Sunday, December 23, 2018

The Maintenance of Certification Controversy 2018: The Year in Review

The American Board of Medical Specialties/American Board of Internal Medicine (ABMS/ABIM) Maintenance of Certification® (MOC) controversy continued unaffected in 2018 despite significant pushback from working physicians.


For those unfamiliar with this controversy, ABMS board certification of a US physicians was once a completely voluntary lifetime accolade physicians could elect to hold after they completed their residency. They paid to take a test created by a self-appointed "board" of academic physicians in their specialty - analogous to the legal bar examination - that "certified" they had a fund of knowledge acceptable to practice their trade. Physicians used this "board certification" as a marketing accolade with their peers to garner referrals from colleagues. 

Prior to 1990, ABMS board certification was never required to practice medicine in any US state or territory. Rather, it was the responsibility of the accredited residency program to train doctors and document they had sufficient experience to enter the workforce as that specialist safely. State licensing agencies verified that training and stipulated that physicians earn "Continuing Medical Education" credits to remain current in their field to maintain their state licensure in good standing.

In the 1960's, seeing the financial struggles of older boards formed 30 years before that created the lifetime board certification accolade, the American Board of Family Medicine, a new ABMS member board, was created with a new financial model that proved to be very lucrative: time-limited certification. The ABFM would soon be rolling in cash, earning tens of millions of certification and re-certification fees annually. Not surprisingly, it was not long before all 24 ABMS member boards shifted their certification models to implement time-limited certification by 1990, arguing that doctors had an obligation to keep up in their field (and pay the boards recurrent fees to do so). By 2015, the physician board certification and recertification industry mushroom into a $5.7 billion a year bonanza for the academic elite and their industry colleagues with publishing priority in influential specialty medical journals while not disclosing their conflicts of interest

The pushback began in 2012 when one physician became frustrated with the arduous and needless re-certification process. After even more new requirements to time-limited certification were added in 2014, a full-blown civil war in medicine between the bureaucratic elite and working physicians began. It was December 2014 when the full extent of the controversy became apparent:  "medical professionalism" defined by luxury condominiums complete with their chauffeur-driven Mercedes S-class town cars, spousal travel fees, high salaries, and undisclosed conflicts of the leadership of the member boards.

Never once in the history of time-limited certification were the potential harms of time-limited certification to working physicians considered or acknowledged.

Caught with their hands in working physicians' financial cookie jar, the ABIM issued an unprecedented mea culpa message in February 2015 to its physician membership, but instead of coming clean, the cover-up and tap dancing began in an attempt to preserve the money flow.

Recaps of the revelations and cover-up/pivoting of the process are included here:

2015: The Maintenance of Certification Controversy 2105: The Year in Review

2016: The ABMS/ABIM Controversy 2016: Year in Review

2017: The ABMS/ABIM MOC Controversy 2017: Year in Review

The 2018 summary of events are recapped below:

 * * *

12 Jan 2018: Practicing Physicians of America (PPA) sponsors a national survey (questions asked here) of physician attitudes about maintenance of certification, including evaluating potential harms to physicians caused by the process.

27 Jan 2018: Psychology of MOC and the Gaslighting of America's Physicians discussed.

2 February 2018: The ABMS tries to quell physician unrest and forms a 'Vision Initiative' with medical specialty societies and state medical societies (among others) concerning MOC.

8 February 2018: The ABMS Vision Initiative Committee is announced and is laced with numerous non-physicians with many conflicts of interest.

15 Feb 2018: The self-selected ABMS Vision Initiative Committee launches their own survey of physician attitudes toward Maintenance of Certification but steers clear of assessing negative consequences of MOC on physicians.

25 Mar 2018: ABMS/ACP announce partnerships with medical specialty societies to keep the money flowing

6 April 2018: ABIM publishes its "how-to" video on the Knowledge Check-in program revealing its mechanics.

23 May 2018: After ABIM publishes its tax forms late, PPA announces GoFundMe crowdfunding effort effort to raise funds for a pre-litigation investigation into the ABIM and the ABIM Foundation's activities.

11 Jun 2018: Results of the PPA survey on MOC announced at the AMA House of Delegates meeting in Chicago.

28 June 2018: A critical review of the ABIM Knowledge Check-in option for Maintenance of Certification (video) is published questioning a physician's right to privacy.

2 Aug 2018: The Federation of State Licensing Boards tries to legislate away their liability.

26 Aug 2018: The ABMS releases the results of their survey on MOC and the results are similar to the survey sponsored by Practicing Physicians of America.

