Friday, February 12, 2016

The American Rebellion is Hitting the House of Medicine

From Peggy Noonan:
We’re in the midst of a rebellion. The bottom and middle are pushing against the top. It’s a throwing off of old claims and it’s been going on for a while, but we’re seeing it more sharply after New Hampshire. This is not politics as usual, which by its nature is full of surprise. There’s something deep, suggestive, even epochal about what’s happening now.
Physicians, too, are rebelling against the established sheltered and elite institutions of the House of Medicine: the ACGME. I can see it. I feel it.
I mention this to say we are in a precarious position in the U.S. with so many of our institutions going down. Many of those pushing against the system have no idea how precarious it is or what they will be destroying. Those defending it don’t know how precarious its position is or even what they’re defending, or why. But people lose respect for a reason.
So true. Greed does this to people. So does money.

It will be interesting to see where things land but one thing is for certain, the staid bureaucratic institutions within the House of Medicine are in trouble and they brought this on themselves.

-Wes

27 comments:

Anonymous said...

Dr. Wes, I truly hope we are at the beginning of a rebellion against the governing powers in medicine. However, I feel like the inertia is still not in our favor. The ABIM has still not provided any substantive answers to the many conflicts of interest that you have illuminated on your blog. I honestly don't think they ever will.

One thing I have always wondered is why don't physicians get to vote about the ABIM's decisions. For example, once you have a ABIM board certification you should get one vote. We could even vote to elect representatives to the board. What we have now is taxation without any representation. I'm embarrassed to admit that it took me way too long to figure out that voting is the last thing cronies at the ABIM want to happen. They know it would mean a quick end to their gravy train of money.

Anonymous said...

ABIM - it was a bad, very unhealthy relationship, but it is over now. I know too much to go back. Anything further just protracts the pain and abuse from them.

Victims of the ABMS don't understand the disdain they show toward physicians and patients. That's because the system has been rigged to favor the powerful and abusive. Present your case. The authorities looked over the scars and repeatedly told us just go home. Your swollen black eye from their repeated stonewalling and lies will heal. The financial stranglehold on your bruised neck is just a bad dream that you will wake up from.

The cover-up continues. The co-dependency is sustained by giving them their pound of flesh which all the 24 strongman bosses demand. They couch their words of "quality assessment" in formal language of "changing culture". Phone conversations are screened. They have supervisors or risk management lawyers listening to your private conversations if you don't walk the line.



Everyone who really understands their hypocrisy and deceit cringes.

What else can Rich Baron do except lie through his teeth to keep the status quo and gravy train coming? He is being monitored too.

Anonymous said...

Politics as usual at the ABMS. Lobbying for increased revenues through regulatory capture to feed the greed. MOC is bogus hocus pocus.

Anonymous said...

ABIM in La La Land. Does their stonewalling only confirm allegations of corruption?

ABIM's last chairman's conflicts of interest were given a free upgrade
by the DOJ on June 17th, 2014. But I'm not expecting any retrospective observations from Dr. Wachter on the subject of the ongoing Hospitalist Company's Medicare fraud and the US attorney's lawsuit.

Neither am I anticipating any apologetic or remorseful remarks on the subject of how his hospitalists' deliberate and systematic false upcoding put patients of IPC on the fastback for serious unintended consequences.

The question I want addressed is how we are going to change the culture of greed, hypocrisy and the self-righteous sense of entitlement at the ABIM and ABMS? It is apparent that change of culture at the ABIM will not come from within. ABMS has and offers no oversight regarding itself or its organizations. Their continued silence is most likely indicative of even more troubling revelations to come.

According to the ABIM Foundation everyone else in medicine needs an overhaul of culture, but nowhere in their expensive propagandistic literature do they mention their own outright deceit, or that the ABIM/ABMS are in a state of total moral crisis and financial ruin? They have never addressed any real issues surrounding their sensational fraud and egregious conflicts of interest.

Will these quality assessment and patient safety experts ever get their self-justifying heads out of lala land? Or will it be business as usual indefinitely with them?

