Frank is one of the smartest people in his cardiology division. He's bright, congenial, and capable of citing the latest clinical trial on the best imaging study to detect hibernating myocardium. He loves learning. Frank is the guy you used to confide in the doctors' lounge (that doesn't exist anymore). Others knew what a good guy Frank was too; Frank was nominated to write and edit questions for the nuclear medicine boards. Deep down inside Frank knows the boards are a problem. But he's afraid that if someone were to implicate his medical society as colluding with the boards, he'd see himself as being partially responsible for losing the one scientific meeting he attends each year where he can re-connect with colleagues and maybe learn something new.
At another center, Frank is the Chairman of the Department of Medicine responsible for the day to day workings of a large urban hospital system. He is a highly respected member of the Internal Medicine community, author of 14 books on the principles and practice of Internal Medicine, and a beloved bedside instructor to generations of internal medicine residents. He also serves as a test-writer for the American Board of Internal Medicine and thinks overall they're a responsible group. He knows how hard his fellow physicians work at constructing a meaningful continuing education process. As the President of his local medical society, too, he knows money doesn't just grow on trees. And if people tried to disrupt the status quo, what's the endgame?
Frank on the other side of town serves as an editor to the preeminent hematology-oncology journals and has held multiple leadership positions in his subspecialty's medical society. He is widely respected by his peers, served as a director at the American Board of Internal Medicine (ABIM) and helps write test questions for the ABIM, too. He finds test-writing challenging and believes in the value of continuous testing to maintain a physicians fund of knowledge. He devotes countless hours to this endeavor to assure it is fair and impartial to those who must recertify. Sure there are some challenges, but given all the good people working on this, no one needs to question the integrity of the process.
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The dilemma facing physicians today is that the majority of physicians who work with the ABMS member boards and our subspecialty societies are good, hard-working members of our profession. It is hard to fathom that a very tiny minority are corrupt and have been operating below the radar for years. I have no fantasy that your Frank or mine would approve of this corruption or even be able to believe it. And yet, here we are.
Our own inability to tolerate this complication threatens to paralyze us from cleaning up the corruption in our ranks.
There have always been good people in our professional societies and ABMS member boards. But these colleagues, who value contributing and community involvement, should be engaged in a far different framework. Doctors need community and support and collegial leadership. Returning medicine to a truly non-profit, voluntary, democratic representation of working physicians today rather than the self-selected, profit-churning, elitist employment service that it has become. Alternative structures are already emerging. It is time to be open to new possibilities or to take on the challenge of creating them.
What we face now is not new. There have always been top dogs who operate with impunity in contrast to all of the good causes that they publicly champion. In 2018, with the Harvey Weinstein, Matt Lauer, and Eric Schneiderman hypocrisies, surely we can understand this reality.
Today, physicians' ability to work, receive insurance payments, and willingness to stay in our profession, are threatened by the out-of-control, corrupt, ever-evolving Maintenance of Certification (MOC™) requirements supported by Organized Medicine. It's time to see it for what it is.
We all know a Frank, or several Franks and Francines. They cannot continue to be a shield for the exploitation of practicing physicians. Or a reason to look the other way. We all honor the hours of work it has taken our esteemed colleagues who have participated with the best of intentions over the years, but its time to clean up the corruption in the ABMS member boards and colluding medical subspecialty societies.
Cleaning up the corruption is the first step. Please contribute whatever you can to our effort to do so.
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