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