Wednesday, June 13, 2018

More Changes Are Coming to MOC!

Today in Medscape, we learn that even more changes are coming to MOC.

The simple answer to the "will physicians get relief" is, of course, no.

Here's the comment I left, just in case it does not get published, that explains why they won't get relief from the changes proposed:
This entire charade - ALL of MOC - is NOT about physician's continuing education, but about using our Board certification and re-certification status/scores/demographics/SSN, etc - in other words, our DATA - as a pseudo-"quality" indicator for Big Business. Big Business includes Blue Cross/Blue Shield and Premier, Inc., the largest group purchase organization for the nation's hospitals. In not mentioning this, Medscape perpetuates the gaslighting of physicians that has occurred for years on a massive scale - (but then, they, too have their corporate conflicts). Physicians have tried to play nice and go with the flow at first, but now the situation is untenable, in large part because the member boards have wound their financial strings around the MOC bicycle spoke so far, they can't unravel it.

Nowhere is there mention of corruption and political activities that have occurred with the member boards, the $2.3 million condo purchased by the ABIM Foundation, the spousal travel, the $1.7 million Golden parachute Christine Cassel MD received from the ABIM when she left to join the National QUALITY Forum.

It's time to end the corruption. But myself and others can't do it alone. We need your help. Please visit our GoFundMe page and learn how you can contribute to pre-litigation investigation and the development of a legal complaint for fraud against the ABIM, the ABIM Foundation, and its leadership and others:

https://www.gofundme.com/practicing-physicians-of-america

Thanks-
Seriously, I can't do this alone.

-Wes

Tuesday, June 12, 2018

Churning Pseudoscience

Recently, two papers published by authors at the American Board of Internal Medicine (ABIM) appeared in the mainstream medical literature that purported to provide evidence to the value of their Maintenance of Certification program.

The first was "Associations Between American Board of Internal Medicine Maintenance of Certification Status on a Set of Healthcare Effectiveness Data and Information Set Process Measures" by Bradley Gray, PhD, Jonathan Vandergrift, MS, Bruce Landon, MD, MBA, James Reschovsky, PhD, and Rebecca Lipner, PhD in the Annals of Internal Medicine. The other was "The American Board of Internal Medicine Maintenance of Certification Examination and State Medical Board Disciplinary Actions: A Population Cohort Study" by Furman McDonald, MD, MPH, Lauren Duhiggt, MPH, Gerald Arnold PhD, MDH, Ruth Hafer, BA, and Rebecca Lipner, PhD published in the Journal of General Internal Medicine.

Both of these studies' senior author was Rebecca Lipner, PhD, a testing psychometrican who currently serves as the Senior Vice President for Assessment and Research at the ABIM earning $435,990 per year. Last year's tax records also disclose Dr. McDonald, ABIM's Senior Vice President "Academic and Medical" earns $419,497 annually for his services. The other author's salaries are not disclosed, but we can imagine their salaries are not zero.

The first study by Gray et al, is a cross-sectional design and used observational data. As such, its results only reflect associations and not definitive indicators of a causal relationship (acknowledged in the limitations section by the authors). The second study by McDonald, et al. is another observational study and cannot determine causality either.

So why are ABIM diplomats funding so many "association" studies? Given the cost of producing these studies, might the ABIM be churning pseudoscience to forward their own agenda rather than forwarding helpful public policy or medical science? Not disclosed in their "Conflict of Interest statements is the fact that ABIM sells our board results and "status" via the American Board of Medical Specialties (ABMS) to others via ABMS Solutions, LLC. As such, these publications serve the organization's undisclosed covert agenda and should be called what it is: very expensive propaganda.

With our current era of the proliferation of predatory journals, it is clear we also have an era of proliferation of predatory publication that supports the needs of our ABMS member boards that is not in their diplomates' best interest as well.

-Wes





Monday, June 11, 2018

Recap: Dr. Wes Goes to 2018 AMA Annual Meeting

It was a rainy day in Chicago.  I elected to take the commuter train downtown to avoid the traffic well before my scheduled presentation for the PA Medical Society at 9AM. After leaving the Ogilvie Train Station, I walked to the cab station to hail a cab to the Hyatt Regency. It was then I saw this Facebook ad at the train station:


Such irony.  There I was, heading to the AMA House of Delegates to speak on this very issue and how it has adversely affected physicians.

"MOC is not about physician education, it's about our data."

-Wes

To view the entire presentation, you can view the live stream of the talk here. (Sorry about the quality, it was my cell phone that was only dropped once...)

Please consider giving generously to our GoFundMe page to begin the process of ending Maintenance of Certification™nationwide.

Tuesday, June 05, 2018

Everybody Knows a Frank

Frank is one of the smartest people in his cardiology division. He's bright, congenial, and capable of citing the latest clinical trial on the best imaging study to detect hibernating myocardium. He loves learning. Frank is the guy you used to confide in the doctors' lounge (that doesn't exist anymore). Others knew what a good guy Frank was too; Frank was nominated to write and edit questions for the nuclear medicine boards. Deep down inside Frank knows the boards are a problem. But he's afraid that if someone were to implicate his medical society as colluding with the boards, he'd see himself as being partially responsible for losing the one scientific meeting he attends each year where he can re-connect with colleagues and maybe learn something new.

At another center, Frank is the Chairman of the Department of Medicine responsible for the day to day workings of a large urban hospital system. He is a highly respected member of the Internal Medicine community, author of 14 books on the principles and practice of  Internal Medicine, and a beloved bedside instructor to generations of internal medicine residents. He also serves as a test-writer for the American Board of Internal Medicine and thinks overall they're a responsible group.  He knows how hard his fellow physicians work at constructing a meaningful continuing education process. As the  President of his local medical society, too, he knows money doesn't just grow on trees. And if people tried to disrupt the status quo, what's the endgame?

Frank on the other side of town serves as an editor to the preeminent hematology-oncology journals and has held multiple leadership positions in his subspecialty's medical society. He is widely respected by his peers, served as a director at the American Board of Internal Medicine (ABIM) and helps write test questions for the ABIM, too. He finds test-writing challenging and believes in the value of continuous testing to maintain a physicians fund of knowledge. He devotes countless hours to this endeavor to assure it is fair and impartial to those who must recertify. Sure there are some challenges, but given all the good people working on this, no one needs to question the integrity of the process.

* * *

The dilemma facing physicians today is that the majority of physicians who work with the ABMS member boards and our subspecialty societies are good, hard-working members of our profession. It is hard to fathom that a very tiny minority are corrupt and have been operating below the radar for years. I have no fantasy that your Frank or mine would approve of this corruption or even be able to believe it. And yet, here we are.

Our own inability to tolerate this complication threatens to paralyze us from cleaning up the corruption in our ranks.

There have always been good people in our professional societies and ABMS member boards. But these colleagues, who value contributing and community involvement, should be engaged in a far different framework. Doctors need community and support and collegial leadership. Returning medicine to a truly non-profit, voluntary, democratic representation of working physicians today rather than the self-selected, profit-churning, elitist employment service that it has become. Alternative structures are already emerging. It is time to be open to new possibilities or to take on the challenge of creating them.

What we face now is not new. There have always been top dogs who operate with impunity in contrast to all of the good causes that they publicly champion. In 2018, with the Harvey Weinstein, Matt Lauer, and Eric Schneiderman hypocrisies, surely we can understand this reality.

Today, physicians' ability to work, receive insurance payments, and willingness to stay in our profession, are threatened by the out-of-control, corrupt, ever-evolving Maintenance of Certification (MOC™) requirements supported by Organized Medicine. It's time to see it for what it is.

We all know a Frank, or several Franks and Francines. They cannot continue to be a shield for the exploitation of practicing physicians. Or a reason to look the other way. We all honor the hours of work it has taken our esteemed colleagues who have participated with the best of intentions over the years, but its time to clean up the corruption in the ABMS member boards and colluding medical subspecialty societies.

