Monday, September 26, 2016

Just Dues

She reached into her large canvas bag and handed it to me. “I read about your award, Dr. Fisher, and wanted you to have this to remember it by.”

I was stunned (and a bit embarrassed). “Thank you, Ms. Smith (not her real name).” There in my hands was a beautifully engraved replica of the front-page story in “The Journal,” the local National Naval Medical Center bulletin describing the Young Investigator Award I received from the North American Society of Pacing and Electrophysiology (NASPE) in 1992. Looking back, it was one of my proudest achievements in my young medical career that I can remember. That experience taught me how to do credible research, speak at a scientific session, support my work in a public forum, and write a scientific paper. Ultimately, the award opened important doors for me, like obtaining a fellowship slot at the University of California, San Francisco, one of the most academically productive electrophysiology programs in the country at the time. This plaque still hangs in my office today.

NASPE has since morphed to the Heart Rhythm Society (HRS) to better reflect the organization's more global mission to raise awareness and foster innovation in cardiac rhythm research and management. Cardiac electrophysiologists from around the world attend their annual scientific sessions to learn the latest and greatest innovations in our field. In 2015, HRS had $17M in revenues ($6.6M in registration fees (from Scientific Sessions and board review courses, I assume), $3M from grants, $2.7M from annual meeting exhibits, and $2M from membership dues, representing the largest source of revenues. These revenues were offset by $20M in expenses in FY 2015, somewhat larger than usual due to dissolution of the HRS Foundation which had accumulated a little more than $2M in losses due to lingering administrative overhead expenses. While it touts practicing physician officers, to each of their credit, none of them earned any revenue from their service to HRS in 2015. The CEO of HRS, Mr. James Youngblood, did enjoy a salary of $682,193 for his administrative services in 2015, however. So from what I can gather, MOC educational programs remain important to HRS’s bottom line. No wonder they are reluctant to lose those revenues for the organization! But supporting an illegitimate program that could damage a physician's career just for the revenue stream is wrong.

These past several weeks I received emails requesting renewal of my annual membership fees to HRS, fees I proudly paid every year since I won that NASPE Young Investigator Award. Usually, my administrative assistant would pay the annual fee automatically from my $2500 expense fund I receive from my hospital system. This year, after two years of struggling to have an impact on the MOC debacle and after having an internal debate with myself, I asked her to not pay my dues to both HRS and American College of Cardiology (ACC).

I do not make this decision lightly. I realize that many of my colleagues will think I’m being silly, rigid, or just plain dumb. After all, I won't be able to sit on steering committees for my profession without that membership or the opportunity to chair a scientific session. But most of them also know how strongly I feel about supporting the ABMS MOC program that was born from nothing more than a desire for our cash and is paid to an organization that has participated in blatant tax fraud, accounting irregularities, and strongman tactics that have threatened and intimidated too many unsuspecting and vulnerable physicians without just cause.

This is not to say I do not appreciate the earlier efforts the Heart Rhythm Society to change the MOC system for the better. Efforts like removing the double jeopardy requirement for cardiac electrophysiologists to have to certify in cardiology as a pre-condition to being granted recertification in cardiac electrophysiology, even though you passed the test, for instance, were influenced by their efforts. I also appreciated when they tried to hold sessions at their annual Scientific Sessions debating the need for MOC. But the session held with Dr. Douglas Zipes as MOC protagonist and Dr. Fred Kusumoto as MOC antagonist, allowed the protagonist to dictate the rules, insisting that no discussion of the finances of the ABIM and MOC program would occur, immediately stifling any real debate. Since that time, both the HRS (and their big brothers at the ACC) have increasingly shied away from their original public rebuke of the MOC program. It appears they have acquiesced to MOC's perpetuation, albeit in some as yet undisclosed “modified” form and with a new "blueprint." For this reason, I no longer find myself able to support any organization that allies itself with this scientifically and morally corrupt program.

