Tuesday, September 08, 2015

Why the History of the Specialty Boards Is Important

According the American Board of Medical Specialties' website, the creation of the first medical specialty board was widely attributed to the ophthalmologist Derrick M. Vail, Sr., MD  because of remarks he made in his presidential address to the American Academy of Ophthalmology and Otolaryngology (AAOO) in 1908.  In 2012 while researching the origins of modern-day specialty boards, Denis O'Day and Mary Ladden from Vanderbilt in Nashville, TN performed a historical literary criticism of the ABMS's assertion that the ophthalmologist Derrick M. Vail, Sr., MD conceived of the specialty board system. By O'Day and Ladden's careful research, the true origin of specialty boards was likely created over a 12-year period by much of the work of ophthalmologist Edward M. Jackson, MD whose "Education for Ophthalmologic Practice" presidential address four years earlier at the AAOO meeting in 1904 sewed the seeds for board certification education system as we know it.

In their paper, O'Day and Ladden published the sentinel characteristics and principles embodied in the American Board of Ophthalmology (the "first" specialty board), the American Board of Medical Specialties, and its Member Boards:
(Click to enlarge)

Today, many of these founding characteristics and principles have been cast aside long ago, specifically, (1) the "Board does not determine the ability to practice" and (2) "Board directors serve without compensation", and (3) "Certification is voluntary."

For instance, with Maintenance of Certification (MOC), a trademarked product created by the ABMS, the program goes much further and is increasingly tied to hospital credentials and is now thoroughly incorporated into the new Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ensconcing the program with the US government and will impact how physicians are paid after the law takes effect in 2019.  So much for the ABMS principle of "not determining the (physician's) ability to practice" or keeping the ABMS "a non-governmental entity."

Also, the entire 24-member specialty board system of the ABMS is mired in large conflicts of interest created by their physician officers earning millions of dollars in compensation on the backs of working physicians.  Only the National Board of Physicians and Surgeons (NBPAS.org) has unpaid board members for its recertification program created to compete with the AMBS MOC program, yet is still at its infancy of being accepted by hospitals in the United States.

Clearly, the original creators of specialty boards recognized the potential for conflicts of interest to arise when non-clinical physicians earned handsome incomes regulating their peers and worked to limit such conflicts.  This is clearly not the case with the ABMS today.

As history reminds us, board certification was once performed to assure the proper education of specialty physicians, not to assure a money stream to the boards. "Re-certification," it seems, is little more than a means to subsidize the overpaid leadership of the ABMS and its member boards.


P.S. Be sure to listen to Paul Tierstein, MD's NPR interview that aired yesterday for more on the origins of the NBPAS.


History of the ABMS. ABMS.org website. Archived Jan 31, 1998. Available at: https://web.archive.org/web/19980131095657/http://www.abms.org/history.html 

O’Day DM and Ladden MR. The Influence of Derrick T Vail Sr, MD, and Edward M. Jackson, MD, on the Creation of the American Board of Ophthalmology and the Specialist Board System in the United States. JAMA Ophthalmology Feb 2012 130(2): 224-232.


Anonymous said...

Corruption of the Specially Boards with a Particular Focus on an Important Juncture in the ABIM Timeline

The ABIM is only one example of the distortion of the original concept of a "specialty board" and its eventual corruption on many levels.

There are key moments in this historical timeline and marked deviations from the original intent that are noteworthy. Look at the signatures on the articles of incorporation and the amendments and the dates. Why were they changed and by whom. For what entities or for what purposes?

The specialty board's original concept of "quality measurement" for the ABIM radically changed well before the Social Security ACT of 1965. This is a fact.

By 1965 the ABIM was already fully placed in the pocket of corporations like "Big Tobacco" supporting the "ambiguity" of the link between cigarettes and cancer. See Dr. Thomas Brem's testimony before the interstate and foreign commerce committee in 1969. The links and the corruption are obvious, particularly when the Surgeon General blasted cigarette smoking in 1964. Brem was mad chairman of the ABIM in 1965.

Note also that he considered the ABIM to be a "membership society" at the time. He lists himself as a member and also former Chairman, etc, in his testimony. This clearly shows that certification had another meaning in the past, which was intellectually altered and quite cleverly afterward. A study of that will lead to many legal and medical implications of the concept of specialty board. Brem was in full understanding of the facts and how to alter medical fact to serve corporate interests and not the public. That is criminal. We can see clearly that this demarcation point indicates the start of the "new ABIM" and the new purpose of the specialty boards.

Big Tobacco and the ABIM as represented by Thomas Brem, former chair and tenured board member.

The ABIM began to serve "insurers", acting as lobbyists for the federal government and corporate interests during the 1960's and 70's.

The ABIM became institutionalized in 1975 "in perpetuity" unfortunately to serve medical bureaucrats financially and their political agendas.

When hard money and core politics came aboard the "quality ship" it sank. It took medicine and doctors down with it. Instead of supporting physicians, physicians supported the various aspects of its corruption.

A study of the corporate/governmental corruption involved many of the chairman and later "independent executive directors". It was just as much about lining the pockets of the officers as serving their corporate and political agendas.

It is a sickening story that needs to be told and acknowledged in full and in all of its corporate and political dimensions.

Tenured board members know these facts or have access, but have chosen to withhold them from physicians and the public.

