On Wednesday, the American Board of Internal Medicine (ABIM) quietly announced their much-anticipated "modifications" to their Maintenance of Certification program on their blog. As expected, rather than ending the MOC program, ABIM has decided to double down and justify their unproven process using an edited video of Skype sessions from their most fervent (paid) supporters.
The ABIM reportedly conducted invitation-only "listening sessions" accross the nation. On the basis of those sessions and months of focus groups and navel gazing, the ABIM unilaterally decided that an "open-book" examination that physicians must participate in every two years could serve as an "alternate pathway" to "maintain" a physician's (previously lifetime) Board certification. They then had the gall to say these were the changes we requested. They weren't.
In actuality, those "listening sessions"were invitation-only. (Yes, I applied to attend the one here in Chicago but was never granted an "invitation.") Selection bias of diplomates was the order of the day. And as their legal fees mount, ABIM has yet to mention what they plan to charge recertifying physicians for their new "pathway." Rest assured it will be plenty.
By now, practicing physicians understand what MOC is really about. It is NOT about making money, physician ongoing education, assuring physician competency, care quality, or patient safety.
MOC is about the control of physicians.
Control doctors and you control health care delivery. Control doctors and you can shape them to corporate ways. Don't like it, dear doctor? Then leave. We'll find someone else to take your place and your patients.
But replacing experienced physicians is not so easy. It takes years to gain credible experience in medicine. MOC is not about experience, it is about rote memorization and data entry. And what the ABIM doesn't get is referrals are still not always guided by who your employer is, as much as corporations and the government try to make it so with their consolidation attempts. They can "innovate" all the new ideas they want, but doctors are not fooled. Tie MOC to credentials or to insurance company payments if you want, but extortion is extortion, no matter how you color it. Because ABIM has not taken accountability for their serious financial transgressions and strongman tactics used to protect their monopoly, they will remain a pitiful example of corporate greed to practicing physicians (the people they claim to "help") and little else.
The Accreditation Council of Graduate Medical Education (ACCME) and their powerful member groups (The American Board of Medical Specialties, American Medical Association, American Hospital Association, the Council on Medical Subspecialty Societies and American Osteopathic Association) know billions of other reasons MOC is important, too. MOC generates about $2 billion in revenue annually for these organizations when one considers the endless board review classes and registration fees for their members. Condos, limo rides, first class airfare, gym memberships, and multimillion dollar golden parachutes are dependent on this program. All done without proof of value to doctors OR their patients. All done without any assessments of MOC's potential harms. The fact that our bureaucratic academic leadership in medicine will not address the many problems uncovered on this blog's pages and what this means to patient care in America is more even concerning than the ABIM's missteps in my opinion.
Doctors have had it with the outright dishonesty and scandal that has plagued MOC from the beginning, especially when they're dealing with much more important life-and-death issues every day. The only realistic and honorable revision for MOC is to end it, or for every practicing physician to refuse to participate and allow MOC to wallow in it's own avarice and greed.