Sunday, March 05, 2017

MOCA-Peds and Its Conflicts of Interest

The pediatric Maintenance of Certification (MOC) propaganda machine rolls on - this week in the JAMA Pediatrics.

Lewis R. First, MD, MS, David A Gremse, MD, and Joseph W. St. Geme, III, MD join forces to publish their opinion piece entitled "Maintenance of Certification - A Prescription for Improved Child Health" in JAMA Pediatrics on 27 Feb 2017. The only conflicts of interests they disclose to the public are their various associations with their institutions and various professional medical organizations with which they have been affiliated with over the years. As is typical for many of the JAMA publications published by the American Medical Association (AMA), they failed to disclose their ties to the pharmaceutical industry or the fact that annual Maintenance of Certification (MOC) revenues almost matches that of initial certification for the American Board of Pediatrics (ABP) every year.

Lewis R. First, MD, MS advertises himself as restricting this practice to inpatients only on his University of Vermont website.  Such a practice is hardly representative to the vast majority of pediatricians in the U.S. who primarily care for outpatients. It would not be surprising, then, that the hours required to participate in MOC would seem trivial to one who works in a sheltered inpatient workshop.  He never mentions that he "won" the Joseph St. Geme Jr. Leadership award created in the honor of the father of his co-author, Joseph St. Geme III, MD, by the Academic Pediatric Association, American Academy of Pediatrics, American Pediatric Society, the Association of Medical School Pediatric Department Chairs (AMSPDC), the Association of Pediatric Program Chairs and the Society for Pediatric Research.  To his credit, Dr. First does disclose the fact that the is chair of the AMSPDC Education Committee, member of the ABP Research Advisory Committee, member of the AMSPDC Planning Committee, editor of Pediatrics, and past chair of the National Board of Medical Examiners, so his enthusiasm for lifelong repeated testing of physicians is at least understandable as part of the vast network of Accreditation Council of Graduate Medical Education (ACGME) certification member organizations' fixation with lifelong testing and revenue generation.

David A Gremse, MD disclosed that he is chair of the department of pediatrics at South Alabama University, chair-elect of the ABP, member of the AMSPDC Planning Committee, and past member of the AMSDPC Board of Directors. He failed to mention that he was secretary-treasurer of the ABP and a pediatric gastroenterologist.

Finally Joseph W. St. Geme III, MD discloses he is chair of the department of pediatrics at the Children's Hospital of Philadelphia and the University of Pennsylvania, associate chair of the AMSPDC Research Committee, immediate past chair of the ABP (often with first class travel from the ABP) and Dr. St. Geme failed to mention his advisory role with PureTech Health, a "cross-disciplinary biopharmaceutical company."

Why mention these conflicts? Because their article is filled with misinformation.

First, board certification for pediatricians in America is no longer "voluntary"as these authors claim. It is disingenuous for them to claim board certification is "voluntary" when the next sentence they note "Hospitals increasingly require board certification for medical staff privileges credentialing bodies and payers often require board certification for participation in provider networks and for reimbursement."

Two "Quality Improvement" projects  are mentioned by the authors that they claim can be used to  justify Maintenance of Certification to all general pediatricians in the United States. These studies were less than robust and filled with uncontrolled endpoints.  For instance, one involved a QI project with the "ImproveCareNow Collaborative" funded by many pharmaceutical companies and the American Board of Pediatrics Foundation that actually admitted in their paper:
'Third, improvements in outcome occurring over time could have taken place independent of changes in care delivery as part of the network. No external comparator group was available to help with this determination. However, not all centers showed improvement, and the improvement we observed took place over a relatively short period of time during which no new therapies were introduced into routine clinical practice. Finally, the processes we measured may not be directly responsible for the observed improvement in remission."
In fiscal year 2015 (from the 2014 IRS Form 990) - the latest tax form the public can review - the American Board of Pediatrics earned $10,644,504 from the Maintenance of Certification program while their senior executives enjoyed first class airfare and paid spousal travel fees. They paid their former President and CEO who worked only 8 hours per week, James Stockman, III, MD,  $793,991  - more money than their current highest paid employees, Executive Vice President of Credentialing and Exam Administration ($675,055) and President and CEO ($624.001). By comparison, one source cites the current median pediatrician salary in the US in 2017 as  $187,376. Might these facts be more important to explain the authors' enthusiasm for promoting MOC than the flawed studies they cite regarding MOC's importance to patient care?

