Amazing Grace: On the ABMS Vision Commission's Draft Report

Amazing Grace, How sweet the sound

That saved a wretch like me

I once was lost, but now am found

T'was blind but now I see...

ABMS Vision Commission's Password-Protected "Draft" Report
(Click image to enlarge)

From the Terms contract for ABMS Board Certification available behind the ABIM physician portal firewall and not readily available to the public for inspection:

"I agree to indemnify, release, and hold harmless ABIM, its employees, officers, directors, members, agents, and those furnishing information about me to ABIM from any claims, liability, or damage by reason of any of their acts or omissions, done in good faith, in connection with: this application; information furnished to or by ABIM; the evaluation of my qualifications; ABIM examinations; the enforcement of ABIM's Policies and Procedures for Certification, and the policies for recertification outlined on ABIM's website, as well as all terms, conditions, and rules set forth in this website, as they may be amended from time to time; and any other action taken with respect to any certification or recertification granted by ABIM.

I understand that all ABIM materials are protected by the federal Copyright Act, 17 U.S.C. § 101, et seq. I further understand that ABIM examinations are trade secrets and are the property of ABIM. Access to all such materials, as further detailed below, is strictly conditioned upon agreement to abide by ABIM's rights under the Copyright Act and to maintain examination confidentiality.

I understand that ABIM examinations are confidential, in addition to being protected by federal copyright and trade secret laws. I agree that I will not copy, reproduce, adapt, disclose, solicit, use, review, consult or transmit ABIM examinations, in whole or in part, before or after taking my examination, by any means now known or hereafter invented. I further agree that I will not reconstruct examination content from memory, by dictation, or by any other means or otherwise discuss examination content with others. I further acknowledge that disclosure or any other use of ABIM examination content constitutes professional misconduct and may expose me to criminal as well as civil liability, and may also result in ABIM's imposition of penalties against me, including but not limited to, invalidation of examination results, exclusion from future examinations, suspension, revocation of certification, and other sanctions."

From the recently filed class-action anti-trust Complaint filed 6 December 2018 against the ABIM:

"2. This case is also about ABIM’s illegal creation and maintenance of its monopoly power in the market for maintenance of certification. ABIM is the monopoly supplier of initial certifications for internists. Beginning in or about 1990, ABIM used its monopoly position to create a second monopoly in the maintenance of certifications for internists. Since then ABIM has used various anti-competitive, exclusionary, and unlawful actions to promote MOC and prevent and limit the growth of competition from new providers of maintenance of certification for internists. ABIM’s conduct, including but not limited to tying and exclusive dealing, has harmed competition by preventing competition from others providing cheaper, less burdensome, and more innovative forms of maintenance of certification desired by internists.

3. The tying product is ABIM’s initial board certification, which it sells to internists nationwide. ABIM sells initial certification services to physicians in internal medicine and twenty foundational subspecialties within the field of internal medicine. Many internists hold multiple ABIM certifications, purchasing initial certifications in both internal medicine and one or more additional subspecialties.

4. The tied product is MOC, ABIM’s maintenance of certification. ABIM has tied MOC to its initial certification. As described more fully below, to drive sales of MOC and to monopolize the market for maintenance of certification, ABIM has forced physicians to purchase MOC, charged inflated monopoly prices for MOC, and thwarted competition in the market for maintenance of certification.

5. Approximately one of every four physicians in the United States (including those practicing in fields other than internal medicine), or about 200,000 internists, have purchased initial ABIM certifications. ABIM has throughout the relevant period controlled approximately 100% of the market for initial certification of internists in the United States. Through its MOC program, ABIM has also controlled in excess of 95% of the market for maintenance of certification of internists. ABIM has unlawfully obtained and maintained its monopoly power in the market for maintenance of certification services for the anti-competitive purpose of requiring internists to purchase MOC and not deal with competing providers of maintenance of certification services.

6. Plaintiffs bring this Class Action to recover damages and injunctive and other equitable relief on behalf of all internists required by ABIM to purchase MOC to maintain their initial ABIM certifications."

To suggest, even for a moment, that the ABMS's Vision Commission's Draft Report is fully transparent regarding the financial, corporate, and political conflicts that have embroiled MOC® from its inception, working physicians should understand that the "Vision Commission" is little more than a puppet for corporate interests. All the "public comment" in the world - especially when the draft is un-editable and proposes no action to end MOC® - makes a mockery (pun intended) of the entire "ABMS Vision Commission" process.

The ABIM employs a medical director with close ties to Price Waterhouse Cooper (PwC), a fact not disclosed on his ABIM employment announcement in 2015. PwC is a network of firms in 158 countries, 721 locations, with 250,930 people that earned $37.7 billion in 2017 alone.

I believe PwC is working with ABMS to salvage MOC® - however it is ultimately branded. Why else would so many non-physicians with ties to insurance companies and other interests sit on the Commission, too? Even worse, we now see that the entire Draft Report is based on the same propaganda and "professionalism" definition that led to the MOC® controversy in the first place four years ago.

Given these realities, it becomes crystal clear that the Vision Commission's Draft Report is little more than 96-pages of unprofessional deception that is not working to end "continuous certification," but rather perpetuate it.

What, then, do the public's comments to the ABMS Vision Commission's Draft Report mean?

Nothing.

T'was Grace that taught my heart to fear
And Grace, my fears relieved
How precious did that grace appear
The hour I first believed

Through many dangers, toils and snares
We have already come.
T'was grace that brought us safe thus far
And grace will lead us home,
And grace will lead us home

Amazing grace, how sweet the sound
That saved a wretch like me
I once was lost but now am found
T'was blind but now I see

Was blind, but now I see.

-Wes

P.S. For those who still feel inclined to comment on the ABMS Vision Commission's Draft Report, please read the National Board of Physician and Surgeon's critique of the draft report that recommends "an immediate moratorium on several harmful components of MOC."

Personally, given the deceptive history of MOC® and the harms caused to physicians and their patients, I see no redeeming qualities to MOC® (or any other forms of "continuous certification" proposed by the ABMS and their member boards) whatsoever and believe the entire process should end immediately for the sake of our profession and our patients.