Cleaning up the corruption is the first step. Please contribute whatever you can to our effort to do so.

Thanks-

-Wes

Sunday, June 03, 2018

Before You Pay Your $155 to ABIM (or Any Other ABMS Member Board)

This past week, the American Board of Internal Medicine sent this reminder to all ABIM Board-certified diplomates participating in Maintenance of Certification (MOC™) (thanks @jtsaxon for sending this):



Before paying this fee, please take a moment and re-read this classic post from Robert Wachter, MD from 14 August 2012 that he placed on his former industry-sponsored blog, Wachter's World. The post is titled "On Becoming Chair and Why the Boards Matter More Than Ever."

Be sure to read the comments included, all 95 pages of them (or at least a good portion of them). (They have been saved to my server in case Dr. Wachter and his industry companions want to wipe the internet archive, too.)

On 1 August 2013, Robert Wachter, MD received 1355 shares of IPC Hospitalist Company stock. On 2 January 2015, Robert Wachter, MD received another 2186 shares of IPC The Hospitalist Company stock. Some of the fees he was paid were shared with his employer at the time, the University of California, San Francisco, too.

Wachter's World no longer exists because it was pulled from the internet in 2016 because Dr. Wachter's company, IPC Hospitalist Company, had to settle claims filed by a whistleblower and the DOJ for "up-billing" Medicare under the False Claims Act.

You decide.

Do I want to send my money to the ABIM to perpetuate the MOC ruse or send my money to the legal fund at Practicing Physicians of America that was created to end the consumer fraud perpetrated by the ABIM and its co-conspirators?

What "matters more than ever" is your decision.

-Wes




Saturday, June 02, 2018

US Board Certification Survey Results to Be Presented at the June AMA Meeting

The largest independent voluntary survey of US physicians on the topic of US Board Certification (and continuous certification) will be presented at the 2018 Annual Meeting of the AMA House of Delegates at the Hyatt Regency Chicago on June 11, 2018, at 9 AM. The social media-promoted national survey was conducted by Practicing Physicians of America and explores the topics of value, cost, burnout, research methods, physician awareness of conflicts of interest, and the negative consequences physicians have experienced from the process. Physicians from all 50 states and nearly all US territories and subspecialties responded.

Pennsylvania Medical Society is hosting the event and I will be presenting. Given your busy schedules, I look forward to meeting all three of you who can make it.

-Wes

Friday, June 01, 2018

UCSF's Embarrassing Appointment

It seems some people can't help themselves. They have to tow the party line. You scratch my back, I scratch yours.

Imagine Christine Cassel, MD, self-proclaimed "bioethics" queen extraordinaire,  and former President and CEO of the American Board of Medicine (ABIM) and the ABIM Foundation when the Foundation purchased that $2.3 million condominium in December 2007 using ABIM diplomate testing fees, now the recipient of the UCSF Presidential Chair for 2018-2019.

And who recommended her?

Why none other than the "loving" Mr. Piano Man himself, Robert ("Elton John") Wachter, MD, the current Chief of Medicine at UCSF and former Chairman of the Board at ABIM.

While it's hard to make this story up, we should not be surprised. This is how interdependent the halls of academic medicine and the US physician credentialling system have become. Like opportunistic parasites, they feed on each other's narcissism to the embarrassment of their fellow working physicians who don't dare say a thing, lest they lose their job.

I'm not sure I've ever seen a more startling example of the sickening hypocrisy in academic medicine.

My alma mater should be ashamed of itself.

-Wes

PS: Please consider donating to our efforts to expose the deep-seated corruption in the halls of Organized Medicine.

Your Dollars At Work

American Society of Clinical Pathologists' (ASCP) Choosing Wisely® campaign needed nominations yesterday. Here were two of the top nominations made on Twitter:




Both are inspired choices.

Especially since the ABIM Foundation (the creators of the "Choosing Wisely® campaign) was secretly funded from US Physician certification fees.

-Wes

P.S.: Please donate to our GoFundMe campaign to end this corrupt redistribution of our certification fees and please share the following link with your colleagues: https://www.gofundme.com/practicing-physicians-of-america

Wednesday, May 23, 2018

Enough is Enough

It is 8:30PM CST on the 23rd of May, 2018.

The American Board of Internal Medicine (ABIM) has still not posted their financials from fiscal year 2017, due May 15th, 2018 after an extension is granted by the Internal Revenue Service, on their website. I wouldn't be surprised if they're insolvent, or close to it.

Maintenance of certification (MOC™) is expensive, costing physicians over $23,000 every 10 years in fees, travel, and time from work. Doctors are sick and tired of being manipulated and coerced into playing the continuous certification game created by the non-profit ABIM that has never been independently proven to improve patient safety, care quality, or patient outcomes after a doctor's initial board certification. Doctors are especially sick and tired of these unaccountable member boards of the American Board of Medical Specialties (ABMS) mandating busy work that, if not performed, would limit our ability to maintain our hospital credentials, receive insurance payments, or even obtain state licensure.

We are also sick and tired of being ethnographic research subjects and "HIPAA Business Associates" for the member boards of the ABMS so our data can be bought and sold while board members and officers of the ABMS member boards enjoy their multi-million dollar condominiums with chauffeur-driven BMW town cars, office buildings, first class and spousal air travel, Cayman Island retirement funds, and health club memberships all on our hard-earned nickel.

The conflicts of interest created by MOC spread far and wide: BCBS, CECity/Premier, PearsonVue, ABMS Solutions, LLC, IPC The Hospitalist Group, National Committee on Quality Assurance, American College of Physicians, Wolters Kluwer, Reed Elsevier, UCSF, Massachusetts Medical Society, the AMA, AHA, CMSS, among others.

The financial orgy within the bureaucratic halls of the ACGME has been going on for years at the expense of hard-working doctors. MOC fees alone have mushroomed 244% from 2000-2014 to fund these shenanigans. Numerous doctors are burning out, or quitting altogether, to avoid the ruse. It must come to an end. The integrity of our profession demands nothing less.

Please join me in this GoFundMe crowdfunding drive by Practicing Physicians of America to end MOC™ nationwide for all subspecialties. The specifics of the campaign's purpose are outlined in the campaign's "story" on the GoFundMe page. Please give generously.

It's time to stand up for what's right.

Enough is enough.

-Wes


Saturday, May 19, 2018

Earning MOC™ Points: A Self-Paid Advertorial

As a follow-up of my earlier post on the American Board of Medical Specialties' (ABMS) Maintenance of Certification™(MOC™) program's tax on medical education, I was sent the "approved" responses of two different physicians that were required to answer questions to "earn" ABMS MOC™credits from the Heart Rhythm Society (HRS) Scientific Sessions after the meeting. These responses were "approved" by an HRS "reviewer" so the doctors could apply these points to remain "Board certified" and employed with their hospital systems. Each doctor had to write between 50 and 100 words (no more, no less) in response to questions posed by the ABIM. Despite their different responses, each received the exact same "feedback" that included links to various Heart Rhythm Society, American College of Cardiology, AMA, ABMS and non-governmental organizations' policies and web pages.

(See Physician 1's responses here and Physician 2's responses here.)

Given these canned responses to these physicians feedback, how is this time-consuming, costly, and meaningless "feedback" exercise for "earning" MOC™ points anything but a self-paid advertorial for the HRS, ACC, AMA, ABMS, and other non-governmental organizations?

It is a sad commentary that our own subspecialty societies legitimize this corrupt process despite all that we know about it today.

-Wes


Saturday, May 12, 2018

Taxing Medical Education with MOC

I just received this in my email in-basket from an attendee at this year's Heart Rhythm Society (HRS) Scientific Sessions:
I just got back from our annual EP meeting (HRS) which was in Boston. As you can imagine, the entire CME process has been bastardized to monetize the ABIM (American Board of Internal Medicine). After dutifully checking off which sessions I attended and rating the speakers, I noted a few things.