These authors need to understand the days of pulling the wool over working physicians' eyes by publishing opinion pieces in journals sponsored by the AMA that has refused to end MOC despite recommendations made by their own House of Delegates are over. These continued efforts to justify MOC without acknowledging the programs many flaws and financial conflicts of interest must end. While physicians who chose to continue to work have little choice but to participate in MOC  currently, efforts are underway across the nation to end MOC for all subspecialties on the basis of its discriminatory practice against younger physicians and because its adverse effects on physicians and their patients have never been studied (or even acknowledged) by these organizations that profit from the program without legitimate independent oversight.

-Wes



16 comments:

  1. Unbelievable that the AMA, ACP and ABMS are allowed to publish anything. Just as incredible that they ignore the resolution by the HOD to end mandatory MOC.

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  2. Unfortunately, the AMA and all the other Chicago assurance clans re-branded themselves long ago. They rewrote their bylaws. In the bylaws when you condense the newly formed words into a single phrase they say, "Anything goes as long as it serves us and our special interests." If it sounds harsh, then reality is harsh and made course by people who have ceased to deeply care for life.

    The AMA, ABMS, ACGME, and the rest transformed into a powerful lobbying and propaganda firms funded by tired physicians, lucrative core ME programs, by selling hordes of data on physicians, the prime source verification enterprises and credentialing businesses, and not to forget the profitable insurance businesses some of them like the AMA run with third party insurance companies. The ABMS hire deep state terror specialists/policemen with felonies to harm physicians, not try to communicate. Communication and the resolution of conflicts is a golden principle that we all must get back to.

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  3. It appears the main task of the AMA along with their partners at the ABMS/ABP/ABIM, and so on, are revenues/profits/maintaining false pride/stubbornness, while humankind suffers with financial burdens, chaotic politics and disease. As everyone kills each other off around the globe and we face the threat of nuclear Armageddon once more our war-mongering politicians push for international discord--not cooperation and peace. I mention this because the AMA and ABMS sows the same seeds of discord here in the United States with physicians and all healthcare workers. The AMA appears to be an analogue of the larger global picture. Greed and callousness looking on as people suffer.

    The AMA, one of the most powerful bodies in the USA, makes all suffer today. I do not see one real face shedding a tear or expression of genuine grief for the human struggle. I do not hear words of true leaders in a time when we have an absence of real leadership. The House of Delegates spoke as one body of humanity. But apparently the HOD is not the AMA, but voice of common people. The AMA is the official voice of the one percent.

    The AMA HOD spoke truly when they resolved to end the idiot policy, conflicts and harms caused by mandatory MOC. Voluntary is not voluntary to the elites. Voluntary is to do what we say is good for you, because we are in charge. Think about those certifications and how much they are worth ultimately. The efforts to learn are the essential ingredient of medical science and the application of that knowledge. The ABMS has it all wrong about education.

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  4. They reap lots of money and sow little for ME, and almost nothing to enhance medical education.

    The coercion of outside forces to shove knowledge down our throats kills the human spirit, that illumined spark of the natural mind, which has at its core a curious and industrious essence and nature. But from the core elites and propagandists within the AMA and the ABMS, we get nothing but a heap of words on an ash heap of disinformation.

    Pathetic articles written in JAMA that disclose little more than the conflicts of interest the authors represent. I am for real learning born of necessity and desire to understand, not coercive measures that dampen the will to learn, this is all MOCK learning. Look at the ABMS how far they have fallen. They cannot come out of their high tower and look the physicians fighting disease in the trenches in the eyes.