The MOC re-certification cartel has become a $5.7 billion business enterprise annually in the US alone. It is incredibly divisive to our profession, dividing the bureaucratic in our ranks from those on the front line of patient care. Because this unproven and unwarranted program also threatens physicians’ ability to practice their trade and care for patients, I believe it causes significant harm to our patients by crushing the morale of too many physicians without legitimate cause just so the ABIM, the ABMS, and our own specialty societies can wallow in the MOC program's revenues. Many senior practicing physicians are leaving medicine because of this MOC requirement because they know it's just about the money. The fact that the adverse effects of this program to physicians and their patients have never been independently studied speaks volumes why this MOC program should end immediately.

I have no idea if withholding my dues will make a difference in the fight against MOC.  Certainly if HRS and ACC change their mind and work to end the MOC program entirely, I’ll be the first to reinstate my dues. But what else can I do in the short term? Keep paying? While I'll lose my subscriptions to the Heart Rhythm Journal and the Journal of the American College of Cardiology, I can search our library for articles I need. Still, I suspect I could lose some of the camaraderie that I have enjoyed in my relationship with HRS over the years, and that will be missed, but it seems like a relatively small price to pay.

My years-long investigation of the ABIM has taken me to places I never fathomed I'd have to go to get to the bottom of this story. It is strange the effect this story has had on me. On one hand, I feel greater connection to more of my peers than ever, yet on the other, I feel a quiet discontent from the House of Medicine's leadership that stands to lose the support of their rank and file as the story unfolds. I suppose I should not be surprised, especially since the MOC program has secretly funded so many for so long. But the stakes appear to be getting higher for all involved.* I just hope that exposing all of the corruption against practicing physicians by those in our own ranks ultimately brings the practice of medicine to a better place.

To offset this ennui, it would be great to have an opporuntity to meet those who might join me in my efforts to stop this program by refusing to pay their society dues. Perhaps we could arrange a trip to Chicago in May, 2017 to hoist a beer together in the epicenter of the ACGME MOC bureaucratic Machine together. It would seem quite apropos and I'd look forward to hosting that event. Let's call it "Lemonade out of MOC lemons."

We need to bring back the integrity of our profession ourselves, one dues payment at a time. It is clearer than ever that no one else will do this for us.  It would be quite remarkable if this movement gained steam, but I'm really not holding my breath.

But if it did, it would be nice to at my patient's thoughtful plaque and feel pride in what it means to be a member of a subspecialty medical society again.


* I would have posted a picture of my award to accompany this post, but it appears my server may have been hacked. I'll know more in 48 hours as technicians are working to resolve the problem.


Marvin Kalb said...

"If you cheat on one thing, you will cheat on something else."
I can't think of one thing that the ABIM/ABMS has not cheated on or lied about!

Baron's Infamous House of Cards said...

Richard Baron's Robust Salesmanship of a Product/Service/Program Without Robust Evidence.

Town hall ala Grand Marnier: Selling the ACA/CMS clinical model of care, payment, and pushing big data without disclosing corporate sponsors' names - selling the myth of shared savings programs by saying it is not rationing and the problems of meeting the CMS milestones . . .

Here is ABIM's CEO Richard Baron in 2012 lobbying for/selling the ACA. CMS, through the ACA has power of "administrative regulation" and does not need legislation to enact policy. Dr. Baron was Director Seamless Models of Care for the Center for Medicare and Medicaid Innovation CMS. 2011-2013

Full Biography: Richard J. Baron, MD, MACP, President and Chief Executive Officer of ABIM & ABIM Foundation

"Dr. Baron, board certified in Internal Medicine and Geriatric Medicine, is President and Chief Executive Officer of the American Board of Internal Medicine and the ABIM Foundation. He was a former Chair of the American Board of Internal Medicine’s Board of Directors and served on the ABIM Foundation Board of Trustees.

Dr. Baron practiced general internal medicine and geriatrics for almost 30 years at Greenhouse Internists, P.C., located in Philadelphia. Greenhouse was a pioneer in the comprehensive adoption of electronic health records in the small-practice environment. Following that, from 2011 to 2013, he served as Group Director of Seamless Care Models at the Centers for Medicare & Medicaid Services Innovation Center, where he led efforts related to accountable care organizations and primary care. Until joining the federal government, Dr. Baron also served on the board of the National Quality Forum and their Health Information Technology Advisory Committee, as well as the Standards Committee of the National Committee for Quality Assurance.