I am anticipating yet another year of expensive ABIM forums and retreats at the Four Seasons (or elsewhere) where they can just sweep all their real issues officially under the table again. Baron and Nora will keep pretending while risk management teams and public relations outsourcing will only add to their already exorbitant costs. The whole of the ABMS is comprised of top-heavy organizations full of useless executives who appear to lack the basic abilities of simple honesty and direct speech.

But somehow this business as usual and the continuous state of psychological denial gives me hope. I am optimistic that a physician-led revolution will sweep this filth from the house of medicine. Legislative action can reverse much of the damage and the ABMS power structure. Adversarial court actions will expose the ABMS as a monopoly full or constitutional violations against its clients and their families. This is happening already.

Growing awareness of ABIM and ABMS fraud and egregious conflicts of interest is an important aspect, but only a part of the process of housecleaning.

lol said...

ABMS is a dissociative mess of top-down madness with the unifying seed being greed.

Anonymous said...

Capitulation has arrived. Despite massive corruption and collusion at the ABIM, the ABMS, the NQF and beyond, the appetite of the rank and file Diplomate for radical reformation is vanishingly tiny. Despite calls to overhaul the ABIM and fire Rich Baron, on online petition at PetitionBuzz has barely 180 signatures. Perhaps the only way to project the future is to let the predictions of tragedy to occur.

Let us face it. The DOJ, the IRS, the CMS will not investigate or prosecute Rich Baron et al. The ABIM will slither along and find a way to parasitically exist off the Diplomates. Diplomates are too preoccupied to mud wrestle with this morally bankrupt organization of bureaucratic tapeworms. The Diplomates have spoken. Rich Baron will keep his job and the $2.3M Condo with the Limo Service.

What of our fellow citizens? John Q. Public wants centralized bureaucracy to permeate all aspects of healthcare and could care less that 30 cents of every healthcare dollar is spent on red tape. One can argue he wants to pay more and more. Let him taste the bitterness of the future as more physicians pack it in.

How ironic would it be if the ABIM snakes, one day, are lying in the hospital bed that they made? What if Rich Baron, Christine Cassel, Bob Wachter, all wind up old, sick and are taken care of by the very system they helped construct? A faceless, army of MOC computer click bait automaton preoccupied physicians working 9-5, drained of any vigor by the vampires at the ABIM.

Dear Rich, Christine and Bob: what comes around goes around.
Payback is a real bitch.

Mary M. said...

Just Before the Fall

Is corporate and government lying the new normal? It is certainly true that physicians and patients believe that they can't trust the ABMS/ABIM any longer. This negative perception extends to most of the "quality assessment" bureaucracy, their top leadership and the industry itself.

A large global PR firm - Edelman - confirms that people perceive/believe lying to be the executive way today - as exhibited from the big corporations and from our government.

Edelman and others have corporate and government services spinning threads of propaganda for its naked emperors - coming with a hefty price tag of course. It could be argued that they take the worry out of lying for their clients. After all, that is what PR spin is about.

If we look at the running facts on the ground, corporate propaganda and executive lies comprise the overwhelming output of the ABMS and ABIM. This is their specialty and subspecialty - lying and propaganda. We can count on this output.

The ABMS has, with great pride in itself, appeared to replace the old medieval notion that the "devil" is the only reliable worker in terms of spinning lies. Now we can count on our ABMS/ABIM to give us our "daily work" observing and fighting "evil" in a very tangible and palpable form.

And what a web of lies they produce with the help of their well-paid arachnids.

In ancient times, and until recently, the wise teachers used to say that the world was created from above. Now the ABMS seems to reverse all earlier beliefs giving us a new credo that life sprang from hell. The ABMS is true to its modern assumptions when we look at their organization. They reveal themselves as a hellish cob full of accumulated filth straight out of Dante's Inferno.

Unbelievable? Well, just imagine the 2.3 million dollar "condo of earthly delights" with the words written on the door, "Abandon hope, all ye who enter herein!"
That is what their self-serving greed has really done to the face of medicine. Love really is the force that moves the world and quality, but even that divine passion has been caged and given its version of regulatory capture. So, do they claim to own "love" now also in their arsenal of foundational delights. They have our money. Now they steal even love from us as their property and export its wisdom abroad - for lots of personal money of course.