    To keep on top of it all the ABMS, AMA, and ACP are creating policy and legislation which undermines/confuses everyone in the healthcare system. Why are they so seldom a real devoted friend. They appear to have a special emphasis/penchant on/for destroying all providers' ability to work, and even at times the desire to go to work.

    Why is it that the AMA and ABIM and all the rest of the quality assurance elites insist on hurting others?

    I am speaking about all healthcare people hurt in the process. Not just physicians. Why do they harm those who have devoted their lives to helping alleviate the common suffering of humanity. Why can't they just help us cope with the suffering we all have/share when the patient's body and even our own succumbs to disease and ultimately death. Instead of fight us.

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  5. Discovering a little more about ICE, NCCA and the credentialing company they keep! Meet the NAMSS . . . at 225 M Street, "Suite 800" in Washington DC.

    Wes, you spoke about the Institute for Credentialing Excellence and the NCCA recently. As you know ICE currently offers accreditation to professional certification programs through the National Commission for Certifying Agencies (NCCA). The offices for both ICE and NCCA are at 225 M Street, Suite 800 in Washington DC. The executive director is the same for both agencies. SmithBucklin manages both corporations and receives the bulk of the revenues for doing so. 990's for both "not-for-profit" NGO's show zeros for all the board members and a big goose egg for the executive director who "contributes" 40 hours per week. SmithBucklin received over a million $$$ per company to manage the organization in 2014 according to IRS filings.

    Now we have another NGO created in 1979 inhabiting the same office suite on M Street. It is uncanny but they also house the executive director and "staff" for the National Association of Medical Staff Services. "Advancing the delivery and quality of healthcare." The CEO is Lynn Boyd. The "executive director" position is an appointment, which Boyd has had for a number of years. The same goose eggs on the IRS tax filings for the executive director and "staff" or should I say "non-staff".

    Listen to this. In 2014 SmithBucklin got nearly 1.5 million $$$ to manage the NAMSS.

    This is one of the most fraudulent practices I have ever seen on a non-profit tax filing to hide compensation and operations from the public. It is all under contractors in the 990. "Managed by SmithBucklin."

    Every credentialing department is listening to the NAMSS and may be credentialed by them in certifying medical professionals. This is a huge one.

    http://www.namss.org/About/MeettheVolunteerLeaders/BoardofDirectors.aspx

    In May of 2016, the NAMSS met to discuss "Real Reform through Positive Disruption."

    "The National Association Medical Staff Services (NAMSS) held its 3rd annual industry roundtable, titled 'Real Reform through Positive Disruption' on Thursday, May 19, 2016 at the Gaylord National Resort in National Harbor, MD. This year’s discussion focused on enacting meaningful, impactful change in the health care provider credentialing and licensure processes. NAMSS recognizes that the time for positive disruption is now, and looks forward to continuing to work with its industry partners into the future to
    create more streamlined, more efficient processes that preserve patient safety.

    NAMSS would like to thank the following industry partners for participating in this important event: the American Association of Physician Assistants (AAPA), the American Health Lawyers Association (AHLA), the American Hospital Association (AHA), the American Medical Association (AMA), the Council for Affordable Quality Healthcare (CAQH), the Federation of State Medical Boards (FSMB), the Health Resources and Services Administration (HRSA), the Medical Group Management Association (MGMA), the National Committee for Quality Assurance (NCQA), The Joint Commission, Cigna, and DNV."

    https://www.namss.org/Portals/0/Regulatory/Official%20NAMSS%202016%20Roundtable%20Report.pdf

    From the above lineup and onerous recommendations that is creating masterfiles and imposing more background screening, and criminal checks, more often, we can expect without doubt more reforms in the form of "disruption" from ICE, NCCA, and the NAMSS, and whoever else inhabits Suite 800 at 225 M Street in DC.