Dr. Baron served as Chief Medical Officer of Health Partners, a not-for-profit Medicaid HMO set up by four teaching hospitals in Philadelphia, from 1988 to 1996. He was the architect of the Best Clinical and Administrative Practices program, funded by the Robert Wood Johnson Foundation and the Center for Health Care Strategies, working with medical leadership of Medicaid health plans around the country in learning collaboratives to improve the quality of care for their members. This program reached plans serving more than half of the Medicaid managed care population in the United States. Dr. Baron is a member of the Commonwealth Fund advisory group on Health Care Delivery System Reform and has served as co-Chair of the Public Health – Health Care Collaboration Workgroup of the Centers for Disease Control and Prevention. He is a member of the Aspen Institute Health Strategy Group.

Dr. Baron received an English degree from Harvard College and his medical degree from Yale University. He completed house staff training at New York University-Bellevue Medical Center and served a three-year obligation in the National Health Service Corps in rural Tennessee."

ABIM Retirement Matching Funds: Lot of Physician Fee Money our the Door said...

Charles P. Kroll ‏@CharlesPKroll wrote:
ABIM Retirement Plan
☐ 304 participants at 12-31-15
☐ $27.1 million in Net Assets
☐ Avg. account balance: $89,145 #MOC

Now $15 million per 2015 Report filed last week. Average 2015 contribution per employee: $13,000 … #MOC

Charles P. Kroll added:
#ABIM's Contributions to Its Employee Retirement Plan Tops $15 Million Since 2009
▶ $2,585,033 For The Year Ending December 31, 2015 #MOC

Questions: Why should physician fees go to beef up ABIM retirement accounts? How long has that practice been going on? How much retirement do executives get versus the low-paid phone people at the ABIM?
Also, with 304 participants in the "retirement plan" how can that be when last I looked they did not have that many employees? And why would they need that many folks to manage their volunteer question bank writers? I understand the question writers at many or most of the ABMS specialty boards are all unpaid volunteers.

W. Bond said...

Name the date in May!

W said...

I noticed on the ABIM consolidated returns for 2015 and in court documents that the ABIM has a tuition reimbursement plan. I want to address the finances and ethics of the ABIM related to this. I have direct evidence of employees being cheated out of their tuition benefits and being submitted to humiliating racial and gender discrimination. The ABIM and executives involved have never publicly apologized for that to the people of color they disparaged and personally harmed.

Here's why I am writing about this. It came to my attention that there is a felon working at the ABIM as "director of investigation". He was hired in the summer of 2008. No one knew about him until this blog wrote the ABIM: Medicine's House of Cards. According to theis felons online CV and blog site bio he outright lies about and fails to disclose his felonies committed in Washington DC and his being fired from MPD and TSA.

His name is Ariel Benjamin Mannes and he scares the living daylights out of many of us - given what he has done to physicians and that he holds files on over 200,000 physicians. He has violated privacy and violated civil rights of physicians and citizens as a former police officer. Mannes was terminated from the DC police after a 2002 episode where he failed to uphold his duty to the constitution and civil rights. He does not disclose that either. He has done bad things to people and does not disclose it. Why? He pretends to be a subject matter expert, but does not tell anyone of his felonies. Why?

Many people think that this is terrible for the ABIM and Richard Baron to aid and abet this felon who is hiding from his terrible past under the respectability cloak of the ABMS and ABIM. That is not ethical, and Dr. Baron/Ballard Spahr should address all of their complicity in investigating/spying on and persecuting physicians and board prep courses from 2007 until this very day.

I understand that Benjamin Mannes, or whatever his real name is, is working on a masters degree in organizational management. First of all I want to know why someone who has lied to so many to this day about his horrific police record and felonies can pretend to be a director of investigations at the ABIM? And secondly I want to know why this Mannes character remains undisclosed on the tax filings of the ABIM? We want to see what his official position is and what his compensation is.

