurement series and conflict of interests.
In association with administrator/faculty at Duke and UCSF


Following the roll-out of Residency, MOH organised a postgraduate medical education retreat to assess the progress of transformation. The retreat recommended collaborating with an internationally-recognised body to strengthen Singapore’s system of assessments and to grow local expertise in examination development. The ABMS was identified as a potential collaborator which met these requirements as it represented an organisation of medical specialty boards with shared goals and standards, and had strong collaboration with ACGME.


Cerner EHR Singapore, etc,

Epic EHR Singapore, etc

Concerned Patient and Citizen said...

We are Reporting:

ABIM Acting as a PAC for Corporate and Government Interests, Problematic ABIM Foundation, Money Transfers, "Phony Professionalism", Erroneous Tax Filings, Iowa "Domicile", Violation of IRS Non-profit Rulings, ABMS MOC Scam, the Obvious Harm in Choosing Wisely, Obfuscation, Cover-ups, and More Lies

If a physician was caught lying in relation to their medical practice or finances,
what would happen to them professionally?
If a colleague or tax official confronted that person and they responded with a "story" to cover over the lie or lies, what then?

We know what would and should occur.

ABIM has been caught lying repeatedly about important matters. They have been confronted by colleagues, reporters, clients, and others; the ABIM and ABMS made up "stories" to cover up the lies. What should happen to those organization and its officers who were caught lying and covering up?

We all know what should happen.

What about the ABMS, which has been confronted about the ingrained culture of greed and corruption rampant among the specialty boards and others? ABMS even supports it with self-justifying answers. What is their real obligation and responsibility to change?

There is strong pressure to change. It is growing. Media coverage is increasing. It is perhaps just a matter of time before there is an investigation.

Where do physicians stand ethically and legally? What must physicians do in relation to the ABIM and ABMS?

The ABIM clearly tells physicians, who have signed a relationship agreement with them, that physicians have an ethical and legal obligation to report these gross violations and examples of highly irregular behavior, which the ABIM and ABMS engages in.

The ABIM has clearly stated in the New York Times, various medical venues and in the signed agreement, that it is your ethical and legal obligation if you witness irregular behavior concerning the ABIM, it must be reported to ABIM officials. In this case it must be reported to outside agencies, due to their failure to respond.

We are reporting this irregular behavior and obvious violation of ethics. We are reporting repeatedly of the potential fraud, the greed, and the reckless negligence concerning the officers.

We are reporting the "Choosing Wisely" initiative. We remind the ABMS, there is no statute of limitation on any deaths resulting from this ABIMF initiative called "Choosing Wisely". We are reporting this obligation of the ABIM and ABMS, ACP, Robert Wood Johnson Foundation, and others to examine this troublesome political invention of "Choosing Wisely" and request in the name of humanity that it be stopped immediately!

We are asking once more for the ABMS and the ABIM to address all the issues that are being reported, especially those that involve patients potentially being harmed. All this must be openly addressed and explained why the multiple harmful conditions exist and continue to plague us.

I want action on these matters. Lives are on the line.

Anonymous said...

"If a physician was caught lying in relation to their medical practice or finances,
what would happen to them professionally? "


Look at what they did to Sarah Von Muller who may have sent some questions around.

Lynn Langdon went after her with sheer vengeance trying to destroy her career. Disgusting !!

Lynn... you cant ask for forgiveness unless you're willing to give it.

Anonymous said...

Anyone know anything about this ???


American Board of Internal Medicine v. Salas-Rutherford

Filed: January 11, 2015 as 3:2015cv01016

Plaintiff: American Board of Internal Medicine

Defendant: Jaime Salas-Rutherford

Third_party_defendant: Company B, Insurance Company A, Richard Roe and others

Counter_claimant: Jaime Salas-Rutherford

Counter_defendant: American Board of Internal Medicine , Insurance Company A

Thirdparty_plaintiff: Jaime Salas-Rutherford

Cause Of Action: Copyright Infringement

Court: First Circuit › Puerto Rico › Puerto Rico District Court

Type: Intellectual Property › Copyrights


"Intellectual Property › Copyrights "......hmmm... Von Muller 2 ?

Verily Anonomous! said...

Not Suitable for Print: An ABIM Cartoon (teleconference with captions for the deaf courtesy of C**** systems)

Rich: That shrill award-winning journalist with Newsweek wrote another damn article about us! They are calling it brilliant. Can you imagine that!

