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.



In the trenches fighting the MOCsters said...

I do not choose ABMS MOC. Nor do any of the other 860,000 indentured physicians. MOC and certification are mandates invented by a lucrative cartel of quality assurance Ponzi schemers and their lineage of outrageously compensated cronies who sold their souls to the corporate devil.

S Antonio said...

Don't you just love the ABMS status quo responses. The defensive postures and statements are as rich and deep as the MOC money that lines their pockets.

It is hard to wrap one's head around the fact that the ABIM and all the medical boards were once really non-profit run by volunteers. Not anymore. The entire messy affair is all about money and control of physicians for political and corporate agendas.

If certification and MOC were truly voluntary and not for profit, MOC would be gone and certification might actually mean something again.

You gotta love guys like Dr. Johnson who can't seem to wrap their heads around the facts. Why is that? MOC is dead in the water. The ship has sunk. The ABIM a corrupt mess beyond repair. Someone needs to do a study of these people who hold on to fiction/propaganda and publish the bizarre findings in a neutral journal somewhere.

The question I have as a psychologist is: are people like 'Baron' and Braddock, 'Stockman' and Cassel, and on and on true believers or are they just totally corrupted individuals.
One would like to believe they are decent, but they don't show any decency. Intelligence seems to be a missing ingredient in the true believer camp that in contradiction to what they say keep backing up the truck and filling it with physicians money and hauling it away for their offshore investment accounts.

It is all so disappointing, Wes! Isn't it. One wants to believe in humanity, but the leadership there just seems to have none (humanity). Whatever their politics or corporate allegiances are ABMS executives and their partners exhibit the worst of themselves and humanity and keep trying to project the best. It just does not work anymore. We see through the masks and naked psychology. It is saddening as well. One would like to be positive and ignore the fallen states of these so-called individuals.

But 'they' have their digs in every one of us (or most). And that is the worst bit of all, that we allow the shams and corruption to continue. We even must pay for it dearly with internal conflict and turning our bank accounts over to them for these flimflam men and women and the circus of MOC every year. Or one cannot work. Where is the court, DOJ or FTC to intervene!

A fallen state all around. We must do something or it will compound and grow into an even a worse state of affairs.

Moral Codes of Behavior said...

What is lacking in the ABMS and their leadership? Ethics is lacking.

This really is outrageous. And to think that it could all end tomorrow with a concerted effort by all physicians to resist it.

MOC is the worst nighmare. An educational fraud that they cannot even call "education" on their tax returns. MOC and cetification as well has really become something other than it was intended. These people at the ABMS do not live by any physicians' code.

They do harm and insist on continuing to get away with harming physicians and patients. These folks even spit on the IRS codes as though they were exempt for the laws. How do they get away with it! This operating outside the margins of the law and ethics - laws and morality which everyone else in medicine must abide by.

Anonymous said...

Kudos to part of the AMA to publish the the letters from Dr. Carlos Cardenas and Dr. Bradley Freeman. Since Dr. David Johnson is spouting the ABIM party line, invite him to debate these other doctors with presentation and question and answer. Dr. Lois Nora did it but did not wish to have her slides or video presented. Maybe, he will be strong enough to stand by his convictions and allow question and answer from working physicians. He is not like Ajit Pai who cancelled his speaking engagement at CES. Bring Baron and Cassel with him and talk to all the working doctors and see if the 800,000 physicians stand with them!!

Anonymous said...

The AMA is a house divided with the House of Delegates already voting/resolving to end mandatory MOC. The physicians want MOC to end. The patients need for it to end.
Who wants it then? Who is holding on and why? Protracted pain is foolish. End it.

Anonymous said...

Maybe NBPAS can put up a booth at the next AMA meeting and be allowed to participate in the meeting especially in the Truth in advertising group and the medical ethics group. If the AMA is serious about the quality of care then they should let this happen and encourage robust debate especially with MOC as it is false advertising, ethically deplorable, no shred of evidence that it helps patient care or makes a better doctor and has shown evidence that that there is harm to patients (unable to see ones physician) and physicians (burnout, physician shortage, loss of effective physician hours, embarrassment and loss of career).

The AMA should look at MOC as a quality issue. As there is no quality improvements with MOC, If I am a hospital CEO at a managed care company I would drop MOC requirements like a bad habit. I want my physicians to care for their patients instead of wasting time and money with MOC. I want their working expertise and skill on site and not their absence which strains the resources of the system as other physicians have to cover for studying physicians.