Firstly, all attendees were electronically tracked with RFID tags. Our attendance at the sessions were electronically tracked and automatically noted. A pretty neat feature and designed, I think, to prevent fraudulent CME behavior.

We had to answer a separate ABIM Maintenance of Certification (MOC) section and actually provide prose with a minimum and maximum word count. There was a warning stating that the content of our replies would be reviewed before the ABIM would bless them for the MOC process.

Which begs the question. Under what circumstances does the ABIM have the authority to legitimize or delegitimize my reply to their nonsensical questions? The MOC portion of the CME conversion was more of a sampling of my opinion. Is this the new MOC paradigm: impose an educational tax on our meetings and then also charge a toll on their MOC highway?

This process is not only corrupt and inefficient; it is now surreal and insane.
Yes. It. Is.

MOC® is little more than taxation of physicians without representation.

(And we still don't have ABIM's financials from 2017 for the public's review.)

-Wes

Sunday, May 06, 2018

The Delicate Dance

There is a delicate dance between two partners every day in medicine: the dance between the benefits of innovation and the costs of that innovation. One can't survive without the other. Patients and doctors benefit from the innovation and corporations benefit by being able to sell more devices to benefit themselves and their stockholders. In a nutshell: this is capitalism.

But increasingly, doctors and patients are being asked to surrender more and more of their personal information non-transparently in a lopsided dance that benefits the corporations and their partners. A once mutual dance turns into an ultimatum.

When a physician's ability to practice medicine is tied to obtaining Maintenance of Certification® (MOC®) points, the benefit of trading that information for both the patient and physician are less clear. Doctors are threatened with losing their ability to work unless they accrue MOC® points and their patients shoulder more and more of the costs for their healthcare non-transparently to fund the ruse.

So it should come as no surprise that the "tag and release" of physicians at this year's Heart Rhythm Societies' 2018 Scientific Sessions in Boston continues unabated. Attendees are not only automatically "opted-in" to data sharing with corporations, but with accrediting agencies, too:


Here we see that a physicians'  personal information is automatically tied to a "Credit Cart" where personal "beacon" information flows to corporations in return for automatic documentation of their Continuing Medical Education (CME) /  Maintenance of Certification® (MOC®) credits. But to receive that credit, doctors must complete surveys for the various accrediting agencies that unilaterally decide what qualifies to earn CME/MOC® approval, and what does not. 

Want to steer physician thinking, give 'em a bone, or MOC® credit, to drive key opinion leaders (KOLs) to your talk, then watch your sales grow!

For doctors, here are the rules for HRS2018 that ties a doctor's information-sharing to their freedom to learn what they want and to practice medicine: 

(Click to enlarge)
Think about it every time you attend a session.

For ourselves and our patients, there's no such thing as a free lunch.

-Wes








Wednesday, April 25, 2018

ABIM Struggles to Keep MOC Relevant and Meaningful

Both MedPageToday and Medical Economics covered the latest American College of Physician (ACP) meeting and know how to drive traffic to their site - just mention Maintenance of Certification, Richard Baron, MD, and their pals at the American Board of Internal Medicine (ABIM).

Their pieces suggest the ABIM is trying to keep their corrupt "Maintenance of Certification" program, born from a collaboration between the ABIM and ACP years ago, "meaningful and relevant."

And in a way, they are.

Nothing brings doctors together more than the topic of the mandated Maintenance of Certification® (MOC®) program and great quotes like:
"Grandfathering is a really vexing challenge," said Baron. "It's pretty difficult to defend ... I would not see those doctors as equivalent to doctors who rectify."
I'd like to thank the editors of both journals.

You are the bomb.

-Wes

Friday, April 13, 2018

What the ABIM, ACC, and Facebook Have in Common

Mr. Mark Zuckerberg, uncomfortably stuttering and stammering before Senator Cantwell about a little-known company named Palantir (aka "Stanford Analytica"), reminded me of a similar moment when Christine Cassel, MD from the American Board of Internal Medicine (ABIM) had to answer questions about her affiliations with Premier, Inc., and Kaiser Foundation Health Plans and Hospitals upon taking the helm at the National Quality Forum. Dr. Cassel brushed off those concerns as "distractions" by resigning from the boards of those corporations, in large part to avoid questions of why those relationships were an issue.

Nowhere did Ms. Cassel explain that her former non-profit corporation, the American Board of Internal Medicine, had changed its bylaws in 1997 to allow virtually unlimited conflicts of interests to benefit their organization. I remember the ABIM's website claiming their organization gets 97% of its money from its physician-diplomates. Now we see nothing could be farther from the truth. Funds are flowing back from the ABIM Foundation as a "Funding Initiative." And ABIM executives have always enjoyed a wonderfully lucrative relationship with CECity, the $400M data-gathering subsidiary of the hospital group purchase organization, Premier, Inc.:
Through Premier, client organizations are able to quickly and cost-effectively launch their own sophisticated online initiatives directly to their target audience (e.g. members, employees, associates, applicants/diplomates, etc.) by leveraging Premier’s multi-million dollar investment in world-class applications and enterprise-level infrastructure (SAS 70 Type II).

At its core, Premier’s products link performance management (data acquisition via web forms, IVR, external and internal registries, data feeds, etc), assessment, benchmarking, peer comparison, and identification of gaps (financial, knowledge and patient care) with interventions that drive performance improvement.

Our platforms align this cycle of performance management and improvement with various incentive programs to drive healthcare provider participation.

As a CMS-qualified registry for the Physician Quality Reporting System (MIPS, ePrescribing, MOC-MIPS) and as the service provider for many physician certifying boards (e.g. ABIM, ABO, AOA) Premier is uniquely positioned to align professional and financial incentives with CQI to deliver ‘game-changing’ quality initiatives that have proven and measurable results.
This CECity/Premier relationship is firmly embedded in the ABIM's HIPAA Business Associate Addendum agreement every practicing physician must agree to as a condition of enrolling in "Maintenance of Certification (MOC)" (also known as "continuous certification").  With the lack of disclosure of this relationship by the ABIM, is clear that patients and doctors alike aren't supposed to know their personal data are being sold.

The American College of Cardiology

The same data-gathering strategy appears to be true for the American College of Cardiology (ACC). The ACC has always had the ability to side-step the ABIM and re-certification but has chosen not to do so.  Physician and patient data are too important to them, too. I was naive to think that was because of the use of physician data for their NCDR "registries" used by the nation's hospitals. Instead, it seems there may much bigger play in mind, as reported by CNBC:
Facebook provided a quote from Cathleen Gates, the interim CEO of the American College of Cardiology, explaining the possible benefits of the plan:

"For the first time in history, people are sharing information about themselves online in ways that may help determine how to improve their health. As part of its mission to transform cardiovascular care and improve heart health, the American College of Cardiology has been engaged in discussions with Facebook around the use of anonymized Facebook data, coupled with anonymized ACC data, to further scientific research on the ways social media can aid in the prevention and treatment of heart disease—the #1 cause of death in the world. This partnership is in the very early phases as we work on both sides to ensure privacy, transparency and scientific rigor. No data has been shared between any parties."

Health systems are notoriously careful about sharing patient health information, in part because of state and federal patient privacy laws that are designed to ensure that people's sensitive medical information doesn't end up in the wrong hands.

To address these privacy laws and concerns, Facebook proposed to obscure personally identifiable information, such as names, in the data being shared by both sides.

However, the company proposed using a common cryptographic technique called hashing to match individuals who were in both data sets. That way, both parties would be able to tell when a specific set of Facebook data matched up with a specific set of patient data.
While I appreciate the flowery take of this breach by ACC's spokesperson, I'm afraid the ACC's hand is stuck firmly in the financial data mine cookie jar. After all, as we've seen with Facebook and our recent election, not all uses of data are always in our patients' best health care or financial interest.