Chis: Gees, I hope he doesn’t get drift of me. I’m the one who created a lot of this mess. Rich you have got to take the fall until we can hold back the Republicans on…

Bob: Yeah, I just read that schmucks lies; all exaggerations of our financial wizardry and overall distortion of the mission to... I’ve checked on him. He’s erratic; a loose cannon. Could be dangerous. Let’s try and get him in our pocket. The Newsweek editors won’t touch him for some reason. They’re too afraid right now. He probably has another movie in mind. Maybe we could get a copyright on the story and you know choose the appropriate wording…

Rich: I love your scientific approach, Bob. We can get our psycho-metricians and communications department involved writing the screen play. It will be another mala of ABIM gems.

Chris: I’m already all over that. I talked with Oliver Stone yesterday. Says he never heard of the ABIM! Can you imagine that the paradigm for keeping patients safe and he’s never heard of us. Geez, not even me! Maybe that’s a good thing. Thank God for Edward Snowden keeping him distracted. I told him about my movie idea and that fringe group of docs that wants to take down the government and impugn FDR and the Kennedy legacy. I could see his mind cogitating already…

Rich: C’mon let’s focus. There's that lawsuit against us in Chicago. The nerve of the AAPS! Making claims that we, THE ABIM, restrained trade and harmed doctors like "Dr. Jones". Those lazy docs are just out to make a name and collect some money to support their fringe ideas.

Bob: Yeah, I thought I already implied that on my blog that they are, you know, "fringe". Probably some were even part of the "Arab Spring".
You know with the right coaching Oliver will make mincemeat out of them, especially if we write the script and continue to keep silent…

Truly Anonomoose said...

ABIM Cartoon (scene 2)

Chris: Our people in Chicago haven't been able to dismiss the lawsuit and our “conservative folk” in DC couldn’t shut that reporter up, but don't worry, boys, I've never failed to get the job done before. Have I?

Bob: Well…if you remember there was…

Chris: Shut up about that Bob. We have no time to waste on your drivel about water under the bridge! They got what was coming to them. And I’m glad we made those docs suffer. It was worth it to see those vicious cheaters and ringleaders squirm and dance. That shut ‘em up for good. And you see what we accomplished on the hill...

Rich: What's our next move? They have a strong case against us in Chicago, and I was just told that 50% of doctors named Jones are either not participating in MOC or just not certified at all with us. You understand that means our revenues will be slashed by well over 50% if those numbers hold for all our clients!
I'm worried about my pay! I won't do this job for a clinician's salary!
The critics say get a real job. They say I’ve got thirty years of clinical experience, but I don’t remember how to manage patients. It’s all changed. I refuse to do another residency cowing to the ACGME and learning how to treat again from uppity chief residents. I hate the ACGME… Get a real job! Right! Those jerks…

Chris: Watch your language about the ACGME. We need them…

Bob: I'm not good with financial numbers, Rich, and as you know I was only 29 years old in 1986, but maybe we could lay some folks off. Maybe the phone people?

Rich: I already checked on that. It’s infinitesimal what we pay those people. I think we will have to increase the failure rate on something. By the time anybody gets the stats we’ll be out of the woods.

Chris: Did you morons forget about Taskforce 2020. Let’s go to press now. It’s time to release some more countermeasures to get them off our tail…
Oh my! Look at the time boys, I’ve got to go and advise the…

Bob: I suggest we meet again soon…

Anonymous said...

How can the competence of Dr. Jones be questioned by those who are blatantly incompetent? Ostensibly, Dr. Jones is held accountable for his test results by losing his hospital privileges.

It was the ABIM with their Choose Wisely campaign affiliated with the ACC that unwisely suggested that only the culprit vessel during AMI should be treated. It was only two scant years later that we witness the abject failure of this guideline with controlled, randomized clinical trials detailing the correct treatment is complete revascularization of the coronaries.

Dr. Jones was punished with the loss of his license. Where is the punishment for the ABIM and their co-conspirator the ACC? Arguably, Dr. Jones failure to darken the correct bubble did not endanger lives. Contrast Dr. Jones error with the lives that were lost by this atrocious ABIM publication. I don't expect that the ACC will review their own database and extrapolate the number of non-culprit vessels in patients that were not treated to determine the number of Americans KILLED by their social justice program.