But there is nothing inspiring coming from them except the "look at me", "look at us forums" and how much change they have accomplished. How special. "We have changed the face of medicine!" That's what they say with such false pride.

Yes, you have changed the world, but wake up you airy political sprites! You have created a hell on earth.

Of course there continues to be massive dissent, but it is isolated. The ABMS bureaucrats quickly invent a series of surveys that will diminish those serious complaints of abuse down to zero in only a year or two. Then they eat cake together in celebration of their imaginary life. They imagine themselves to be part of the "one true medical community" changing our culture and all our lives for the better. I have never seen such a pure expression of hubris and sadism. Only in global myths, religious books, and fairy tales!

I advise everyone to catch this "freakish show" while it lasts. I guarantee it is a rarity in the history of the planet to witness such a pure archetypal expression of everything our ancestors and wise teachers warned us about.



Robbers rules of order said...

Philly Gazelle, 2/13/2016 Weekend entertainment

What's happening with the ABIM luxury condo? "Come on down and see me sometime."

Dickey's dacha is depreciating fast like an oyster out of water. Purchased at the 2007 market high as an "investment" for 2.3 million, ABIM is listing Cassel's condo for 1.7 million. There are two other units for sale at the Ayre. Hurry a 1-bedroom 1200 sq. ft. gem for 800K and 3 bedroom jewel for 2 million.
http://www.theayer.com/listing_view.php?id=97

I had my eyes on a 3-bedroom in 2013 listed at 4.95 million, but I think the bank laughed at the assessed value versus the asking price and monthly association dues of $xxxxx and would not issue a loan on the property. http://philly.curbed.com/archives/2013/03/14/10th-floor-condo-at-the-ayer-asks-495m.php

Here is a Zillow listing of properties sold at the historic Ayre building where "Baron's bungalow" is up for grabs to the highest bidder. Hurry such a house belonging to notorious Philly fraudsters, Chicago mobsters, and corrupt Washington lobbyists will not last long at this price. I suggest getting the Ayer 1-bedroom unit also where an infamous....
http://www.zillow.com/b/210-W-Washington-Sq-Philadelphia-PA/39.947146,-75.153379_ll/?view=map

Bring cash and we'll make a special deal for all three available units. No illegal structured withdrawals please. We like being straight up with the banks and IRS boys.

"All discarded lovers should be given a second chance, but with somebody else."
Mae (Jane) West

Dan said...

Great article above by Noonan from the WSJ. Thanks for bringing all these things to our attention.

Arbi Khodadadi said...

Maybe it was because that petition was written in apoplectic language wrought with hyperbole. Remember, we have right on our side, we don't need to resort to outrageous comparisons or stringent, belligerent language. That petition could have gotten a lot more signatures if it stuck to the facts, which paint a much more compelling picture rather than the colorful language used.

This core of this movement is based on lack of evidence and the obvious, non-transparent, non-accountable, financially conflicted nature of the ABIM.

Thomas Nielsen said...

Physicians everywhere: We are good people, but we are doing evil by our complacency.

I am writing this to every physician who is frustrated with the certification system that we have in place and that is becoming increasingly encoded into our laws. We have reached a crossroads in the evolution of health care in America. We, as physicians, have been under assault literally for decades.

We have suffered degradations and loss of prestige as an army of administrators has constructed a fortress of policy around the hospitals and issued ‘guidelines’ which now are treated as treatment mandates for our patients. And, I am very sorry to say, many of us have been complicit in this tragedy.

Some physicians have been overtly complicit by taking non-practicing administrative positions and dictating not only how we should care for our patients, but also implying that we are not competent to do so. Many others have been silently complicit, as we have sat by and let the rot set in. As the great theologian and anti-Nazi dissident Dietrich Bonhoeffer said “Silence in the face of evil is itself evil: God will not hold us guiltless. Not to speak is to speak. Not to act is to act.”

We are now subjected to MOC in order to somehow prove ourselves, when by the very act of treating our patients and looking up information to do so shows that we are dedicated to maintaining our profession. Our profession: that is what is being called into doubt and what many bureaucrats would like to do away with. Instead of dedicated professionals seeking out the best treatments for our patients, they would prefer us to be interchangeable widgets.