It's amazing, isn't it? These databases once thought to be a product of ingenuity by for-profit and non-profit organizations, are looking more and more like a product born of little more than opportunity and necessity.

But others much smarter than I have known this long ago. To the ABIM, the ACC, and Facebook: it's all just about guns, germs, and steel.

-Wes

Monday, April 09, 2018

An Internet Quiz: ABIM's Website Moves the Goalposts Again

The Internet loves mystery...

and cover-up.

There are very bright minds out there, and nothing gets those juices flowing for the dedicated Internet sleuths than when someone is trying to hide a carefully crafted change that benefits the Big Guy and screws the Little Man.

Lately, I've been watching the myriad of changes to the ABIM website.

It's got a whole new look and feel, full of big flashy graphics, but little on content. They will argue, no doubt, that it's all made to improve the navigation on their website and to introduce the bold new ideas they have concocted to be sure the fine print is missed.

So here's the challenge.

Take a minute and go the the ABIM website. (Warning, you'll need more than just a minute for this contest, but if you've got the time, this might satisfy criteria for some MOC points/CME credit).

Click on the Maintenance of Certification banner.

Look over to the left and find the "Policies" button. Here's what the screen looks like today:

(Click to enlarge)

Scroll down to look at what you've missed below the fold, as shown here: 

(Click to enlarge)

Now, this is where things get fun. It will be like The Price Is Right, where Bob Barker asks the contestant to look behind Door Number 1, Door Number 2, or Door Number 3. Go ahead, and click on one of those drop-down arrows of your choosing. What you don't realize, it that behind every one of those arrows, is the hidden surprise that has changed - your MOC® contract with ABIM in all its (hidden) glory.

So here's the challenge...

... which part(s) has(have) changed in the last six months?

Good luck!

-Wes




Wednesday, April 04, 2018

Feldman: MOC is Good For You

It was helpful for me to read this take on maintenance of certification from Wake Forest dermatologist Steve R Feldman, MD, PhD in The-Dermatologist.com. There are so many straw dogs here it boggles the mind, but the piece exposes a level of naïveté by academic supporters that really don't seem to understand the myriad of problems with MOC. Take this quote, for instance:
The provision of medical care is highly regulated. Not all the regulations are to physicians’ liking. Along with our monopoly power, comes controls that are designed to assure the quality of the care we provide. Our education has been regulated, getting licensed has been regulated, and getting certified has been regulated. Now, maintaining that certification has been regulated, too.
Dr. Feldman justified MOC because, well, we need more regulation! He seems to imply we should just get over it folks: the unaccountable member boards of the ABMS can do as they please with your money. Buy a condo in the name of "Choosing Wisely?" Sure. Send some funds off-shore to the Cayman Islands for their retirement fund while you do the dirty work of seeing patients? Sure. Buy a nice pond or purchase a nice car collection with your colleagues testing fees? Heck yeah! And why not run a for-profit real estate management firm with certification funds, too? Why of course! Then you can perform research on your colleagues without informed consent! And best of all, you can make sure your pals on the Dermatology board force working physicians into becoming HIPAA Business Associates to CECity (A subsidiary of the $4 billion hospital Group Purchase Organization, Premier, Inc.) when they sign up for their recertification tests? Man, the digital data party never stops giving!

Poor guy. Maybe Dr. Feldman didn't know about all this. Or maybe he still needs to threaten working doctors to scratch his social justice itch. (Let's hope not.)

But if that was not enough, Dr. Feldman made this suggestion as an alternative to our current re-certification mess:
If the argument that MOC has not been shown to improve quality, claiming a CME requirement assures quality seems suspect at best. What would a serious solution look like? It would have quantitative, representative measures. Perhaps, it could include random independent evaluation of videotaped patient encounters, supplemented by review of treatment decisions made of lesions and rashes based on photographs or on “secret shoppers.” All the really serious means to document and assure quality would be far more heinous than anything being considered now.
Threats of physicians won't dispel the truth about MOC: it is corrupt to the core. It has harmed physicians. It threatens their right to work on the basis of metric that does nothing to improve the quality or safety of patient care.

Dr. Feldman asks for a viable alternative to MOC. Really, the answer is very simple.

End it.

Completely...

... just as the AMA House of Delegates voted to do so almost three years ago.

-Wes

Saturday, March 31, 2018

AOA Agrees to Settle Antitrust Claims

According to the court docket, the American Osteopathic Association (AOA) is in talks to settle the anti-trust claim (Case 1:2016cv04644) made against it on August 1, 2016, by four osteopathic physicians. The terms of the settlement are still being negotiated, but the case has been dismissed on an administrative basis without prejudice. Perhaps the evidence of the AOA President's address in July 2017 that attempted to spin the benefits of decoupling AOA membership to certification and the evidence that the AOA stood to lose over $1M in revenue each year as a result of the decoupling made it clear to all that the AOA was caught with their hand in the regulatory capture cookie jar.

US Doctors of Osteopathy deserve to have the terms of the settlement disclosed publicly.

-Wes

Sunday, March 25, 2018

ABMS/ACP "Vision:" Specialty Societies To Do MOC® Dirty Work

With the ABIM still holding out on filing its FY 2017 Form 990's for the ABIM and the ABIM Foundation, the newly-formed ABMS "Vision Commission" is serving as a distractor to what's really happening behind the scenes. Instead of ending the corrupt Maintenance of Certification (MOC®) program, the ABMS and its colluding specialty societies are working feverishly to recruit willing doctors to build content so they can take the lucrative MOC® baton from the ABIM. It is abundantly clear to everyone that the ABIM is in a world of financial and legal hurt, and the ripple effects of their corruption are being felt across the ACGME and the US medical subspecialty society infrastructure. Here's a copy of the letter the American College of Cardiology (ACC) and Heart Rhythm Society (HRS) are circulating to carefully-selected individuals:
As you may know, The American Board of Internal Medicine (ABIM) has announced plans to offer new options for Maintenance of Certification (MOC) assessment beginning in January 2018. ABIM’s current 10-year exam will remain available as an assessment option for those seeking to maintain one or more Board certifications. In addition to the two MOC options offered directly, the ABIM has committed to working with three medical specialty societies – the ACC, the American Society of Clinical Oncology (ASCO) and the American College of Physicians (ACP) – to explore development of additional collaborative maintenance pathways (CMPs) through which physicians can maintain board certification. The goal of this effort is to offer board certified physicians additional flexibility in how they can demonstrate to their peers and the public that they meet standards and are keeping their medical knowledge current.

The ACC has proposed an MOC option for cardiovascular medicine that uses enhanced versions of its Self-Assessment Program (SAP) collection (with a formal knowledge assessment function built into the products) as an alternative to taking the ABIM 10-year examination or the 2-year Knowledge Check-In series. The enhanced SAP collection would comprise ACCSAP (general cardiology), CathSAP (interventional cardiology), EP SAP (electrophysiology), Heart Failure SAP (heart failure) and ACHD SAP (adult congenital heart disease). Developing this comprehensive collection of enhanced SAPs that covers all cardiovascular topics with ABIM board certification exams supports the tacit position that the College is the professional home of all cardiovascular specialists.

Dr. Patrick O’Gara has accepted the invitation to serve as the Self-Assessment Program Editor-in-Chief for the SAP Collection. Dr. Joe Marine and Dr. Ken Ellenbogen have accepted the invitation to serve as Co-Editors of EP SAP and Dr. Edward Gerstenfeld as your Topic Editor. On behalf of Drs. O’Gara, Marine, Ellenbogen, Gerstenfeld and the ACC, we are pleased to extend an invitation to be an author on the topic of Pathophysiology in the chapter entitled Clinical Arrhythmias: Atrial and sub-topic Atrial Fibrillation in ACC’s newest offering in line with the EP SAP product. Please review the attached letter and position description. We look forward to your response by Monday, March 26, 2018.

