"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."
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.
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.