Enough! It is time for ACTION.

Our leaders have abandoned us, and it is not enough to moan and complain to your colleagues. I have faith that you will continue to keep your knowledge up to date, but it is time to STOP ALL MOC ACTIVITY. DO NOT PAY ANOTHER PENNY TO THE ABMS, ABIM, or whatever specialty board you fall under.

CALL the hospital executives. ASK about the bylaws. PROPOSE changes to any language regarding maintenance of certification, and make sure the NBPAS is included as an acceptable alternative. DEMAND that these things be discussed at the hospital board meetings.

To anyone who is grandfathered in, or beyond the last needed certification, you are HURTING MEDICINE if you do not act. You need to help the people behind you who may be taking care of you when you are sick and dying.

Nelson Mandela said “We fought injustice wherever we found it, no matter how large, or how small, and we fought injustice to preserve our own humanity.” This is precisely how we need to shape our fight.

We must take action. Signing petitions is not enough. You should call your hospital administrators on a regular basis and let them know that the physicians are not happy.

Burnout is at an all-time high, and good men and women are leaving the field of medicine in record numbers. The surveys show that it is bureaucracy and maintenance of certification that is driving good people away. We must put a stop to this. Do not hang your head and say that the fight is lost, because the very future of American medicine is at stake.

The administrators of every hospital should be harassed until every single hospital in this country accepts alternate board certification rather than the ABMS monopoly.

Be brave and act boldly. I will leave you with a last quote to remember when you have doubts. “You should never let your fears prevent you from doing what you know is right.” – Aung San Suu Kyi

sacredcowonaspit.com

Anonymous said...

Is this the petition you are referring to?http://www.petitionbuzz.com/petitions/abim-vote-of-no-confidence

I thought the petitioner stated their strong concerns about the ABIM as neutrally as possible. I did not detect hyperbole. The brave petitioner brought up very alarming facts that really should be discussed and turned into issues - even acted upon.

For instance, the whole medical community and ABMS umbrella should address the DOJ False Claims lawsuit against IPC, the Hospitalist Company which Drs. Adam Singer (CEO)and Robert M. Wachter as team leader/board director/quality chairman and other IPC prinipals are party to.

This is unprecedented and is being hushed up.

Look at the facts: IPC hospitalists were under pressure from management to systematically upcode on a large scale in all 29 states/locations that they operated, thus defrauding/cheating the HHS/CMS out of millions of dollars and thereby compromising patient safety.

Dr. Singer founded IPC in 1998 and Dr. Wachter joined the hospitalist training teams in 2010 profiting handsomely off the rapid stock growth and cash payouts to him and his university in San Francisco. As I am a native of the Bay area, I find this appalling and shocking. What I find most insulting and repulsive is that physicians are also burying this major issue of Wachter's hospitalist movement profiteering with IPC. IPC sold to Team Health after merging with countless hospitalist groups at the end of 2015. By selling a couple of months ago they were hoping to get rid of the problem and public attention. They sold on a high note with a premium offer.

Personally, I can't buy into an apathetic MOC movement that does not demand more from these "quality assessors", like Christine Cassel and Robert Wachter. I would push to have this IPC fraud case pursued as as a criminal case, which is what it is. Unless pressure is put on Chicago authorities at the US Attorneys office nothing will be done to punish our real criminals. These elite top-tier criminals are the same individuals who persecute physicians with onerous MOC. The same ones who hypocritically deprive SNF and other elderly patients of the health care they deserve.

Who will know if they did not do what they were supposed to? Right? The patient was gaga anyway!

It is absolutely sickening if the MOC movement or individuals through legislators do not start contacting the DOJ about this travesty of justice and double standard of our law enforcement system. I would be pouring into the streets and demanding change of this corrupt hypocritical legal system that pursues doctors across the country criminally for Medicare fraud - even putting them in prison - yet a golden HHS boy or silver NQF girl working closely with the government gets a walk.