Regards,


Liara

Liara Fredericks-Brown
Digital Content Specialist
American College of Cardiology
This is not about "quality" health care. This is not for "patient safety." This is about one simple thing: the money.

It is also about manipulating their colleagues with rent-seeking for their own political avarice and greed.

-Wes

Friday, March 16, 2018

One Final Push

This weekend, the national multi-specialty survey of US physicians sponsored by Practicing Physicians of America will be closing to allow time for analysis. To date, the response to the survey has been remarkable: physicians from all 50 states and nearly every US territory have participated with 47 subspecialties (both medical and surgical) represented. In case I should forget, I should also like to add a special word of thanks to those who helped spread the word about this survey, especially members of the Pennsylvania Medical Society, the Association of Independent Doctors, and Doximity. The power of social media to reach working physicians has been amazing.

Currently, I estimate the error of the survey will be as low as ± 1 or 2%, depending on the question asked. Obviously, the more (credible) responses we receive, the more powerful the survey since non-responder bias is present with surveys.

So talk it up one last time, share it like crazy, and encourage your colleagues who have not competed the survey to do so. I have no doubt the results of this survey will be eye-opening to all.

-Wes


P.S.: Goodness: Just realized I published this without the link to the survey!  Here it is: https://www.surveymonkey.com/r/PPA_MOCSurvey





Friday, March 09, 2018

ABIM and the ABIM Foundation: Consumer Fraud?

Early Tuesday morning I attended an excellent continuing educational video-conference hosted by Paul Friedman, MD at the Mayo Clinic at our institution. Anyone who knows Paul knows what an excellent educator and mentor he has become for electrophysiologists around the world. The case involved patient that was a CRT failure, the workup of that condition, the decisions made, and how they handled the case using His bundle pacing, with some pearls about that physiology. I attended the conference voluntarily and without coercion because of the excellent educational value it provides me yet I received no continuing medical education credit (CME) or ABMS Maintenance of Certification (MOC®) credit for doing so.

Because I wasn't scheduled to start a case after that, I then attended a lecture on pulmonary hypertension and its management delivered by one of our cardiology fellows. That lecture was  sanctioned by the University of Chicago as qualifying for CME credit, but not MOC. It, too, was excellent, and refreshed my understanding of the various oral and intravenous therapies available to treat this disorder. I then traveled to another hospital to perform three procedures.

ABIM Website - Click to enlarge
Later that day between cases, I had a colleague who has been forced to re-certify in April of this year and perform MOC® modules lest he lose his credentials to practice at our hospital, look up my publicly available information on the ABIM website for me, and there I was: certified in Internal Medicine, Cardiology, and Cardiac Electrophysiology, but not participating in MOC®.

I know most of the long-time readers of this blog are probably thinking that I should wear that "Not Participating in MOC" designation as a badge of honor, but I look at this very differently.

This designation on their website does not include my CME credits (which the ABIM co-brands with their MOC product) and suggests to the public that I "don't keep up" in my field. By co-branding MOC® with CME, they suggest they are equivalent, but they clearly are not. Not participating in certain CME offerings can't remove me or my partner from my job, but not participating in MOC® can. And if MOC is so important to the ABIM and its corporate cronies in the ACGME heirarchy (inlcuding the powerful hospital and ABMS lobbyists), how am I advertised as "certified" yet not participating in MOC®? This is confusing to the public and makes no sense, particularly when we see the fighting going on at the state legislative level over the "need" for forced "continuous education" of physicians.

Yesterday, I was also tipped to this (seen at the right): an event hosted by the Jewish
Health Activist Network Announcement
(Click to enlarge)
Healthcare Foundation entitled "Spreading and Sustaining the Choosing Wisely Campaign" to be held on Thursday, April 12, 2018 from 5:30PM to 7:30PM in Pittsburgh, PA. The ABIM Foundation's Executive Vice President and Chief Operating Officer, Mr. Daniel Wolfson is the keynote speaker. "Following his comments, Mr. Mark DeRubeis, CEO of the Premier Medical Associates, and Mr. Jim Coslow, Director of Value Based Care, will share how - and why now - Premier has embraced Choosing Wisely."

We must recall that the ABIM has no money on paper, and all of their remaining assets reside with the ABIM Foundation who is speaking and promoting their marketing campaign at our expense at this program. All of their funds come from working physicians' certification and re-certification fees (with the exception of a few grants from the Robert Wood Johnson Foundation). The ABIM Foundation has nothing to do with physician certification, as evidenced by this notice. They have a different mission than assuring physician competence - rather, to promote the next physician payment model of value-based care for themselves.

The ABIM does not place our continuing education credits on their website, yet lists us as not participating in MOC. They call me "certified" publicly on their website, yet the ABIM and my hospital consider my colleague somehow less qualified because he didn't participate in MOC® and pay his money, but are more than happy to continue billing on his behalf in the meantime. Through regulatory capture, the ABIM forces my colleague to take the ABIM MOC® test in April, while not forcing me to do the same and promoting me as "certified" on their website. If my colleague should fail (he won't, just speculating), then me and my colleagues would have to manage his patients and take call more frequently when he is removed from our staff. In effect, there is a multiplier effect if one doctor doesn't recertify on other physicians.

I know this is a strong statement, but given these realities and given what I know about the ABIM Foundation (especially how it received its funds) and its financial shenannigans that include the purchase of a multi-million dollar personal condominium, off-shoring of funds to the Cayman Islands, its many public tax filing discrepancies, I believe the ABIM and ABIM Foundation are engaging in consumer fraud when they post my MOC® status as they do and claim recertification is about physicians "keeping up." As others are noticing, their monopoly on this lucrative product  should not allow them to be qualified tax-exempt organization either.

I believe MOC® is a shell game that deceives the public about the quality of their physicians on a massive scale. It's time to just say no.

-Wes

Monday, March 05, 2018

Physicians and the Remarkable Power of Social Media

Social media is proving remarkably powerful for physicians across all subspecialties to voice their opinion on US Physician Board certification. Respondents to the Practicing Physician of America survey on US Physician Board Certification circulating via social media channels appears to be reaching all subspecialties in a proportion remarkably similar to the 2016 AAMC published workforce numbers:

Click to enlarge
There is power in numbers. We could not have had such a response without so many dedicated clinical physicians from all specialties taking the 6-minutes or so needed to complete the survey. There's still time to add your voice (and those of your colleagues) to the survey if you have not done so already.

We'll be wrapping up the survey to clean the database in the next few weeks. Please be sure to take the time to make your voices heard.

With heartfelt gratitude to my colleagues -

-Wes

Friday, March 02, 2018

ABMS, Online Testing, and Breaches of a Physician's Right to Privacy

Are the American Board of Medical Specialties (ABMS) and the American Board of Internal Medicine (ABIM) violating US physicians' right to privacy through their online certification process?

Who is in charge of ABMS/ABIM testing security?

ABIM has been advertising Maintenance of Certification® (MOC®) using two-year assessments in the "privacy of your home or office." They are avoiding the obvious fact that they are not ready and the platform is wholly untested for the theft of identity, credit cards, bank accounts, email content, patient information, and the whole gamut of personal and professional information. 

If the American College of Cardiology (ACC) is involved with the ABIM to promote their products, then they, too, are either totally ignorant of this or purposefully turning a blind eye to this reality.

