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.


P.S.: Goodness: Just realized I published this without the link to the survey!  Here it is:

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.


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 -


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.


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.