This failure to research and report the truth on the part of the specialty boards and in particular the ABIM is reprehensible and criminal in nature.

That is where we are today. Floundering around a ship that should have been scuttled long ago. We are led by a deviant corrupted institutions and the bureaucratic milieu of officers the serve not the public but themselves and corporate and governmental concerns.

ABIM is a cancer that needs to be surgically removed from society to prevent further harm to the public.

Anonymous said...

A Dynasty of Corruption. The Making of the ABMS Boards and Executive Leadership.

It enrages me that ABMS's dynastic lineages of professional medical politicians "pulled a fast one" lying to everyone with their clever invention of MOC. I find it outrageous that physicians, who are the intelligent trusted decision makers in medical care, were unwittingly duped in a scam designed to line pockets of elite medical professionals and further hidden political and corporate agendas.

The current journalistic investigation of the ABIM clearly reflects the same overall pattern of corruption at the ABMS and each of its specialty boards. It reveals how the "bureaucratic medical business" was conceived and executed. MOC as a scam and scandal involves all of the "boards" and their "independent executives."

Dynastic lineages were created at the ABMS specialty boards to work political and corporate magic serving "special interests", while controlling physicians and not serving them. ABMS executives inured themselves with lucrative payouts never allowed under the original articles of incorporation and their humanistic charter with patients and US taxpayers.

Easy cash and loose time written into the perfect executive contract allowed unelected bodies of skillfully manipulative medical politicians to zealously alter the course of medical history by digging their spurs deep into the backbones of hardworking physicians; men and women who have sacrificed their lives trying to make a difference in patients' lives where it matters most--in real personal exchange with patients providing meaningful and effective care.

Politically motivated bureaucrats at the ABMS altered that ancient sacred trust by playing with medicine in the name of greed and politics. I think this should be clear now. It never was about "quality measurement" or "social justice"; only in name. It was and still is all about corporate and government interests and personal bank accounts.

While acting like demiurges, ABMS's succession of bureaucratic medical professionals, each with their own autocratic style of leadership steered the ABMS medical ships toward shores that favored, not the patient, but the bottom lines of corporations and government's need to cut costs.

MOC was a means and is now a deflection from seeing the real aims of the ABMS and their related web of "not-for-profit" bureaucratic medical corruption.

Any trust in these political elites and their "false idols of quality measurement"--which physicians and the public were forced to worship--has vanished in a wrecking ball of unrelenting self-destructive bureaucratic medical malpractice involving lies and irresponsible financial behavior.

The ABMS has lied to their theoretical statistical patients, which they never cared one bit about. ABMS has misled physicians with financial inurement, misstatements, and covered-up "errors" that have caused the present structure of bureaucratic medicine to unravel at its "seamless" seams.

What we are discussing is worse than any corruption we might find in world soccer like the current FIFA bribery scandal. Soccer is entertainment; ABMS affects the life and death of millions of patients!

Where is our Department of Justice? Instead of FIFA (world soccer executives), the DOJ should be utilizing its resources investigating and charging people involved in these real forms of bureaucratic medical bribery and vital life-threatening issues involving our vulnerable public here at home in the United States!

We have domestic threats involving bureaucratic medicine of much more severe and far-reaching consequences. Where is the DOJ, the OIG, Senate Judiciary and Financial Committees, and the state Attorney Generals? Where is the Medical Advisor to the United States President!

Anonymous said...


Concerning the ABMS and ABIM today: there is a breech of trust and cloud of suspicion forever among informed physicians who now have an intimate knowledge of the facts.

ABMS specialty boards have become the victims of the unintended consequences of their own self-serving desires and actions. An empire of political power--now just tainted images of greedy administrators who are out of touch with medical practice. But not out of touch with "big corporate politics" and "the religion of fast money" which they personally follow and receive.

The ABMS and its "not-for-profit web of corruption" produces grave harm to patients and physicians. ABMS is a self-serving, self-inuring institution serving not the public but corporate and government interests.

Anonymous said...

Many of the 9 founding members of the ABIM in 1936 were also active leaders at the ACP and AMA.

Below: some relevant history and thoughts from the 1936/37 documented in the ACP Annals.

Some articles of interest: ABIM's Iowa based founder Walter Bierring. On the Growth of Specialism, 1937 ACP Annals.

ABIM incorporation, 1936

ACP nominations 1936

ACP business minutes 1936 (investments and purchase of home)

Michael Gilbreath said...

Wes, Sent you a little more history via FB file transfer. Michael Gilbreath

Anonymous said...

Interview with David A Benson, MD
An Oral History Project, OHSU 1999

Mention of former ABIM president David A Benson's ABIM mentors Drs. Saul Farber (Chairman), Lewis, and Jones. Kaiser, RWJ Foundation, etc.


Anonymous said...

ABIM diplomates get "boarded to death" while men like Thomas Brem, who lobby for Big Tobacco, become chairman of the ABIM, president of the ABMS, and later gets a prestigious "Chair" at a major medical school in California named after him!

Christine Casell has "inured her way to the top" as current POTUS advisor. What Chair will be named in her honor to go along with all the other honorary attributions?

Are we any smarter now in 2015 than we were in 1965, 75, 85, 95, 05? I'd like to believe we are more intelligent. But we seem to lack the moral power to act and do what we need to do in order to change things for the better in this time of medical crisis.