I am outraged about all this and the fact that the ABIM is possibly coddling Mannes with tuition reimbursement! Is this felon who has harmed so many and not disclosed his true past, his true and real CV and bio to physicians really working for the ABIM. Physicians and patients who demand transparency. Is Mannes being groomed by Dr. Baron or the testing industry for a higher executive position at the ABIM as a reward for all the past harm he has done? How can this be?

I have no words to express how dumbfounded I am at the total disregard for 200,000 physicians reaction to this and the public who need to be informed. Dr. Baron, do you really think that you can keep going like this forever - with total silence and false pictures and words that you continue to propagate? It is unacceptable to us.

continued said...

The public demands an investigation of the ABIM and the ABMS MOC program!

At this point there is more evidence proving fraud and financial negligence/malfeasance at the ABIM than there is data that MOC or certifications have any value at all for the patient, physician or any taxpayer of the United States of America that has blindly granted tax-exempt status to the ABIM and ABMS.

"Of the profession for the public." None of the ABIM's motto has basis in reality.
Unless I am convinced otherwise the executives at the ABIM are politically full of themselves. And it is obvious they are just going for the big money in order to maintain political control and support their extravagant lifestyles.

Director of Investigation: aggravated assault, illegal weapons possession and use, impersonating a MPD officer of the law (metro police department DC.) Mr Mannes states he was reinstated to the MPD after a leave of absence. I would like to see that paper work for myself, because we know it is not true. ABIM lies and their Director of Investigations has lied about major events in his life. He does not disclose facts relevant to the physicians he continues to persecute. The ABIM does not disclose or admit his existence to the public who have a right to know what a fraud the ABIM is and what safety net the ABIM is not!

Physicians should do their own research and ask questions directly to those Mannes Lynn Langdon, Christine Cassel et al, and Ben Mannes' current boss, Richard Baron, have hurt.

Trud said...

I understand completely why you are voting your conscience and cutting off the money to these medical societies, Dr. Fisher! At this point, anyone who supports the ABIM and medical societies promoting and profiting off MOC are betraying physicians and patients.

IBF said...

Moc is outright fraud!!!!

Anonymous said...

Does ABIM support

Anonymous said...

Anonymous wrote: "Does ABIM support"

Before I discuss the Benjamin Mannes/ABIM investigations director's website and its controversial racially motivated slurs toward the value of black lives and vulgar and biased political content, I have to say I was quite shocked to look at this link. This is the ABIM's director of investigations' website! Many alarming questions arise from examining this site and in exploring Benjamin Mannes and who he actually is.

Mannes is actually a double felon (I verified it) and a fraud in the sense that he pretends to have an unblemished work history as a public safety officer. Not a whit of this appears on this SME's website. He is woefully lying to the public (and the ABIM' diplomates therefore) in his expert articles, stated biography, and interviews by concealing these important material facts about his past. They also reveal important aspects of his psychologically makeup. It is an absolute fact that the ABIM is lying about all matters related to Ariel Benjamin Mannes and his roles and activities at the ABIM.

Given Mannes' position at the ABIM as 'director of investigations', withholding such important criminal background history and employment information, that he was sacked twice for violating policies as a police officer and TSA inspector, this is the same as withholding important information presented to a judge or lawyer in a criminal or civil lawsuit.

We believe that a judge or law firm should be told about a key witness' past or the testimony should be thrown out. As director of investigations for the ABIM who indulged himself in the ABIM 'witch hunts' against thousands of physicians, the victims of the ABIM and their attorneys, and equally important the judges involved, should have been told this information. Also the ABIM 'panel' which adjudicates sanctions cases should have been made their diplomates aware of this! So, why were sanctioned physicians - the objects of Mannes's investigations - never been told about Mannes felonies and bad public service records/terminations as police officer and TSA inspector.

This is all a tremendous liability for the ABIM/ABMS and their insurers. The board of directors should make a statement about this and make sure the insurers/underwriters made aware of this. To withhold information from an insurer is to nullify your insurance coverage in many cases. Is the ABIM acting in a negligent and reckless manner to not have a viable insurance policy or policies if they were to come under scrutiny? This is madness and needs to be addressed by the board of directors. Why did not Bob Wachter address this when he was the board member, chairman and a trustee for nearly a decade?