MOC is here to stay and corruption is here to make MOC even more onerous and "user friendly" when the ABMS makes/completes their behind the scenes financial deals with medical societies, the CMS and AMA for a part of the control of physicians and share of the MOC take - even a share of the "at home" remote proctoring test fees. Physicians need to retain attorneys and get an injunction against any more MOC money being demanded and a freeze on Foundation funds spent on anything until a complete and thorough federal investigation is launched and completed.

Anonymous said...

What about...

Just as we should not shy away from palliative care issues, we must also discuss head on issues involving fraudulent billing and huge corporate profit pocketed at the expense of many vulnerable elderly Medicare, Medicaid and government retirees. This should be addressed.

How about forcing an investigation by the ABIM's office of the COO to consider revoking Bob Wachters certification and bring him in front of an internal panel of ABIM officers to engage the issues of patient safety and alleged billing fraud. I would expect nothing less of a fair transparent organization. But they are not. They are corrupt and present well to you and in a rare public appearance but they give physicians only endless empty words.

If I, as a patient, demand a much higher standard at the ABIM, why should a physician presenting a decent petition be accused/admonished for being apoplectic and not following your movement according to a narrow vision and aims it encompasses. That is frighteningly small to discourage someone with courage to get in line and tow the party line whatever that is.

I assume the movement's narrow aims are centered around the ending of recertification/MOC only. I hope I am wrong. But it is naïve to think that having right on your side is enough let alone change anything. It takes political savvy and organizational skills. The MOC movement should considering electing an interim team of volunteers to lead the new ABIM. I think no good has ever come from the organization so first order and last order of business should be to dissolve the organization and distribute the funds to another organization - a real non-profit scientific organization.

Anonymous said...

I agree with Wes, Thomas Nielsen and countless others.
It is time to speak out. It is time to act.
It is time to clean up the house of medicine.

Lisa said...

Yes, Wes, it is time to clean up the house of medicine. But people need to realize the extent that this is a self-inflicted wound. Every time a Doctor chooses to cover up for another Doctor, to the detriment of the Patient, the problem is enabled. This is largely a self-regulated industry (sad, that it's become an industry) with Boards that look after the interests of Doctors and profits. The scum rises to the top: now that scum is lorded over Doctors instead of just Patients. What was tolerated decades ago got promoted and is the bug up the butt of the house of medicine--Doctors are feeling the pain that Patients felt long ago and Boards stood by and allowed it. Selective clean up of only what is causing pain to Doctors is not enough. Deep down inside, you know it. Whenever someone says, "I'll cover up for you but just this once" bear in mind that individual may have had dozens of just this once's--and those are the people who can scheme their way into power. Now there's a painful price to pay for everyone.

ground zero patient said...

thank you lisa!

Anonymous said...

I've been in practice for over 30 years and have never heard someone say "I'll cover up for you."

Arbi Khodadadi said...

I did not sign it because the language was too strong. We can focus on "being right," or we can focus on winning. I suggest doing the latter.

Anonymous said...

So-called "healthcare reform" was a well-oiled highly financed decades-long corporate plan. Not an accident. From Johnson to Nixon; from Ford to Obama!

Anonymous said...

MOC has been a mere tool in the corporate/political machinery to dominate and control/steer the healthcare industry by shaking down and manipulating phycians.

Ashok V. Daftary, MD, FACP. said...

The rot was apparent nearly a decade ago
In the Annals Of Internal Medicine (Jan 3 2006)

Improving Patient Care | 3 January 2006
Who Is Maintaining Certification in Internal Medicine—and Why? A National Survey 10 Years after Initial Certification
The authors will be familiar to most of the readers

Rebecca S. Lipner, PhD; Wayne H. Bylsma, PhD; Gerald K. Arnold, PhD, MPH; Gregory S. Fortna, MSEd; John Tooker, MD, MBA; and Christine K. Cassel, MD

Their conclusion
"The most surprising finding is the relatively large proportion of general internists (21%) compared with the small proportion of subspecialists (5%) who claim to be working in a medical field other than internal medicine."
"The fact that a higher percentage of physicians who completed the program claim that is required by their employer suggests an external influence on participation rates, although it was clearly not the most compelling reason stated for participation."
"fewer than half of all respondents perceived the program requirements to be appropriate."