Recall that ABIM's former Direector of Test Security was never formally disclosed to physicians in 2008, nor was his departure from ABIM last year. That individual used an online alias that never hinted at his past nor disclosed his relationship with the shady test security firm, Caveon, with whom the ABIM is using for their (unsecure) Knowledge Check-in's. It was only after a Puerto Rican physician who was sued by the ABIM for possible copyright infringment (a case which they lost), that the true identity and troubling background of ABIM's Test Security Director became known. That Test Security Director's also worked (works?) for Caveon. Caveon uses a former Ballard Spahr (ABIM's legal team) lawyer, Mr. Marc Weinstein, to target test-takers they feel may have cheated. This opens a huge Pandora's Box of concerns for physicians who undergo online "continuous certification." The potential to ruin a physician's hard-earned reputation and professional credibility on the basis of an online proctor's insinuation of an errant keystroke pattern or suspicious gaze during testing without due process is real. And Caveon's system test security system offers no credible safeguards against identity or credit card theft, or mirror-imaging of our computer's files or keystrokes for their purposes.

Are physicians really going to allow such testing tactics to occur in our own homes?

Not only no, but hell no.

This MOC® craziness has to stop. It is now officially violating physicians' civil liberty protections.

-Wes




Thursday, March 01, 2018

Medical Subspecialty Societies Rush to Bail Out ABIM

The American College of Cardiology (ACC) and Heart Rhythm Society (HRS) are negotiating with the American Board of Internal Medicine (ABIM) and the American Board of Medical Specialties (ABMS) on how best to preserve the Maintenance of Certification (MOC®) educational product for their mutual interests.

The ACC Board of Governors will be meeting at the ACC scientific sessions in Orlando in early March to decide how best to continue the educational and financial benefits of MOC® for their organizations. Each of these organizations have significant financial and political conflicts of interest with the unproven MOC® "continuous education" program that was foisted on physicians as a quality and patient safety measure above and beyond conventional Continuing Medical Education credits in 1990.

This is not the first time this discussion has occurred. The ACC has had a long history of attempting to provide educational content without having to  resort to the strongman testing tactics of the ABMS Board certification cartel propped up by the much richer and politically powerful member organizations of the Accreditation Council for Graduate Medical Education (ACGME). With ABIM's looming fiscal insolvency thanks to years of waste, fraud, and abuse of physicians' resources, the ACC must now weigh the benefits of maintaining their relationship with the ABMS versus the risk to the organization from ACGME fallout if it abandons their lucrative relationship. One only has to see the many MOC® offerings at this year's Scientific Sessions to see where the decision is likely to fall.

We should recall that the ACC was the organization that quickly came to ABIM's rescue when their financial scandal surfaced, issuing this public statement:
In addition, the ACC's accounting staff have reviewed and discussed the ABIM’s publically available financial statements with an outside accounting firm and have found the statements to be in compliance with Generally Accepted Accounting Principles, as utilized by not-for-profit organizations in the United States.
While I am not an accountant, I am a Board certified diplomate of the ABIM that has worked tirelessly to uncover the financial and political shenannigans of the ABIM in an attempt to understand their motivations and conflicts. If the ACC sides with the corruption uncovered in this blog's pages without addressing head-on the financial benefits to themselves, they risk compromising their reputation as a credible scientific organization capable of transparently managing those conflicts. I would be a shame if they don't care.

ACC Board of Governors should vote to break ties with the ABIM completely and return to CME, lest they fall prey to the same forces that dissolved the ABIM: avarice, politics, and greed.

Early forecasts predict the odds of that heppening are close to zero.

-Wes

Friday, February 16, 2018

Dealing With the Ol' ABIM Soft-shoe

Resolution 607 from the AMA House of Delegates, passed in June 2016, stated:
"Whereas, The ABIM Foundation uses the income of the $56 million for internal salaries, dubious research which consistently publishes data in support of MOC, and approximately $500,000 a year for high-end retreats at the county’s most expensive resorts; and

Whereas, The ABIM paid its President $2,774,000 for her final 30 months of employment (an annualized salary of $1.1 million dollars); and

Whereas, The ABIM President gave her First Assistant a raise of $103,000/year in 2011, $83,000/year in 2014, and a bonus of $313,000 in 2011 for total earnings well in excess of $500,000; and

Whereas, The ABIM purchased a condominium for $2.3 million and sold it for $1.7 million losing $600,000 in cash along with real estate sales and transfer fees adding another loss of approximately $200,000, and chose to house its out-of-town guests in the most expensive per square foot real estate in the city of Philadelphia as well as provide a chauffeur-driven limousine for their use; and

Whereas, The top employees at the ABIM are receiving retirement contributions of 18 percent per year (fully funded by the ABIM with no employee contributions) in contrast to the industry average of five percent; and

Whereas, There may well be many more undiscovered excessive expenses at the ABIM; therefore be it

RESOLVED, That our American Medical Association, prior to the end of December 2016, formally, directly and openly ask the American Board of Internal Medicine (ABIM) if they would allow an independent outside organization, representing ABIM physician stakeholders, to independently conduct an open audit of the finances of both the American Board of Internal Medicine (ABIM), a 501(c)(3) tax-exempt, non-profit organization, and its Foundation (Directive to Take Action); and be it further

RESOLVED, That in its request, our AMA seek a formal and rapid reply from the ABIM so that issues of concern that currently exist between the ABIM and its Foundation and many members of the AMA and the physician community at large can be addressed in a timely, effective and efficient fashion (Directive to Take Action); and be it further

RESOLVED, That our American Medical Association (AMA) share the response to this request, as well as the results of any subsequent analysis with our AMA House of Delegates and our membership at large as soon as it is available. (Directive to Take Action)"
In response to this resolution, the ABIM sent this response to the AMA, skirting the concerns outlined and directing diplomates to its webpage containing only its most recent financials, and to the President and CEO of the American Board of Medical Specialties.

Not only were the concerns raised by the AMA House of Delegates not addressed directly, the House of Delegates were asked to turn to the fox guarding the henhouse for answers.

Currently, the ABIM and the ABIM Foundation still haven't filed their non-profit 2017 Form 990 Federal tax forms for public inspection. We are quite aware they may have squandered over $78 million of our testing fees.

What should be diplomate physicians' response be to this previous ABIM soft-shoe tactic?

I believe the AMA should move to have the Internal Revenue Service investigate the ABIM and the ABIM Foundation on our behalf.

We have tried to be polite and self-regulate our regulators in a responsible, transparent way using accepted channels. It has gotten us nowhere. It's time proper authorities get involved to examine the evidence and, if appropriate, take action to end the years of deception and collusion, and to take corrective action in the name of the integrity of our profession.

-Wes

PS: A survey of Board-certified practicing physicians regarding MOC® is still being conducted. If you have not done so already, please complete the survey here and then email the link (https://www.surveymonkey.com/r/PPA_MOCSurvey) to your colleagues. This is particularly important now that ABMS is performing their own survey that will ignore their conflicts of interest with "continuous certification."

Monday, February 12, 2018

Getting Behind the Iron Curtain

Thanks to all the physicians that have completed the MOC Survey so far. There has been an impressive outpouring of physician responses so far with many thousands of physicians responding to date. But we are not done.

As most of us are aware, numerous errors can occur with surveys. For instance, sampling error and coverage errors are two of the most commonly cited, but measurement and non-sampling error (those who choose not to complete the survey) can be sources of error, too.

To improve the reliability and acceptance of the MOC survey we're collecting, it is imperative that we obtain as many responses from as many physicians in different geographic locations and practice environments as possible. This is especially true when trying to collect responses from "Behind the Iron Curtain" of hospital employment. In my view, this is an especially important group of physicians to survey, but also one of the most challenging to sample. Any and all assistance we can garner from those who have already participated in the survey would be greatly appreciated. Once again, all practicing US physicians from all subspecialties are invited to participate. Here's the link to share with your colleagues: https://www.surveymonkey.com/r/PPA_MOCSurvey.