6 Sep 2018: A video reviewing the main PPA survey results on MOC from 7007 physicians is published.

7 Sep 2018: PPA's GoFundMe effort reaches its goal of $150,000.

14 Sep 2018:  DOJ issues opinion on MOC, calling the program "anti-competitive."

25 Sep 2018: The ABMS and American Board of Urology offer their spin on the DOJ letter concerning MOC®.

1 Dec 2018: The ABIM Knowledge Check-In program crashes and hundreds of physicians are left in limbo.

6 December 2018: Four physicians sue the ABIM in a class action lawsuit representing over 100,000 physicians claiming anti-trust violations, among others.

10 December 2018: ABIM issues a statement concerning the suit on its blog promising that "the organization will vigorously defend itself, recognizing that doing so will consume resources far better dedicated to continuous improvement of its programs."

21 December 2018: The far-reaching implications of the antitrust suit reach across the pond.

* * * 

It's been quite a ride.  Here's to a productive New Year in 2019!



Baron's "Ten Plus Seven" Report said...

Medical Hypocrisy in the New Millennium: A Business Charter

The only service to equity we perceive @ABIM is their focused attention to serving private equity.

ABIM's Commitment to Trust said...

ABIM is committed to maintaining lifelong executive autonomy, while defending its perpetual policy of "business-as-usual" with unlimited conflicts of interest and no accountability.

Sixty Million Dollars Worth

Universality of Purpose said...

- a million clams dredged from the river of physicians' sweat equity
to pay the CEO of a non-profit charity?

"It doesn't sound like a non-profit to me."


Wes- what this ultimately is about is how to ensure that American healthcare maintains quality while exploring alternative platforms on affordable delivery. The current regime incestuous as it is, relies on support from insurance companies and hospitals( big Pharma-unclear) to prevent free enterprise. If this continues doctors will be excluded from practice and we will be a community relegated to receive care from scantily supervised nurse practitioners.

HIPPA or Health Insurance portability act is another layer of legal sanctions imposed by government with hefty fines to doctors as a way of ensuring "cooperation" that the current system perpetuate as it deceives the public about its commitment to confidentiality as it pertains to billing but ultimately places barriers to collaborative care.
Thank you.

Let me simplify it as I see it said...

The 3 major players: hospitals, insurers, public. Hospitals and insurers want to ensure quality care. They rely on ABMS to do that. ABMS has a duty to its diplomates and to-be diplomates to be fair in order to uphold their mission which according to their appointed commission is to provide the public with trusted analysis of the doctors who will be serving them. If the cost in terms of money and time are prohibitive then they are not adequately performing their duty.

Anonymous said...

EU meddling by the ABMS to push MOC? Physicians in the US are the only ones to be coereced.

True Believer (no more) said...

ABIM Foundation work on "professionalism"

Has ACP and ABIM along with the ASIM and EFIM defrauded medical professionals and the public?

If so for what purpose? What are the real goals/aims of these organizations and why are they perceived by a large number to be deceiving their clients and the public on a regular basis?

I would like a proper investigation into what aims these four organizations really serve and what motivated them to herald so quickly and push through what appears to be a fraudulent document - in light of the political motivated manipulations that transpired subsequently.

Anyone with any insight who reads the ABIM Foundation's Charter can see that it reeks of deception and hypocrisy.

Public safety or public menace?

Robert W Donnell said...

Wes, isn't it about time for a book?

Transparency2 said...

Colonoscopy at 52
I am trying to schedule a colonoscopy

at 52 I am overdue

I will be self pay

how much is it

you cannot say

call the 1800 number they advise

to the cost we are not wise

be here at 645 and make sure

you devise a ride

when you are thru

cause we are responsible

that is true

calling Uber will not do

cause we’re responsible for you.

Anonymous said...

Here's to an ABIM/ABMS/MOC free America. Whichever comes first.

A Message of Apology from Mr. Pearson Corporation, London, UK said...

To all our alleged stressed-out/burned-out high stakes test takers:

On behalf of our US subsidiary, ABIM*, please accept our humble and sorriest apologies regarding the December 2, 2018 Knowledge Check-in experience. There was a slight glitch as you already know.

You may have heard already from ABIM MYTHBUSTERS that slight technical problems arose in our online proctor host program during our current beta test in early December.
However, we must stress that it was not a dismal failure as the rumors were alleging online. In fact, many happy testing campers at home or in one of our reasonably-priced and extremely secure PearsonVue testing centers were in joy over the new choices being offered by our ABMS jewell in the crown enterprise, the ABIM.