Let us examine what is happened in the intervening years, Primary Care Internal Medicine is on life support.
Hospitalists are burning out and the corporatization of healthcare is near complete
ACGME has winnowed clinical hours for current trainees to levels that do not allow adequate clinical exposure.

There is an underlying common factor....The ACP, NQF,ABIM ACGME have revolving doors and the exits open to new positions on other boards

Much Like Washington eh?????



Anonymous said...

Lisa, your input is always insightful, but does the image of cover-up you paint match the facts? I would appreciate to hear more of what you have witnessed. None of us has a bird's eye view of the whole, but I would say with the last poster that I've never heard of such a thing personally. I can think of some administrative cover-ups and institutions committing possible billing fraud, but they were addressed.

But there's something I am concerned with. If we look at the IPC billing fraud, Robert Wachter, Adam Singer, Ronald Greeno and others, this is a hospitalist cover-up of unprecedented dimensions. There could have potentially been thousands of physicians who worked for IPC between 2003 and the present who participated and were instructed to comply with he pressure to upcode or potentially lose their job. They had harsh restrictive covenants with threat of legal enforcement. E-mails indicate that management was instructing folks to say nothing about the up-coding.

What kind of quality, safety, ethics and law and order message is Robert Wachter, Adams Singer, Ronald Greeno and the rest at IPC sending to the hospitalist movement and all the other ABIM/ABMS phycians? Especially since Bob Wachter was one of the first presidents of the Society of Hospital Medicine and father of the hospitalist movement. He was chairman, director, and trustee concurrently at the ABIM. Dr. Wachter also works for the HHS.

What signal does this alleged fraud send to the guest speakers and participants at the upcoming SHM conference in San Diego in March?

http://www.hospitalmedicine2016.org/program/featured-speakers/

And if this gets covered up is not Lisa, right in her statement? Please put on your thinking cap and look at the list of guest speakers for SHM 2016 above.
The lawsuit is a federal whistleblower false claims act document filed in Chicago. The original accusation comes from a physician who worked for IPC. The Federal Government intervened and filed the case in June of 2014. CMS and other federal payers have been defrauded.

Anonymous said...

If the ABIM did to me as a private business man what they did to you physicians, I's own a lot of real estate in Philly, Chicago, San Fran, Jersey and DC.
Get some real legal advice and weaponry. Then back it up with political ammunition - or hang it up.

Firestorm "we got it right" petition said...

A love of democracy, love of our profession, and love of the patient will drive this movement and the promise of greater fruition of each specialty. The three clear principles of this simple but decisive movement and plan of change are:

1. To create and sustain fair and democratic elections for all board positions. 1.a End the executive position; it is corrupt and expensive. 1.(b) Make the board a voluntary time limited position of one year only. Out of pocket expenses only.

We must remember that we the United States of America ensures fair democratic elections in countries all around the world. This will be an exciting new change and will invigorate medicine through a spirit of cooperation and shedding an old worn out skin. Let's get the Carter Foundation (or another) to adjudicate and help set up the elections. If we don't have democratic principals we are a very poor, hypocritical example for the rest of the world.

This democratic spirit will also invigorate and stimulate the medical specialties societies and bring a flood of much needed money for educational materials in order make CME the very best available to physicians who choose to meet their state CME licensure requirements in part through their voluntary society.

2. End maintenance of certification.

3. Voluntary lifetime certification for all with no ties to employment. 3(a) Lobby for clear legislation that ensures/makes it illegal for government or private payers, employers, or any stakeholders to tether employment to a specialty board certification. 3.(b) No CME requirements should be required to maintain certification. 3.(c) Leave CME between the physician and the state licensing boards.

This is a fair honest solution to the dilemmas that we face. I encourage the ABMS and the medical specialty societies to begin working on these changes in order to make it fair and democratic; but moreover, to restore the American healthcare system into the brightest and healthiest star in the constellation of developed nations again.

Free and Fair said...

Changing the ABMS and the 24 Medical Specialty Boards: transitioning to free, fair and democratic elections of officers - this year. Three simple and honest solutions.

ABMS and each of the 24 participating medical specialty boards need to be contacted that change is needed and that meaningful change will be coming soon to each organization.