Anonymous said...

Who hired Mannes and what for?

So why did the ABIM hire Mannes? For what purposes and what were Christine Cassel, Lynn Langdon, Robert Wachter and Richard Baron's motives really? Should we also look outside the ABIM as well for a motive examining the lucrative relationship with the testing/security industry for answers? Are there political motives and financial boons for hiring a double felon and keeping it secret. In silence we can only suspect a great many evils. Are they cooking the books and need the protection of a felon with knowledge of how the criminal justice system works. Maybe connections with the police and FBI, which Mannes claims to have?

Mannes was hired to head COO Chris Cassel/Lynn Langdon’s goon squad. We understand this from court documents and physicians who spoke about their experiences from 2007 to present in the ABIM's sting operation against phycians and board prep companies involved in potential "copyright infringement". No one has ever been proven to have intentionally harmed the ABIM or been found to have infringed on their copyrights involving candidates studying for ABIM's tests. ABIM lost millions of dollars trying to prove just that, so why did they do it when any lawyer could have told them they could not win any money? It was political persecution to get legislation passed with little opposition and it is/was fear-mongering for the guarantee of a financial stranglehold over physicians.

Lynn O Langdon worked for the ABIM for over forty years and has overseen many of
ABIM‘s questionable endeavors and projects, including the formation of ABIM's transference of millions of dollars to the newly formed ABIMF at a time when the risky investing of that money by Drexel and 1838 Investment Advisors should have been disclosed to the IRS. Whatever they were doing they appear to have gotten away with it. However their independent auditor/CPA may have been covering himself when the suggestion was given to the ABIM CFO for ABIM to retain their tax records indefinitely. (Letter included in 2002 tax filings - returns which have tens of millions of dollars being traded in a negligent/risky practice quarterly.)

So, it is no wonder why the ABIM hired a goon-squad to keep their empire of wealth well protected and hidden. We don't know what golden parachutes and questionable compensation/retirement packages the former CFO wrote for himself and others on the bet of high returns on their investments. Much of the trading went on during the time Christine Cassel was working for the Clinton administration, ACP and the ABIM Foundation. Bob Wachter called the ABIM Foundation the ABIM's big piggy bank to ridicule those who would call it such. But this is in fact what it is - a big bank and hedge fund right in the same offices with Richard Baron, Mr. Mandes and Lynn Langdon.

Anonymous said...


I have never seen such an organization as the ABIM in my entire life. It is a mixed mess of unethical and illegal activities including financial self-dealing and political agendas involving DNC healthcare platforms to the point of fanaticism.
And then you have Benjamin Mannes, the Director of Investigations, whose website supports radio talk show pundits who call everyone on the left including Hillary Clinton - the author of Obama Care - and her cronies to be "willful liars", "morons", and "useless wastes of air".

Dr. Baron, do you care to comment on the extra curricular activities of ABIM's director of investigations who frequently appears on a vulgar talk show hosts program spouting offensive racially biased statements about blacks, supports the profiling of Muslims, supports the excessive use of lethal force by police on minorities, and on and on, and it is all done Monday through Friday during normal ABIM working hours? Who is in charge there and what kind of disciplinary actions do you have for such outrageous and embarrassing activities paid for on the physicians hard earned dime and during ABIM's professional working time?

NO words can express the profound disappointment we feel toward the ABIM culture, its executive management and board of directors. I have never seen such a useless mess and waste of money all across the ABMS board - given the fact that this double felon also works for Lois Nora's other medical boards as advisor and counsel.

Atlanta Dr said...

Thank you for your much appreciated anti MOC efforts

DrWes said...

Thanks, Bill.

L said...

Yes, you were hacked and it seems I have the injection script after all as all my data is being parsed out into logs--regretting our email since this time.

Go ahead, don't pay. Good for you. It's not as good a "badge of honor" as escrowing the rent and having the slumlord make you homeless--but it's a start, good fellow.