    MOC equals MOL for "regulators" and "policy makers" at NAMSS. It is much easier and more streamlined and less redundant they say.

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  6. Do you know what is happening to your credentialing information right now? Did you sign a disclosure form so that unvetted background screeing companies can search into every part of your personal and professional life. Who is allowing all this? Who is recommending more survieilance and background on physicians. No other group has so many hoops to go through to work and maintain employment.

    HireRight/Kroll consumer reporting/background investigations
    https://www.ftc.gov/news-events/blogs/business-blog/2012/08/where-hireright-solutions-went-wrong

    Regarding the onerous trend in the industry to impose more frequent credentialing, screenings and criminal background checks. (After all the reappointment criminal and credentialing verification, you'll be begging to have it all streamlined at their fingertips.)

    Do some research online about HireRight/Kroll and the defunct USIS and all the rest of their ilk that went bankrupt after they violated federal laws and lost 20 million personal and very sensitive profiles on federal employees. KROLL was known as the CIA of Wall Street. Pretty serious violations of rights to privacy and strong arm tactics to climb to the top. The only trouble is they are not gone, they just merged and changed their names.

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  7. Is your credentialing staff certified by the National Association of Medical Staff Services?
    What are they doing with your data to manipulate the profession and who is vetting them? Who does that credentialing company serve? How do you know your data is safe from theft or misuse every time you give your approval for a background check? Is that check limited to what they say they are doing? Probably not. Better ask to see the report. Can a physician trust even the AMA? ACP? ABMS? They are not working in the best interests of the physician, provider or patient.

    ABP should have disclosed the conflicts of interest.

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  8. Thanks for backing up us pediatricians Wes!!! What a racket... but I'll bet the Moms of America won't like hearing that powerful docs are beating up on their beloved community pediatrician, taking their $ and funding a cush retirement. Those same bullies are NOT answering the line at 4 am , working nights or weekends either.

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  9. The american board of pediatrics shows tremendous arrogance and greed . . . instead of really studying the problems of MOC and choosing wisely to end the practice of ordering unnecessary and potentially harmful testing . . . they do not choose wisely, but rather poorly, showing poor judgement by leaving enslaved pediatricians tethered to the MOC ball and chain . . . ABP supports the status-quo-gravy-train of self-dealing professional medical politicians. . .

    Instead of thinking clearly and independently as scientists, looking at the issues and producing real scientific studies that have value, not pseudo PR babble, they pay for advertising to be placed in JAMA . . . how academically low can they go?

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  10. [More love] That's all

    I'm gonna tell you the natural facts
    That the man don't understand
    The good book is right and that's all
    That's all

    You know what?
    We got to have more love
    More understanding everyday of our lives
    And that's all!

    When you see folks jump from this or that
    They don't know
    they don't know where the devil's at
    That's all!

    They got to have more love,
    More understanding
    Everyday of their lives
    I tell ya that's all.

    Listen, people are fighting one another
    And think they're doing swell
    And all they want is your money
    And you can go to hell!

    That's all,
    That's all!
    Ya'll got to have religion,
    I tell ya that's all

    Now he can go to the college
    Go to the schools
    Haven't got religion
    He is an educated fool

    That's all
    Yeah, that's all
    He got to have more love, more understanding
    Everyday of our lives and that's all

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  11. Joseph W. St. Geme III's advisory/financial relationship with Pure Tech is troubling.

    Pure Tech imo is a completely speculative company to invest in and I would steer clear of the stock. One should not invest in Pure Tech if you value your money. The company and speculators involved needed to raise a great deal of cash to stay afloat in 2012, 2013, and 2014. After they quickly burned through that 60 million pounds or so they raised in 2014, then came the IPO.

    It is no wonder the Pure Tech advisors and financial savants listed their IPO on the London Stock Exchange!