The defining message: Democratically elected officers for each medical specialty board is necessary and overdue.

We need to call upon our medical specialty societies to arrange for free, fair and democratic elections. The specialty societies have each in their way decided to listen to the needs of our evolving times. There is a strong movement in the United States for fair representation responsive to the will of the people. We need to embrace this principle in our healthcare community as well - especially the quality assessment organizations.

We need this change now. It is vitally important before indecision, distraction and division destroys the house of medicine - harming all who participate in the system.

The foundational principles that the United States was founded upon are proven to be sound and have created one of the greatest countries today. Democracy will charge the ABMS with intelligence, creativity and vitality that it has lost. Only a democratic spirit - a simpler, highly focused organization without executive financial temptation and involvement - will renew the ABMS into a supple, highly respected, transparent organization.

Elections and transition will be fairly simple. Current leadership will be highly regarded as the initiators who helped launch a bright fresh beginning to the ABMS by bringing democracy home to thrive there. As such society and board members and officers will be recognized as the major contributors to the transition.

Medical specialty societies who have political power and wish to have more to offer to physicians are in constant communication with the ABMS specialty boards. Many societies have ABMS members that can certainly arrange to usher in this new era of democratically elected officers to run the certification boards.

Medical specialty societies also have the power to ensure that our laws protect physicians from abuses experienced today. These include helping write and propel simple legislation in Washington to decouple employment from holding a certification. Medical specialty boards and respective societies have the power to end MOC even before the establishment of free and fair ABMS democratic elections.

Free and Fair 2 said...


A love of democracy, love of our profession, and love of the patient will drive this movement and the promise of greater fruition for each specialty. The three clear principles of this simple but decisive movement and plan of change are:

1. To create and sustain fair and democratic elections for all board positions. 1. (A) End the executive position; it is corrupt and expensive. 1. (B) Make the board a voluntary time limited position of one year only – reimbursement for out of pocket expenses only.

We must remember that we the United States of America ensures fair democratic elections in countries all around the world. This will be an exciting new change and will invigorate medicine through a spirit of cooperation and shedding an old worn out skin. Let's get the Carter Foundation (or another) to adjudicate and help set up the elections. If we don't have democratic principles we are a very poor, hypocritical example for the rest of the world.

This democratic spirit will also invigorate and stimulate the medical specialties societies and bring a flood of much needed money for educational materials. This will help make CME the very best available for physicians who choose to meet their state CME licensure requirements in part through their voluntary society.

2. End maintenance of certification.

3. Voluntary lifetime certification for all with no ties to employment. 3.(A) Lobby for clear legislation that ensures/makes it illegal for government or private payers, employers, or any stakeholders to tether employment to a specialty board certification. 3.(B) No CME requirements should be required to maintain certification. 3.(C) Leave CME between the physician and the state licensing boards.

This is a fair honest solution to the dilemmas that we face. I encourage the ABMS and the medical specialty societies to begin working together on these changes in order to make the boards and societies fair and democratic; but moreover, to restore the American healthcare system into the brightest and healthiest star in the constellation of developed nations again.

Anonymous said...

Robert Wachter has done it. The digital hounds have been released on the NHS heath.
You start with skepticism (a foggy UK place) and then you move to the product line that works. (the virtual barking hounds from your own backyard kennel.)

“I call it ‘The Safety Deposit Box Theory’ – you need two keys to unlock this… one of them is that the work needs to be reimagined… the second is the adaptation of technology.”

— Robert Wachter, UCSF

http://www.theguardian.com/society/2016/feb/17/nhs-digital-paper-technology-work
https://nuffieldtrust.squarespace.com/digital-technology
http://medcitynews.com/2016/02/uk-health-it-remote-patient-monitoring/
https://medium.com/public-innovators-network/how-do-you-smooth-the-path-to-a-digital-nhs-ea6da4db9c36#.tr6vc3jmu
https://thedianerehmshow.org/shows/2016-02-09/improving-doctor-patient-communication-in-a-digital-world

Following the BMW Twitter takes you to strange medical places.
https://twitter.com/Bob_Wachter?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor