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."

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

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.

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.