Let me explain what we discovered. The true explanation for the December KCI testing experience is quite simple. Our program Mr. PROCTOR/PV, who is endowed with a high degree of humanoid AI, decided to suddenly without any warning go out for a beer in a local pub in Boston. This event lasted for an unspecified number of hours. All our staff could say at the time was, "to err is human, and therefore to err is humanoid, as well."

Ordinarily, this kind of error would be impossible to expect from a Pearson computing machine, but due to the sophistication of the program, formerly named Mr. ProctorCam, and given the stout temperament of PCam's CEO, we can understand the technical anomaly completely.

Here's what we know so far. After considerable research we learned that the former CEO of Mr. ProctorCam had a predilection for drinking more than a few pints at this time of day, every day. So, it is not surprising, that the product MR. ProcterPV (our brand name) bears a resemblance to the former PCam's CEO. But still it is unacceptable.

What we are doing. For the former CEO there is nothing we can do as he is already a reformed drinker, as his attorney tells us, and only drinks non-alcoholic slightly carbonated beverages.

As for the machine Mr. ProctorCam, now called Mr. ProctorPV, we are initiating disciplinary action with a team of ML experts.

If after a probationary period of six months, we do not get the desired result, we will terminate Mr. ProctorPV's contract and spin-off the bloke to an unsuspecting company in China.

In the unlikely event, rehabilitation fails, we will use another vendor based out of Arizona, run by a reliable British ex-pat. So not to worry, and Cheers for the next hundred years of MOC. May it make us rich beyond our corporate dreams.

So, from us here at corporate at Pearson, Plc in London, we wish you joyous MOCers in the US all the best for the holdidays and far into the future.

Mr. Pearson Corporation, Plc

*ABIM - a privately held asset of Pearson Plc and Wolters Kluwer. ABIM is registered as a non-profit in Iowa and operating as a for-profit foreign agent in Pennsylvania. A true success story for the crowns of both countries here.

Mr. Pearson@Pearson Blog posting
Too little too late - a corporate apology from "accross the pond", mfa!

Meet ABIM's "Ben Mendelson" said...

ABIM's Undisclosed Director of Investigations/Political Hitman- busted for impersonating a reporter in Pennsylvania.

Ben Mendelson, aka Benjamin Mannes, A Benjamin Mannes, Ariel B. Mannes, aka DC cop, aka ABIM candidate, aka Mr. Bouncer, aka who knows what else ...

I wonder if he is still a contractor for the ABMS, member boards and ABIM. How about Caveon, the Pearson Plc/Pearson Vue/ABIM go-to company for spying on their high stakes test takers . . .

Any comment Dr. Baron? Ms. Browner White? Ms. Cassel? Dr. Battaglia?

Busted said...

ABIM will not be the first corporate monopoly to lie in order to crush its political opponents and corporate competition and it will not be the last.

ABIM's Restless Ship Without a Port said...

Through a mirror darkly - ABIM's undisclosed undercover man

ABIM's "Director of Investigations at Large" is currently a ship without a port. Ben Mannes or whatever fictitious name he uses lied, impersonated and cheated while at the ABIM/ABMS and he has lied and cheated/impersonated yet again recently.

The ABMS man of the hour with all his self-announced privately bestowed accolades from the ABIM and other ABMS member boards was never once disclosed to the public. Nobody knows, therefore, when he was officially hired and when and if he was ever released.

If Ben Mannes was terminated, we do not have any guarantees that he is not a direct of indirect contractor working for the ABIM or ABMS member boards - or any of their dark money partners. It is fair to call it dark money, because it is not disclosed on the tax forms. But moreover, when we are speaking about the ABIM's Director of Investigations, we are speaking about a totally unacknowledged employee, which for all intents and purposes was hired as a black ops man.

Mannes according to his own words is a self-proclaimed specialist in terrorism and we can only conclude that Mr. Mannes and his ABIM "emergency response team" were hired for a dark and hidden operation to be used against the ABIM's political opponents and the corporate entities that stood in the way of their monopoly position.

Why is that. But we learned of him through suppressed court records and a quickly withdrawn press release about fake certificates.

The truth about Mr. Ariel Benjamin Mannes is slowly coming to light. The truth about the ABIM is slowly getting clearer as we piece together the stories and connect the missing dots.

What does it mean then for the thousands of victims in the medical profession that he harmed with his political and corporate character assassinations.

Who's on first if you know Who steals second? said...

Pearson global operations, in their recent apology, says they take full responsibility for the 12/2 KCI online proctored test meltdown.

Think about it. Who is in charge . . .