I guess that is the definition of social justice and these dead Americans are just a bump in the road to cost savings for society. In the meantime, Dr. Jones career is cratered while the executives at the ACC and ABIM ride off into the sunset over the corpses of dead Americans--victims of true incompetence.

Anonymous said...

Someone once said to never let a serious crisis go to waste. This crisis is an opportunity to rethink the meaning and purpose of physician credentialing.

At a minimum, no licensed physician who has graduated in good standing from a ACGME-credentialed residency program, who is in good standing with his/her state medical board, who is current with CME, and who has a reasonably clean malpractice profile should be denied hospital privileges or participation in insurance plans. With midlevel providers assuming the privileges and responsibilities once reserved for general practitioners, it is unconscionable and impractical that a physician with an umblemished record should not be able to practice unfettered as a general practitioner regardless of board certification. An added layer of protection for the public is provided by ever expanding physician quality metrics that can be easily accessed by the public.

Beyond that, most board certifications should be a truly voluntary achievement. A mark of scholarship and competency achieved after completing intensive training in an actual consultant-level specialty. It could be argued that internal medicine is no longer a true specialty, since for all practical purposes it has devolved from consultant-level practice to simply "primary care." Internal medicine could re-invent itself as a true specialty by reserving internal medicine board status for those who have completed fellowship-level training in internal medicine and passed an examination following fellowship. Short of that, it is becoming increasingly difficult to understand the relevancy of ABIM certification.

Robert Weinmann said...

It is reasonable on the basis of this series of publications to assume that a formal investigation has been launched by IRS to assess whether or not the ABMS and its contingent boards have used IRS Form 990 properly, e.g., have all the names or persons and organizations that should be included been named? Are the figures accurate? FTC needs to examine if there's evidence of interference with legal business practices. Because of the federal and statewide sweep of the practices involved, it is reasonable to expect by now that states' attorneys general have expressed interest in addition to the IRS and FTC. If not, why not?

robert L. weinmann, MD, Editor, The Weinmann Report, www.politicsofhealthcare.com

Film maker and critic said...

ABIM. Grim Reapers of Finance!

The obduracy and silence of these professional medical politicians is frightening. They are literally sowing a field of morbidity and worse for Americans--particularly the chronically ill and vulnerable populations.

These elite representatives of "quality measurement" are hard to stomach. They profess medical equity; yet they blind side us with ethically unacceptable policies which harm the public health and its professional providers.

These grim ministers of finance create chaotic conditions as they test physicians to death, reaping a bumper harvest of dollars for themselves.

Is it the terror beyond our borders we must be concerned with? Or is it we ourselves that we must fear?

--Interesting articles in Newsweek, your blog, and many comments. Thank you for alerting us of this medical/ethical/political situation which most of us are totally unaware of. This is my take on it.

Anonymous said...

Did anyone happen to notice the new guidelines for cardiac arrhythmias that were released on-line in JACC today (assuming anyone still reads it)?

Did anyone notice who was the lead author of the new guidelines? It was none other than Dr. Sana Al-Khatib!! I wouldn't blame you if you didn't recognize her name but I am sure everyone is familiar with the paper she published years ago which coincided with the investigation by the Justice (just us) Department into inappropriate placement of ICDs. Her review of the ACC database suggested that up to 30% of ICDs were unnecessary. I am certain that nearly every hospital that employees an EP who implants ICDs had their judgement impugned and had to pay a fine to the Justice Department. The flaws in the paper by Dr. Al-Khatib are voluminous as described by the letters to the editor but who cares. Any journal article with an iota of credibility will be published if it discovers guideline violations.

I bring this up to highlight the social justice of our professional societies. When a cardiologist attacks the illusory abuse/overuse of procedures, they are promoted to chairperson of a section promulgating more guidelines. The vast majority of these guidelines are not evidenced based. Of course, the guidelines ALWAYS lean towards a less invasive approach to keep the folks at Kaiser Permanente happy.

There is a bright future in store for Dr. Al Khatib. She is a rising star who will soon have her own condo and limo.

Consumer Avocacy Group said...

ABIM's pre-Halloween Chill with the Same Unpleasant Taste of Money and Crony Politics

Cosmetics can't change a monsters face.