    Probably no one here in America would be allowed to bet on this "phantasmal" pipeline of treatments and cures from a collection of a dozen-or-so esoteric companies like "Vedanta". US security laws would certainly blocked such a risky IPO. "Vedanta" in Sanskrit refers to a commentary on the "Vedas" (knowledge/seeing) and "Vedanta" is a treatise on the nature of "knowing". It does not take a sage to see this stock for what it is and know you should stay away.

    The pediatrician/politician/bureaucrat Joeseph III did not do his due diligence on Pure Tech. Or maybe he did. He most likely got some big bucks or stock out of the deal for adding his name to it. I'd like to know about his arrangement. Can someone fill us in.

    I looked at Pure Tech's IPO prospectus from 2015 and it was a shocker. The cash Pure Tech was burning through was enormous. Huge appetite for dollars. They had to get funding from investors to raise enough to keep going and obviously for the management to keep milking the investors and keep paying the hefty bills and compensation to themselves.

    The IPO was a flop right out of the box and the shares if you bought-in you'd painfully know that the shares have lost 75% of their value. After you paid Jeffrey and Peel Hunt their underwriting fees and commission to your broker, you'd be down even further.

    The key thing in the prospectus I was looking for was as I thought, tucked away in the voluminous fine print:

    "The Ordinary Shares have not been and will not be registered under the US Securities Act 1933 (as amended) (the ‘‘Securities Act’’) or with any securities regulatory authority in any state of the US."

    That means US investors are screwed for the most part, unless you hire an expensive London solicitor.

    Maybe this item should be posted under Wes's "big short", because if you shorted this IPO you'd have done quite well.

    I would question any "adviser's" integrity who would have allowed or encouraged even an enemy to put their money into a purely speculative play like Pure Tech, which surprisingly involved some industry executives - heavyweights from big pharma.

    I have been to investment meetings/seminars with big sports icons, where they try to sell you something that is imo completely fraudulent. Pure Tech seems imo just that. It smells like fake investing, a false hope of getting a home-run return, and a lot of excitement mostly about a chance for an investor to have a go at rolling the dice.

    They issued a quarter-of-a-billion shares and consequently raised a lot of money, but guess who got the bulk of the money?

    The story of the ticker symbol MOC is the same. DOCS have been suckered into buying into MOC by savvy "advisors" who are for unsavory reasons quite clear to everyone, still making a market out of MOC.

    http://www.londonstockexchange.com/exchange/prices-and-markets/stocks/summary/company-summary/GB00BY2Z0H74GBGBXSSMM.html

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  12. Re: National Association Medical Staff Services "Real Reform Through Positive Disruption"

    There is great possibility to abuse these non-profit organizations as the title of the NAMSS' national conference might suggest - political and financial abuse such as pushing for tighter stringent control of physicians credentialing process with employer and with state licensure. The NAMSS' close affiliation with the AMA, NQCA, TJC, FSMB, URAC and so on could be "deadly" to the anti-MOC movement.

    Already from the same "NAMSS offices" in DC (SmithBucklin 2025 M street, Suite 800, Washington, DC.) ICE and NCCA have launched an attack on the state-level legislative movement and actions to end mandatory MOC. ICE (SmithBucklin PR/lobbyists) are already using fake "grassroots public protest organizers" and "volunteers" to raise loosely-traced dark money in order to influence public opinion. Billions of dollars in the medical quality assurance market could be impacted.

    SmithBucklin, an assoication manager, oversees operations of ICE and the NCCA, so I would be suspicious of their so-called grassroots "patient safety" slogans and "protests" which come straight from a PR firm. SmithBucklin appears to not have an ethics and conflicts of interest policy. What's worse SmithBucklin also manages the NAMSS with the above ties to powerful credentialing and licensing bodies.

    Looking more closely at the structure of the NAMSS: They have local non-profit associations - state NGOs that administer for the national DC-based organization recommendations on industry standards and policy changes filter down through them and directly via email/newsletter, etc. The partner associations/chapters are currently in 25 key states. Including Illinois, Pennsylvania, Ohio, Florida, California and so on. To belong to local NAMSS associations, you generally must be certified with the NAMSS and register with the local association, which require credentialing specialists to pay annual state membership dues. States are divided up into sections and the national organization can disseminate through locally appointed people. Conferences are organized as well for members and others.