I have moved to a new office and I don't want to put up my board certification on the wall because it is from the ABIM. I don't want any part of them. I have given up my memberships to a lot of medical specialty organizations as they are part of it and won't condemn the ABIM/ABMS/MOC as they should. Because of all this corruption, I am left to wonder how much of the journals that I read have accurate information as their is so much conflict of interests. My belief and trust in new data has eroded that much. I don't want to prescribe treatments to line someone's pockets. I want to help my patients.

When this shakes down and the ABIM/ABMS and everyone who was involved with this are found to be corrupt, the stench of their sleaze will reek and all will be pariahs.

Anonymous said...

This is a nice step in recognition of the actual problem, the boards themselves. Killing MOC will just be a temporary respite while leaving the heart untouched. There exists no valid reason for the boards in the first place in this day and age.

It is simply accepted a priori by doctors and something passed from older members to new generations, which are simply, if one is honest, repeating back what is just marketing material.

If doctors want to get real we need to end the ABMS and board certification in its entirety. What does it really accomplish? Anyone competent that takes it can pass, anyone that doesnt just practices anyway.

Anonymous said...

Regulatory capture and the pathetic stance of many physicians to follow and get along have led to this mess. Silence and unimpeded greed have made the ABMS powerful enough to destroy their pesky customers--doctors of medicine--and then use that money for lobbying, offshore retirement villas which I'm sure exist, foundations, bonuses, etc. The goal is to have a cowed and subservient medical community that it owns outright. I implore doctors to immediately end their involvement with MOC, massive noncompliance and massive loss of cash is the only way we can effect change quickly. Fight with all your might at the hospital meetings, at your business meetings, and talk to everybody you can about this criminal enterprise.

Anonymous said...

Maybe in the 1930's lifetime certification was a good thing, but not anymore - when the industry and ABMS with their quality assurance cartel/test security mob got involved.

We still don't know if the ABMS' hit squads and violators of civil rights are still on the take in exchange for their silence. We assume they are as no statement to date has been made as to their status. We all know who they are. Why do they keep pretending and burying their heads. These people violated laws and the violated the foundations of our country -
the constitution.

These diabolical actions against physicians (as described by Wes on this blog and elsewhere) have been presenting since at least 2008. They represent heinous disturbances of the social compact and ethical values we all value and must live by as interdependent human beings.

The worse part is we know that the ABMS/ABIM executives know better, but their better judgement has been compromised to the degree that they have been turned into pimps and prostitutes for the industry and unfortunate political agendas that serve corporate and special interests. This and much more consumes their better judgement.

The ABMS and crony NGOs are corrupt as hell and need to be shut down as soon as possible or everyone will continue to suffer - patient and physician. That means every human being in the United States including these elites who perhaps stopped feeling their own suffering and remorse.

madhu said...

Physicians and patients are waking up more and more to realize they've been had by a corrupt and conflicted corporate-backed Ponzi scheme called MOC.

Physicians are exercising their voluntary right to not participate in onerous and costly scam. Many are prepared to go to court and exercise their rights in court.

A few lawsuits will bankrupt the ABMS medical boards. The lucrative gravy train paid to deceitful medical politicians and brokers for the health industry will dry up.

The money will start pouring out of the ABMS rather than in. And it should.

All must imo exercise their right and file their complaints with a court of law when the quality cartel's mandates cause them and their patients the ultimate harm.

The ultimate harm is not being able to work and patients not being able to have access to their physicians.

Patients are opening their eyes and demanding that the MOC scheme be investigated by the justice department, FTC and IRS.

Patients and physicians can and will work together to alleviate their common pain.

Physicians have a right to work and patients have a right to care.

The Barons of the ABMS (and the world) and their partners living in their ivory towers will and should be be summoned and put in front of a judge who will most likely give them some time behind bars to make an example of them.

It will be hard to find an impartial jury comprised of their peers. These elite executives who have sold out have no friends among the public and have alienated their peers. The only friends they have are the ones that they pay to spread their glossy lies about certification and MOC.

Anonymous said...

Can you believe this horse puckey. Just opened this ABIM end of year announcement in my email.

Anonymous said...

It is hard to believe (for anyone be with common sense) but it is happening. ABIM and .... ASCO are "collaborating" and surveying us on our practices! So ABSURD, given what we know about the creepy ABIM.

Anonymous said...

This corrupt beast is still alive and well.... and extending the reach of their corrupting influence (ASCO). Deeply disturbing!