ABIM produces a chill up my spine when I think of their corruption, influence peddling, and the self-appointed political action machine, which they have created over decades of insider efforts.

Just like a Halloween character, their bony fingers reach far inside the DC Beltway. But they hide it with cosmetics. Always!

Never let their costumes, appeasing words, or pleasant faces fool you!

And they (officers, and others) get paid far more than any laboring physician or politician for their hypocritical brand of cronyism. The ABIM officers write their own contracts paying themselves exponentially more than any public servant.

The mask grows thin and the real face beneath appears.

The 'heinous lie' is they pretend to be a testing company. What a façade!

Only a few days after Eichenwald's article "To the Barricades" more of their brand of hype and cronyism pokes through the 'suit and tie'. This time it comes from a fake consumer advocate website (and published in Forbes magazine).

I have never seen a website with authorship that reeked more of special interests.

How ugly can you get!

How undignified and corrupt can writers of consumer advocacy get sporting their experience and educational degrees on the website like elephant trophies. I am completely disgusted in Steve and his team of head headhunters for stooping this low!

Here it is, if you are not afraid of ghouls, shadows and darkness:

More hoarfrost and cronyism just inside the DC Beltway. (This should be the real title for the American Consumer.)


Consumer Advocacy said...

Forbes Anti-Physician Article: Author's Reticence to Say the Monsters' Names.

If you look at the above referenced article by AmericanConsumer closely you will see that he carefully left out the names of the monsters ABIM or ABMS.

It is a pattern of the media industry to obscure your paid for hire writing. Never respond to inquiries is the other rule of thumb. Steve obviously does not like what he wrote either and wants to divorce himself from this kind of "paid for hire" consumer advocacy. He does not want to risk his reputation having association with the ABIM and ABMS; and perhaps for additional legal reasons.

Any honest reporter that looks at such articles as this recent Forbes Science and Tech head fake of Steve's boils inside with rage on the lie (BS) meter. (No gut instinct needed.)

Out of respect to the AmericanConsumer author's reputation I will not give his full name out.

My main concern is to the public that they do not fall for this kind of BS written for pay or personal favor. Ignore it!

Anonymous said...

Meanwhile Dr. Jones is replaced by a nurse practitioner who has a year or so of education beyond nursing school... And the NP is "board certified" for $395 or as low as $270 if he is an American Nurses Association Member. Recertification every 5 years is as low as $200 for ANA members and proof of professional development which typically consists of practice hours and continuing education.
Home study course book is only ~$100, three day board review course is <$500, and has PASS rate >99% http://www.npcourses.com/
And the NP Requirements and options for renewal of certification (page 22-23) are:
Option 1: Recertification by CE and Clinical Practice Hours:
• 1000 hours of clinical practice as a Nurse Practitioner appropriate for the population of certification.
• 75 hours of continuing education (CE) applicable to the Certificant’s population focus. [Starting in 2017, this will be 100 hours (25 of the 100 hours must be pharmacology credits and Optional: a maximum of 25 of the non-pharmacology CE credits may be replaced by preceptor hours at a conversion rate of 120 preceptor hours replaces 25 non-pharmacology credits.]
• Hold a current and unencumbered RN or APRN license during the period of certification.
• Requirements must have been met within the current 5-year period of certification.

Option 2: Recertification by Examination:
• Take the appropriate National Certification Examination that is congruent with the Certificant’s education.
• Hold a current and unencumbered RN or APRN license during the period of certification.

An experienced MD who knows what he/she doesn't know should not be driven out of practice in favor of an NP who never had the training and experience of a physician.
However there are some things that may make sense here: requiring half day per week of practice for board certification would exempt the ultra-clipboard doctors from board certification. Certainly I would not choose her as my physician.

Anonymous said...

I agree wholeheartedly. The noble thought behind the MOC allowed for the ABIM to be granted more power than it could handle. As all entities that exist to raise money for itself by power abuse, it had to come up with justifications for the increased cost. It does that with this every 2 years and 5 years mod points. Thus, the noble idea has taken a downfall. I for one do not feel that it is right or just to simply rent my board certification. Thus, it is time for MOC to disappear entirely. Further, perhaps it is time for the ABIM to be moved out of the state of Philadelphia so that individuals who are currently in charge will never have the opportunity to do so again.