Grandfathers, Lattes, and the ACC's CMP Pathway

Drs. Kovacs (L), Fisher (C), and Marine (R) discuss MOC and
the ACC/HRS Collaborative Maintenance Pathway (CMP)
at the Heart Rhythm Society's 40th Scientific Sessions

As I head back to Chicago today, I wanted to take a moment and reflect on my experience before, during, and after my opportunity to speak at the Heart Rhythm Society's (HRS) 40th Scientific Sessions in San Francisco yesterday.

Before I do so, I want to thank Tom Deering, MD, President of HRS, for reaching out to me and asking me to share the findings of a small survey I did on working cardiologists and electrophysiologists on the new "Collaborative Maintenance Pathway" (CMP) for "maintenance of certification (MOC)" that the Heart Rhythm Society and the American College of Cardiology have created.

It was clear this session was really an afterthought. It was organized about a month before the scientific meeting after I placed the survey I helped create to gather physician perspectives on the new CMP pathway on the HRS online discussion forum. Dr. Deering ask that I create the title for the talk while the HRS assembled the moderator and speakers.  Ken Ellenbogen, MD, longtime organizer of the HRS Board Review Course held each year in Chicago, was selected as moderator.  Bradley Knight, MD, member of the cardiology committee for the American Board of Internal Medicine (ABIM) was to participate (so I thought), as was Joseph Marine, MD, an EP from Johns Hopkins who helped create the ACC/HRS CMP pathway. It was held on the show room floor at one of those speaking "EPicenter labs" with a computer screen, pretty good sound system, and about 20-30 chairs before the speakers.

Despite the small venue, it was clear the talk was "important" to the ACC leadership. Both C. Michael Valentine, MD and Richard J. Kovacs, MD (out-going and incoming ACC Presidents) were there and warmly welcomed me. In our initial chat together, I learned they were both "grandfathers" to the MOC process but had worked hard to create another way physicians could comply with MOC using their cell phones. I had not met Dr. Marine before, but it was clear he really believed in the MOC process and the CMP program the ACC had created. Dr. Knight, I later came to realize, did not show, likely because of his work with the ABIM and the pending litigation against them.

Dr. Marine kicked off the session with a 15-minute talk describing the CMP program. To his credit, he included the costs circulated by HRS, regarding the program, and was quick to note that the costs really were acceptable, as he showed the relatively high salaries of cardiologists published recently and compared that cost a number of ways, including a comparison that it would only set back participants the equivalent of "2 or 3 lattes a week." It was like a line from the ABMS script.

Then I spoke. Gratefully, I was able to use slides (withheld from me in my discussion at the IL Medical Society) several weeks ago. As I looked around, there were plenty of people standing on the edges and reluctant to take a seat. As my talk progressed, I paused to have those in attendance answer one of the questions. It became clear they were reluctant to do so, but it was clear they sided with the sentiments of the first question - that the ACC should not leverage the sale of their CMP product to our certification. I did not press the audience to answer more questions since I did not want to put anyone on the spot. I continued on reporting the results, limitations, and my final thoughts on MOC in general.

Question and answer time arrived. Dr. Ellenbogen started off and again asked a version of the same hypothetical question Dr. Knight had tweeted earlier - if you had a loved one in another city that needed a cholecystectomy, who would you pick, a doctor who was board certified or someone who was not?" Of course, this question was a straw dog. We are not talking about initial board certification, we were talking about a re-certification product that, unless purchased, invalidates a physician's initial certification. Dr. Ellenbogen then urged one of the ACC Presidents to respond. I would see Dr. Valentine encouraging Dr. Kovacs to step forward, which he somewhat reluctantly did as he complained he really wasn't unprepared. But he sat down and shared the ACC's position: that CMP was a "different" pathway and that doctors have a commitment to show they "keep up."

Then several of the audience members stood up and gave emotion-packed questions of why only select sessions at this meeting are "approved" for CME while other, informative learning (like poster sessions) receive none? "We have to follow rule stipulated by the ACCME," was the (paraphrased) response. On and on it went, back and forth, but NOT participating in some form of MOC was never an option despite my seeming rational lines of logic ("Why grandfathers?", "Why no other country requires "maintenance of certification?", all falling on deaf ears.)

Afterward, I felt like I had just been through a few rounds in a boxing ring but had survived. Everyone left a bit worn, but unscathed.  Ethan J Weiss, MD tweeted from UCSF, "Who won?" I can honestly say that neither side "won." This really was not a debate. MOC continues and at least five antitrust lawsuits against the ABMS or its member boards are filed. But it was clear that working physicians and our little organization, Practicing Physicians of America, are having an impact.

I also came to realize that this battle's far from over.

-Wes

PS: Please consider donating to our efforts to support those trying to end MOC for all subspecialties nationwide.