Wednesday, December 06, 2017

On the December 4 Meeting of the Untouchables

From the invitation-only December 4, 2017 meeting on Maintenance of Certification (MOC®) practicing physicians were not allowed to attend, came this synopsis from Ohio:
Fellow Council members,

The following are my thoughts following the long-anticipated MOC® meeting in Chicago. An official report that will be distributed to the general membership will follow.

The meeting was hosted by the American Society of Anesthesiologists in Schaumburg, IL. The auditorium designed to hold 150 people, was filled to standing room only.

A bit of background, this meeting was the brainchild of Donald Palmisano, Jr., CEO Medical Society of Georgia, and Hal Lawrence III, MD (Executive Vice President and CEO) ACOG. (Editor's note: The American College of Obstetrics and Gynnecology (ABOG) are subcontractors for "Test Development" with the ABMS.) During the interim and annual meetings at the AMA, the state and specialty societies meet. It was during this meeting in Chicago that the idea for today's meeting was formed.

Dr. Lois Nora, current President and CEO of the American Board of Medical Specialties spoke first. In her 20-min remarks, she acknowledged each of the points raised in the letter penned by the state and specialty societies. Dr. Nora's term ends on December 30, 2017. Her successor is Richard E. Hawkins MD, who is leaving his position as Vice-President of Medical Education at the AMA to take this position.

Her Key Points:
  1. Committed to improving continuing certification
  2. Add state society representation to the Committee on Continuing Certification
  3. Admits that the current MOC® process is problematic
  4. MOC® should not be used as the only criteria for state licensure, credentialing, or employment
  5. Agrees that professional self-regulation is valuable
  6. Asked that the states not support anti-MOC® legislation (citing possible unintended consequences)
Summary of the comments from state and specialty society representatives:


  1. Physicians insist on trust, input, transparency, and improved communication from the boards
  2. Create a process that is developed with us not forced upon us
  3. Process should not be punitive. Use the carrot and not the stick
  4. MOC is an irrevocably tarnished brand
  5. Following initial certification, the high stakes exam should be only one of several options
  6. Create a process that is fair to physicians holding more than one certification
  7. Several specialties have already implemented processes that offer ongoing demonstrations of competency as an alternative to the high stakes exam.
  8. Two specialty societies (Family Medicine and Psychiatry) stated that they were considering up thir own boards as a solution
  9. Anesthesia was the only specialty that admitted that reducing the burden on physicians had a negative effect on their bottom line
  10. Multiple states vowed to continue legislative efforts until tangible efforts in the MOC® process can be seen
  11. Need for dur process for physicians whose ability to work has been adversely affected by inappropriate use of MOC®
  12. The hospitals (AHA) and insurers (AHIP) should be invited to the discussion as they are the entities most likely to use MOC® inappropriately.

Please note that I spoke personally to the organizers of this meeting to request that Ohio be included in future discussions regarding MOC.

Respectfully submitted,

RF Chatman MD, MPH
President, Ohio State Medical Association
It appears the thrust of this "meeting" was to try and get states to NOT pass anti-MOC legislation. It didn't take long for an analysis of the Ohio synopsis to appear in my inbox from one observant physician (printed here with permission):
It seems to me as though this debate has now been quietly and cleverly re-framed in terms of retaining and "improving" (compulsory) MOC®.

Remember, it is only made "compulsory" through collusive "enforcement" by those twin paragons of virtue, the insurance and hospital corporations.

"No more high stakes exams we promise" they cried. The implied subtext being that the obligatory ABMS MOC parasite will remain Ebola-like, in some mutated and quiescent form, and continue to infect us all.

Debating the "character" of MOC® was four years ago. Pretty please. That didn't work. Now the issue is not MOC® but the utter and complete repudiation of ABMS lock, stock, and barrel. (Editor's note: Recall the AMA House of Delegates already voted to do so in June, 2016. We now see the AMA's answer to that resolution: to place physician puppets in position of power at the ABMS to assure their lucrative international medical data mining project grows ever stronger and more valuable.)

MOC® should be in reality just another innocuous and palatable Continuing Medical Education (CME) option, but has become a forced and toxic one. A most profitable and poisonous bubbling brew concocted and fed to us by our "peers in leadership positions." The ABMS have become the very caricature of witches on MacBeth's "blasted heath."
The ABMS and their 24 specialty lackeys should now go off and hawk their wares like any tawdry CME street vendor in the chaotic for-profit "medical education" bazaar. Through their grotesque avarice the ABMS have irreparably tarnished their brand. No physician will ever respect them again. Ever. They are done.