    And of course to belong locally to the state association you must not only be current in your certification with NAMSS, you must also be on the NAMSS good standing list.

    http://www.namss.org/Portals/0/Certification/Good%20Standing%20Reports/Good%20Standing%20Report%20-%202.20.17.pdf

    Quick links provided by the OAMSS for NAMSS certified credentialing officers.
    http://www.oamss.org/links/

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  13. Funny, but I just can't see Chris Cassel, Rich Baron, Bob Wachter or Richard Battaglia walking into a Perason Vue or Prometerics testing center to do a 10-year recertification exam. Bob said he recertified and found it fun. That puts him under suspicion right there. Richard Battaglia, the current CMO of the ABIM is grandfathered. He just never really worked on Main Street, but mostly quality assurance stuff like the NCQA or advising for "Wall Street", so I don't see him as ever doing a 10-year recertification exam. The ABIM site says that he is participating in MOC, but I simply can't believe it. Sorry. It is too much of a waste of time and an intelligent man who never saw value in it before, suddenly goes to work for the ABIM a little more than a year ago and suddenly he gets MOC religious on us. I don't think so. I think we need some verification on this. Christine Cassel is not even listed as certified in gerontology anymore with the ABMS verification service, although her gerontology cert. still shows up on the ABIM web site. I thought the ABMS was a prime source for verification. ABMS verification services say Cassel is only certified in internal medicine. What is going on? Who is right? The prime source folks out of Chicago, or the ABIM website based in Philly. Is the ABIM keeping up with their website and updating it correctly. OR is the whole of the ABMS just a sloppily run business enterprise that we cannot trust?

    http://www.abim.org/verify-physician/Battaglia-Richard-NndaMNoDmGs=.aspx

    Further, I'd like to know, I have become very skeptical of the entire ABMS, which of the ABMS big shots (any specialty) who claim to be participating in MOC actually do the required maintenance themselves? I suspect that they might not have time for it and the ABMS staff "takes care of it" for them. Or they may use a proxy test taker, but not the 10-year exam. That requires ID and other verification. I hear they want to do away with the 10-year exam unless you do poorly on the annual MOC testing.

    So the ABMS executive MD's would have motive to phase out the ten-year test for themselves and they can have someone give them the answers or do the MOCA- style testing for them.

    It is the same for the writing. I have my doubts, because I have published myself. Which of the three ABP physicians above who allegedly wrote the JAMA article actually did the writing? Or did they utilize a ghost writer?

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  14. As a financial planner I can easily see how patients are being hurt today by healthcare. There is great confusion and patients needs often go unmet or the care they need is delayed.

    In looking at the issues that I see presented here, I can clearly see the ABIM has done nothing for physicians and patients except harm them. How can that be I ask myself? There is no greater example of this fact than the cruel and cunning way they have conducted themselves in relation to maintaining their financial and political empire. It is astonishing that the federal government allows such graft in the modern era.

    Look at what they have done to physicians who attended, what looked like an ACCME/ACGME approved/accredited board preparation course. A course that they put out of business after twenty years of service. Did I get that right? Now the ACP has their accredited live course and taped courses along with ACP MKSAP products filling the void in the region where their competitors once addressed the need.

    And please note how they carry on with this folly still today by persecuting an exemplary young physician from Puerto Rico. It is unbelievable to me. Absolutely unconscionable. I can't begin to express the sympathy I feel for those physicians and patients the ABIM wantonly destroyed with their testing revenue greediness and desire for power over others. It is inexplicable why they wish to hurt the public and their client-physicians with such behavior and with this MOC business that further harms the public by turning off so many doctors to medicine.