Thank you all -

-Wes

Thursday, February 08, 2018

Vetting the ABMS "Vision Initiative Commission"

"Society cedes to the medical profession the privilege of self-regulation based on 3 assumptions: the assumption of expertise, altruism, and self-scrutiny. Among other responsibilities, self-regulation requires the profession to establish the means of setting and maintaining standards of education and training, entry into practice, and practice. Integral to effective self-regulation is the responsibility and obligation to ensure that these standards are met."
From: David H. Johnson, MD
Member of the American Board of Internal Medicine Board of Directors 2007-2015
and Board Chair 2013-2015,
"Viewpoint: Maintenance of Certification and Texas Senate Bill 1148 - A Threat to Professional Self-Regulation"


In his article, Dr. Johnson describes the process of "self-regulation" quoted above. Most practicing physicians have no idea that the ABIM and ABMS's definition of "self" includes nurses, lawyers, and executives, yet with the appointment of its new "Vision Initiative Commission," it seems it does.

It is ironic that after years of controversy, the ABMS finds itself embroiled in a desperate fight to regain legitimacy lost amongst practicing U.S. physicians since the ABIM Foundation condominium/Choosing Wisely debacle surfaced in late 2014. As a result of ongoing pressure and the admitted short-comings of their self-imposed time-limited Board certification, the ABMS recently initiated a "Continuing Board Certification" proposal called "Vision for the Future." They described the "initiative" as:
"A collaborative process, the Commission will bring together multiple partners to vision a system of continuing board certification that is meaningful, relevant and of value, while remaining responsive to the patients, hospitals and others who expect that physicians specialists are maintaining their knowledge and skills to provide quality specialty care."
But by structuring the commission this way, they immediately invalidate Dr. Johnson's "assumption of expertise, altruism, and self-scrutiny" integral to "self-regulation."

The list of selectees to the ABMS Vision Initiative Commission was recently released. While the Commission thankfully includes long-time Maintenance of Certification (MOC) critic Charles Culter, MD from the Pennsylvania Medical Society, it also includes numerous non-physicians poised to help doctors understand ourselves and the ABMS's version of "professional self-regulation." These include Ms. Catherine M. Rydell, CAE - the executive director of the American Academy of Neurology, Jann T. Balmer, RN, PhD a self-described nurse "clinician," Ms. Carol Cronin, Executive Director of the "Informed Patient Institute" (that receives government grant funding from many in the Quality Cartel, including AHRQ and has close ties with AARP), Ms. Patricia (Patti) Davis (I'm assuming that Ms. Davis is Ronald Reagan's daughter - physicians are supposed to know who she is, it seems), and two lawyers: Donald J. Palmisano, Jr., JD (Executive Director and CEO of the Medical Association of Georgia and Medical Association of Georgia Foundation) and David J. Swankin, JD (President and CEO of Public Citizen and Board Member of the Accreditation Council of Continuing Medical Education). Finally, there's the Big Daddy of them all: William Scanlon, PhD, a "Consultant" to the National Health Policy Forum, a group most physicians have no clue about, but appears to have helped the government determine how doctors should be paid (and now no longer exists)and was funded (in part) by Blue Cross Blue Shield, the Robert Wood Johnson Foundation, and the Josiah Macy, Jr. Foundation.

It is remarkable that out of 176 applicants from across the United States (many of whom were doctors), the ABMS chose 27% non-physicians (7 of 26) to help doctors define "self."

Frontline practicing physicians want to know many basic things before anyone embarks on a replacement for the ABMS MOC program. Where's the data that Continuous Certification is needed for anything other than padding the coffers of these unaccountable non-profits who define "self" with non-physicians? More to the point: why have our recertification funds been off-shored to the Cayman Islands? Why do the executives of the American Board of Internal Medicine earn four times the average internist's salary but only work 35 hours per week and are allowed to hold lucrative board positions with Kaiser and Premier, Inc.? Why is Christine Cassel listed as the Chief Financial Officer for the ABIM on the 2012 Form 990? And where are the 2017 tax filings for the ABIM and ABIM Foundation? It seems hypocritical for us to have to complete our recertification by a deadline and risk losing our ability to practice medicine, yet the ABIM can't even file their federal taxes by the appropriate deadline for public review. It is time to start talking about the money. Because if re-certification is about our education and "professionalism," it should NEVER be tied to our ability to retain hospital privileges or insurance panel participation, especially since "continuous certification" has never been independently shown to improve patient outcomes or patient safety. Finally, why haven't the adverse effects of "Continuous Certification" on physicians and our patients ever been studied? Would we introduce a new treatment to our patients without testing its side effects first?

The "ABMS Vision Initiative Commission" should step forward and answer these basic questions before embarking on a new "Continuous Certification" pathway. Because without addressing and understanding the real problems with MOC that we've uncovered, doctors will have a hard time believing anything proposed by this commission is being done for our good or the benefit of our patients.

-Wes

PS: A survey of Board-certified practicing physicians regarding MOC® is still being conducted. If you have not done so already, please complete the survey here.

Addendum: Seems others in Texas feel the MOC Commission is a Stacked Deck, too.

Friday, February 02, 2018

ZDoggMD Interviews Paul Teirstein, MD on MOC®



Great fun! (With a purpose.)

-Wes

PS: A survey of Board-certified practicing physicians regarding MOC® is still being conducted. If you have not done so already, please complete the survey here.

How Family Medicine Physicians' MOC® Data Are Used Without Their Permission

James Puffer, MD, the President and CEO of the American Board of Family Medicine (ABFM), gives an account of some of the ways the ABFM uses diplomate data collected from various sources, including their "continuous certification" program in the Winter issue of the American Board of Family Medicine's newsletter, The Phoenix. Not only are data being used without diplomate consent, they are being merged with other databases in uncertain ways. In one case, it appears the data are used to publish data on burnout rather than serving as a potential cause for the phenomenon.

Here's an example from the newsletter:
We have rapidly expanded the data sets that we are gathering to provide us with additional information about the specialty. These have included the Milestones data that we receive from the Accreditation Council for Graduate Medical Education (ACGME) for every single family medicine resident in training, and data from the Resident Graduate Survey, developed and administered in collaboration with the Association of Family Medicine Residency Directors (AFMRD), that characterizes the work of recently graduated family medicine residents. Important examples of the use of these data sets include recent data that we have published on burnout among family physicians, the changing nature of the scope of practice of recently graduated family physicians, and the powerful and long-lasting imprinting that occurs as a function of the environment in which family medicine residents train.
Read the whole thing (Highlighted text mine.)

-Wes

PS: A survey of Board-certified practicing physicians regarding MOC® is still being conducted. If you have not done so already, please complete the survey here.

Saturday, January 27, 2018

MOC® and the Gaslighting of America's Physicians

For the past several years as I (and others) have uncovered the corruption and the profit-driven nature of the American Board of Medical Specialties' (ABMS) Maintenance of Certification® (MOC®) program, I've had a growing sense of professional ennui and self-doubt concerning my effort and wonder if my efforts over all of these years will change anything and ever be worth the time and effort I've expended.

No matter how hard I've tried to expose the theft of millions of dollars of our testing fees to purchase an expensive $2.3 million condominium for the ABIM Foundation, the millions more for real estate purchases (see here and here), exorbitant salaries and use of our dollars to hire felons and legal teams as a "Test Security" division to strong-arm physicians, expose the undisclosed financial conflicts of interest ignored in our most esteemed medical journals, discussed with main stream media, appeared in person at AMA House of Delegates meetings and before state Heath Committees to testify on this corruption, nothing seems to change.

Instead, I have been called an 'unhinged' and 'virulent' critic by American Board of Internal Medicine lawyers or threatened with allegations of defamation by Wall Street attorneys as verifiable findings are tossed aside, ignored, or new Vision Commissions created to continue the manipulative (and financial) status quo. Despite everything exposed by myself and others regarding the harm imposed on physicians by this program, MOC® remains strongly supported, promoted, and (more importantly) mandated by our largest bureaucratic professional medical organizations and hospitals - all members of the Accreditation Council on Graduate Medical Education (ACGME) - as if the corruption regarding MOC® didn't happen, isn't true, and not that serious.

After a much needed vacation away from my clinical demands, I now understand why I feel the way I do.