Why on earth does anyone even stoop to converse with the ABMS anymore? It is too late for that. As Texas Medical Association President Carlos J. Cardenas, MD said "Physicians in Texas and across the country... do not see the certifying boards as 'self.' They are, instead, profit-driven organizations beholden to their own financial interests. In fact, they are now one of the outsiders intruding into the practice of medicine."

States should pass their anti-MOC laws, the ABMS and its apologists should be disregarded, and we all should move on.

Why did the state medical societies, which (with very few exceptions) also lack any standing amongst rank and file doctors, even bother to meet with the ABMS?

It is a total charade, a Jersey boardwalk puppet show populated by unrepresentative and self-aggrandizing narcissists lobbying each other. What on earth were they doing, imploring the ABMS on a bended knee to change their wicked ways?

"My" state medical society (sadly not one of the exceptional ones and one having less than 5% of state physicians as members) has no right to negotiate the character of MOC® on my behalf. It is too late for that. The state medical societies have become little more than the mini me's of the hated and corrupt AMA.

The single demand going forward should be to break up the ABMS monopoly and open up the market to competing boards like the NBPAS, recently delineated in an article by an FTC member. Let the physician marketplace decide which boards truly represent their interests. Period.

The hospital and insurer enforcers should be met head on now. Forget the disgraced ABMS. The MOC® debacle has catalyzed the onset of a transformative phase in medicine, one we physicians must be the first to recognize and guide.
Somehow, I didn't think I could improve on this cogent analysis.

-Wes

6 comments:

  1. Dr. Wes,

    Has any of your information and Mr. Kroll's analysis been sent to the state medical boards for them to take against MOC? Is so, what has been their response?

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  2. The ABMS is a House of Romanov. No invective suffices to describe these individuals and their self-serving antics that have become an anathema to the physician community at large. And Dr. "Schnorrer" Nora has the audacity to ask that the States not support anti-MOC legislation? I'd rather cast my lot with the Devil I DON'T know!

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  3. Why wasn't this ABMS future of MOC meeting televised over the internet or on C-Span with everyone invited to view and respond via questions. Where was the "free press" to cover it?

    I share the same feelings as John F. Kennedy on the inherent harms of secret societies.
    The only unintended consequences of ending MOC would be freedom from MOC. Deliverance from a useless and redundant program that stifles education, creativity, the value of individual rights, and the pursuit of happiness.

    The imposition of MOC restricts independent thinking and constrains action based on the informed intelligence.

    John Kennedy's message to the "free press" in 1961, speaking about the dangers of estranged societies that fail to fulfill the fundamental obligation to report and speak the truth. The perils of shrinking from controversy warned about and emphasized in his speech. He speaks of the consequences of failing to create and sustain transparent fountains of knowledge and fact that helps lead men and women to understanding.

    Only then can we as individuals and a society be what we were intended to be - free and independent.

    Kennedy "61" press club

    "The very word 'secrecy' is repugnant in a free and open society; and we are as a people inherently and historically opposed to secret societies, to secret oaths and to secret proceedings. We decided long ago that the dangers of excessive and unwarranted concealment of pertinent facts far outweighed the dangers which are cited to justify it. Even today, there is little value in opposing the threat of a closed society by imitating its arbitrary restrictions. Even today, there is little value in insuring the survival of our nation if our traditions do not survive with it. And there is very grave danger that an announced need for increased security will be seized upon by those anxious to expand its meaning to the very limits of official censorship and concealment."

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  4. Dr. Fisher, thanks for this revealing analysis of MOC politics. We are exploring problems with MOC in MN. Wish us luck. Bob at regeistmd@comcast.net

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  5. Thomas Benzoni, DOThu Dec 07, 10:39:00 AM CST

    James Surowiecki (New Yorker) said it better than I can:
    Speaking of COI on Wall Street: "Transparency is well and good, but accuracy and objectivity are even better. Wall Street doesn't have to keep confessing its sins. It just has to stop committing them."
    https://www.newyorker.com/magazine/2002/12/09/the-talking-cure

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  6. Thw San Francisco Chronicle headline for 16 July 1981 was "Stanford to Repay $1.5 million to Medicare" in addition to $300,000 already repaid to MediCal. The Medicare settlement was based on a June 29th audit from the U.s. Department of Health Services. The audit was brought about by numerous press conferences that exposed double billing & how it was done to authorities at the Federal Trade Commission and others. Later SCIENCE Magazine covered the story. If the anti-MOC contingent is serious and committed, it would be wise to get FTC and IRS into the act to do its own investigations re allegationns of restraint of trade and violations of 501(C)3 tax codes. -- robert L. weinmann, MD, Editor, The Weinmann Report, www.politicsofhealthcare.com (11/29/17 and others)

    ReplyDelete