    With healthcare in crisis still the ABMS execs and officers are incapable of change

    With the cost of education skyrocketing and interest rates climbing, who can afford to sustain such burden of debt. Or who can afford to be pushed out of practice by all the MOC requirements on top of everything else. What the ABIM and other ABMS specialty boards appears to be inadequate or useless and the CME one needs takes up enough of one's time and financial resources.

    Reasoning with the ABMS is like trying to reason together with an individual addicted to narcotics or alcohol. It goes nowhere, because in this case the money fix or unsustainable high the ABMS is dependent on you can be sure they will not relinquish voluntarily.

    https://www.doctorsjustice.com/blog

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  15. "The impact of MOC interventions to promote quality improvement is not yet well defined and will be the main focus of future research by the specialty boards." -Christine Cassel, 2006

    This was Christine Cassel speaking just a couple of years before she would transform the American Board of Internal Medicine, not into a scientific community serving physicians or proving her thesis, but instead Dr. Cassel turned the ABIM into a greed-stained rigid legalistic corporation that would allocate tens of millions of dollars to violatory lawsuits and counter-suits instead of providing the funding and inspiration that could link better outcomes and patient safety to participation in the ABMS maintenance of certification program. Cassel failed in her stated aim, just as Richard Baron, who headed up some of the pogroms against physicians has failed.

    After plundering the ABIM's treasury, draining it of close to 12 million dollars enriching herself and her family, Cassel moved through the revolving door to an organization that she herself helped set up at the end of the Clinton era during a time of colossal scandal. That quality measure organization, the NQF, was going through its own scandal where fraud was being investigated and justice meted out by the DoJ. Corruption and propaganda have been Dr. Cassel's legacy. Such things are the products of a leaden touch.

    Dr. Cassel bruises herself once again by being a hypocrite by not participating in MOC and letting her prized sub-specialty certificate go by the wayside. She said in 2006:

    "Enrollment in MOC, which is voluntary, is an important act of professionalism. It demonstrates that the physician is willing to perform a comprehensive self assessment for the benefit of his or her patients. Indeed a survey of physicians by the American College of Physicians found that the most important reason for enrolling in MOC was professional pride." -Christine Cassel, 2006 (with Eric Holmboe)

    Now that Dr. Cassel is becoming Dean of an innovative new medical school, it is incumbent that for the students' and patients' sake that she addresses the 950,000 certified physicians who are keeping up with their certifications while she is not.

    Christine Cassel, the mother of MOC promotion and enforcement, does not participate in MOC and has let her geriatric medicine certification expire due to neglect of her professionalism and pride. I would like to see her get both back and show us the real value of MOC, if she truly believes in her own medicine. Only when all these grandfathered professional medical bureaucrats show us a unanimous vote by taking the tests they refused to take for years, only then will I believe. There can be no discrimination or gentle rides given to those in political power or who live elite lives. Either MOC has value for all or it has no value. All are equal in the responsibility we have to this one life. Either we are all in, or the great MOC experiment (or heist) is over for the rest of us as well.

    I say this with profound disappointment. Dr. Cassel knew all along that MOC had no real scientific merit or medical value. There was no magic MOC formula; and never can there be proof coming from a negligent and greedy organization who has lost most physicians trust. They have not focused and produced anything of the kind of high quality CME that physicians need. We are better off with our own focused study and tailored CME. End mandatory MOC now.

    It was all about the money and political control after all. It truly is disgusting what the ABMS has done to us all. A divided house cannot stand. It can only break apart and fall.

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  16. All of us must speak out, organize and go to our state legislatures and draft a bill to get some protection and relief from the ABMS' maniacal appetite for money and power.

    Physicians have rights and patients have a right to care. We need to get motivated and work together. There is no tomorrow in this fight to restore the right balance of work and life.

    We can even get our churches, synagogues, mosques, and temples involved. The anti-MOC movement needs to get fed into the mainstream media. There is a passionate need for change now.

    Lord, free us from this creature called MOC and all the countless profiteers coiled around it.

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