On the Anniversary of the ABIM's MOC Mea Culpa

Happy (belated) Anniversary, ABIM!

It's been over a year since you told us your now famous mea culpa message that said you "got it wrong" with your Maintenance of Certification (MOC) program.

And yet the program still continues despite everything your colleagues have disclosed about this travesty to our medical profession.

Let's review what you've done instead:

• You've suspended (temporarily to the end of 2018 when MACRA blossoms forth) Part 4 of the MOC program with its Practice Improvement Modules and Patient Safety and "Voice" sections because you were caught red-handed performing research on physicians for your own gain.


• You've finally stopped making residents pay for "maintaining" their certification before they even sat for their first certification examination.


• You also stopped requiring that physicians subject themselves to a "double jeopardy" situation where those with more than one Board certification had two pass BOTH examinations to maintain each one of their certifications.


• You also made sure you took down the comment section on your blog. So much for transparency and a sense that you really cared what your practicing colleagues thought about your program.


• And now, according to Stephen Weinberg, MD at the American College of Physicians in a recent email to ACP members, you've been "addressing any factors that might be contributing to the relatively high failure rates" by "making changes to the most recent internal medicine MOC examination administered in October" and "changing the process" for setting the pass rate cut-off resulted in ABIM reporting "a notably higher pass rate for the 2015 Internal Medicine MOC examinations." It seems those declining pass rates that you dismissed in your Medscape interview were getting lower after all.

But what STILL hasn't happened more than a FULL YEAR later is tell us about all about the money and the secret deals.

• You haven't explained why you funneled over $70 million of our testing fees from the ABIM to your secretly-created ABIM Foundation.


• You haven't explained why you paid Christine Cassel, MD a whopping $8.9 million from May, 2003 through 30 June 2013 and allowed her to earn another $1.9 million from Kaiser Foundation Health Plans and Hospitals and $230,000 in cash and stock from Premier Inc while she was supposedly working full time at the ABIM. And why on earth did Ms. Langdon - a non-physician administrator - deserve a bonus of over $297,646 in fiscal year 2012? Was it because of all those sanction letters she sent out to physicians acusing them of cheating?


• You haven't explained why cash-flush ABIM Foundation had to purchase a $2.3 million luxury condominium complete with a chauffeur-driven Mercedes S-Class town car. Was it really as an "investment" or was this another perk for Ms. Cassel as she and her husband flitted back and forth from Philadelphia to their home in Arizona?


• You also haven't disclosed how test and physician demographic and practice data, paired with your unproven re-certification metric, are being sold to the likes of CECity Premier, Inc and others for political and personal favors.

It is now clear to practicing physicians everywhere that you can't let go. That's what happens to people who have an addiction problem. Given these and prior actions it is clear you have an addiction. You are addicted to spending other people's money. And we understand that when an addict is caught with their hand in the cookie jar, they get creative with new ways to support their habits and obsessions. They change the rules. They make fellow doctors co-dependents. They make others feel guilty for not playing the game and not paying in. They even result to strongman tactics with threats of revocation of board status and using threats of Copyright infringment to protect the money flow.

Anyone who has ever had a loved one caught in this viscous addiction cycle understands. This is what the hostile-dependent relationship with an addict looks like: untrusting, two-faced, dysfunctional, love-you-one-minute-then-stab-you-in-the-back, sneaky.

From the very beginning when time-limited board certification was introduced to the physician community, this is what how you and your supporters framed it::

Previous attempts by the ABIM to mount programs of voluntary recertification for non-time-limited certificate holders had met with only limited and declining interest. Over four exams, only 8621 candidates were issued since 1974. The last of these efforts, the Advanced Achievement in Internal Medicine exam given in May 1987 attracted only 1403 registrants from an estimated pool of over 40,000 eligible certified internists despite extensive marketing efforts by the Board. Thus, the stage was set for the Board to embark on an era in which diplomats would be asked, but not required, to renew the validity of their certificates at periodic intervals or face the uncertain consequences of loss of their status as certified internists, subspecialists, or holders of certificates of added qualification." (emphasis mine)

Back then as it is now, the ABMS/ABIM MOC participation was born upon a strongman/boss approach, not on proof of its value to patients or our profession.

But there's still time. You can start your 12-step process, but first, you must admit you have a problem. Committing to an $85 million lease through October 2040 and shaking down your fellow physicians for your extravagent ways is part of the problem. But you know and I know there's even more behind the scenes. You really don't want us to tell the rest of the story and all of the sneaky and disturbing ways you secured your monopoly. This story is very messy, Gruber-esc, indeed. It will take bravery and resolve, but you can do it.

Here's how.

I would suggest you come clean. Stop trying to clean up your horrible MOC mess. Change your bylaws to one that supports working physicians, rather than yourselves and your "stakeholders." Insist that ALL financial and political efforts be disclosed - that's right: ALL of them - including all of your leadership and directors' securities deals and consulting arrangements. Disclose all of the fees that flow between professional societies, medical journals, and other members of the ACGME hierarchy as well. Dissolve the Foundation and return the money to those who funded it: practicing physicians. Make certification free for the next ten years (the same amount of time you (quite literally) stole from us for your political agenda). And stop insisting that MOC can be improved when it's clearly little more than a corrupt, dysfunctional, and untrustworthy self-created credential for your income stream. MOC (and all the sickening and non-transparent permutations that keep getting created) needs to end completely.

Because here's a secret: clinical doctors won't participate in this program without these actions to dissolve MOC, no matter how much pressure you and your cronies apply.

-Wes
Reference: Glassock RJ Benson JA, Copeland RB, Godwin HA, Johanson WG, Point W, Popp RL, Scherr L, Stein JH, Tounton OD. Time-Limited Certification and Recertification: The Program of the American Board of Internal Medicine. Ann Intern Med 1991; 114(1): 59-62.