Practicing physicians are being "gaslighted."

Gaslighting is a malicious and hidden form of mental and emotional abuse designed to plant seeds of self-doubt and alter physicians' perception of reality. It is my belief that by supporting MOC® in spite of the evidence against it, the ACGME and their member organizations (chief among them the American Board of Medical Specialties (ABMS), the American Medical Association (AMA), and the American Hospital Association (AHA)) use gaslighting to establish power and control over physicians on the front line of patient care and state legislators that are being encouraged to support it.

I encourage physicians to review this brief video on the origin of the term "gaslighting," and how it is used to manipulate the narrative on MOC®:



What to Do About the Gaslighting

A second interesting Ted Talk (video) by Ariel Leve gives tips on how to deal with the gaslighter. I encourage those interested to view it. In the video, Ms. Leve, a journalist who endured gaslighting by her mother for years, suggests four ways to deal with the gaslighter that have applicability to physicians and politicians at the forefront of the anti-MOC® movement today:
  1. Remain defiant.

  2. Recognize there will never be accountability.

  3. Let go of the wish for it to be different.

  4. Develop healthy detachment.

Given this reality, broad-based physician defiance and non-compliance with MOC® remains our most potent weapon against it. Understanding the psychological manipulation caused by gaslighting by the ACGME in promoting MOC® is the first and most important step in overcoming this damaging program (and others that will likely be developed in its place) in the future.

-Wes

PS: A survey of Board-certified practicing physicians regarding MOC® is still being conducted. If you have not done so already, please complete the survey here.

Thursday, January 25, 2018

MOC Survey Update

The MOC survey, sponsored by Practicing Physicians of America, continues to be completed by a wider and wider physician group across the United States and US territories. Every single state and US territory have physicians who have contributed so far, but more are still needed to improve the credibility and statistical significance of the survey. Many physicians and state medical societies have worked diligently to assure frontline physicians voices are heard.

ALL physician voices are welcome. The average time to complete the survey has been about six minutes. Realize that all physicians will not see all questions on the survey due to logic contained in the survey. For instance, physicians who have not recieved their initial board certification will be have to complete questions on MOC (or Osteopathic Continuous Certification (OCC)).

I would encourage all doctors to share this survey with their colleagues and continue to circulate if as far as possible. I hope to be able to present these data at the AMA House of Delegates meeting in June 2018.

Thanks to everyone who has contributed so far. 

-Wes

Friday, January 12, 2018

Collecting Practicing Physician Perceptions of Board Certification

An important new survey was launched today to gather information needed to provide strong, data-backed, counter arguments to the American Board of Medical Specialties and the American Osteopathic Association that continue to advertise their lucrative Maintenance of Certification® (MOC®) and Osteopathic Continuous Certification (OCC) products. Thanks to social media, this survey has the potential to be the largest and most authoritative of its kind, but not without your help.

As the MOC® controversy continues, I encourage all practicing all US ABMS and AOA Board-certified physicians to share the survey with your colleagues and include your names and email addresses (not required) to improve the survey's integrity.

Please take about 10 minutes of your time to complete this survey to provide us with the data necessary to defend practicing physicians at a national level against regulatory capture and third party intrusion into our profession.

-Wes

Saturday, January 06, 2018

In JAMA: MOC® Denounced

This week in JAMA, the ABIM and the entire ABMS member board structure received scathing repudiations in letters from Carlos J Cardenas, MD, President of the Texas Medial Association, and Bradley D. Freeman, MD from the Department of Surgery at Washington University School of St. Louis in Medicine. Here's a snippet from Dr. Cardena's letter:
As Dr Johnson pointed out, self-regulation is a core attribute of the learned professions. It encompasses the responsibility and authority to establish and enforce standards of education, training, and practice. Physicians routinely defend that responsibility and authority in advocating against the intrusion of all third parties (such as government, private insurers, or hospital administrators) into the practice of medicine.

However, as evidenced by their comments at the Texas Medical Association and American Medical Association House of Delegates and at the committee hearings on SB 1148, many physicians today simply do not acknowledge the certifying boards as “self.” They are, instead, profit driven organizations beholden to their own financial interests. The MOC process is too expensive, requires physicians to take too much time away from their patients and families, and, most importantly, lacks sufficient research to document the benefits to patient care. Many physicians say the information studied and tested has little applicability to their day-to-day practice.

Thus, the certifying boards, for all their talk of ensuring physician competence in a world of rapidly expanding scientific and clinical knowledge, are not “self.” In fact, they are one of the outsiders intruding into the practice of medicine.

Until and unless the boards acknowledge their position as outsiders and completely overhaul their processes, finances, and lack of transparency, physicians in Texas and across the nation will have no choice but to continue to seek statutory defenses against these third-party intrusions into the medical profession.
In reply, Dr. David H. Johnson, former member of the ABIM Board of Directors from 2007 to 2015 (and its Chair from 2013-2015) and author of the original JAMA article entitled "Maintenance of Certification and Texas SB 1148: A Threat to Professional Regulation" attempted to defend ABIM's actions. He parroted these tired ABIM talking points while referencing the ABIM website or blog:
  • 800,000 physicians "choose" ABMS Board certification (as if they have a choice if they want to get a job)
  • The reorganized their personnel to assure "more than 70% of current ABIM governance members spend more than half their time in clinical care." (as if that addresses the ABIM's actions)
  • How they "rolled out" every 2-year "Knowledge Check-Ins" (so we could be distracted from patient care even more frequently)
  • And most of all, assured physicians of ABIM's transparency by referring the reader to their website and "Guidestar Platinum designation" (which they pay for and create themselves), calling this the "good faith effort certifying boards are taking to address the concerns of Cardenas and Freeman."
We should not be surprised that a massive $2 billion dollar a year industry would do MANY things to protect its income stream and avoid responsibility for its actions against practicing US physicians. Here's a short list of EVEN MORE things Dr. Johnson failed to mention the ABIM and the ABMS member boards have done since the MOC controversy arose over five years ago to cover their tracks:
  • Sold the ABIM Foundation's luxury $2.3 million dollar condominium at a loss
  • Offshored millions of our dollars to the Cayman Islands
  • Authorized Cristine Cassel, MD a $1.2 million golden parachute as she left for the National Quality Forum in 2013 under Dr. Johnson's leadership
  • Said goodbye the Eric Holmboe, MD, the unlicensed physician "Medical Director" of the ABIM now works at the ACGME.
  • Changed the ABIM Foundation webpage to erase the fact that they had claimed it was created in 1999 for the purpose of "defining medical professionalism" while giving our money to their favorite institutions and causes without generating revenue for itself (other than investments).
  • Claimed that the ABIM "only" took $55 million from ABIM diplomates to create their ABIM Foundation from 1990-2007, when, in fact, they took well over $78 million for their personal and political purposes.
  • Fired their long-time auditor because of the tax fraud that has taken place for years.
  • Ended their contract with their long-time lobbyist (reported as a "consultant") after this improper expenditure for a 501(c)(3) organization was exposed.
  • Said goodbye to their much-loved felonious "Director of Test Security" that helped organize a "sting" operation against vulnerable residents attempting to study for their board examination and closed his division in the organization
  • The ABMS member boards are making even more changes now, creating a whole new "Vision Commission" that plans to spend countless hours creating the next bureaucratic boondoggle for themselves at our expense.
  • Thanks to the entire ABIM Board of Directors' lack of leadership and oversight, the ABIM is likely insolvent (video).


Dr. Johnson should know all of these points, but chose to ignore these details in his reply letter in JAMA. He would likely claim he was constrained to add these points by a word count given to each respondent. Yet by failing to mention the past and current financial and political transgressions of the ABIM that he helped direct, Dr. Johnson, the ABIM, and all ABMS member boards represent the antithesis of what credible professional self-regulation should embody and should remain responsible for their actions going forward.

-Wes