Tuesday, April 18, 2017

Teirstein: An Urgent Call to Action

This important email has been widely circulated today from Paul Teirstein, MD, President of the National Board of Physicians and Surgeons (NBPAS) and is an urgent call to action for practicing physicians. I urge all physicians to take a brief moment and contact your representative as Dr. Teirstein suggests. He's made the process as easy as possible:

Dear Colleague,

Several states now have anti-MOC legislation pending. Recently the Georgia legislature passed HB 165, similar to Oklahoma's SB 1148 which prohibits Maintenance of Certification (MOC) as a condition of licensure or reimbursement from third parties. However, the ABMS and its member boards have been heavily lobbying state legislators to defeat the pending bills in other states (click here to view ABMS lobbying materials). Those of us opposed to MOC must educate legislators in these states regarding how MOC requirements are onerous, expensive, have no proven benefit, and are forced on physicians by conflicted, self-appointed private ABMS member boards.

Here is how you can make a huge difference:

  1. This is going to take you a few minutes. I spend hundreds of uncompensated hours per year on this issue. Please take 5 minutes of your time to help yourself and our profession.

  2. This is your action item:

  3. Click here to effortlessly send a letter by email to your district's state representatives. You will be asked to "register" by entering in your name, email and address.  That's it.  From your address the system will pull your specific state bill and a letter tailored for your specific state representatives you can edit (if desired) and click to send to all your district's legislators.  We have made it as easy as possible for you.

  4. There are currently many states with strong anti-MOC legislation pending. If your state currently has no anti-MOC legislation pending, your letter will encourage your representatives to create anti-MOC legislation.

  5. If you are curious and want to view all the sample letters we have written by state, click here.

  6. Please spread the word. We have 18,000 email addresses of physician supporters but we need many more. This will not work without your help getting this message out. Forward this email to your colleagues, your patients, your med staff office for hospital wide distribution, your specialty organizations, your FB, Twitter, Linked In and other social media friends. (You can also refer them to the NBPAS Advocacy Webpage).

  7. To join the National Board of Physicians and Surgeons (NBPAS.org) and obtain continuous certification based primarily on AACME accredited CME, click here.
Thank you for your help and support.


Paul Teirstein M.D.
National Board of Physicians and Surgeons (NBPAS)

Monday, April 17, 2017

For Texas Legislators: MOC's Myriad Conflicts of Interest

The American Board of Medical Specialties' (ABMS) Maintenance of Certification (MOC) proprietary continuing education program has a myriad of conflicts of interest. I thought I would assemble a partial list of some of them below:

1) The American Board of Internal Medicine (ABIM), the largest ABMS member board responsible for credentialing one-quarter of all US physicians, is increasingly in debt thanks to high salaries and expenses. Its latest 2015 Form 990 shows a NEGATIVE asset and fund balance of balance of $50,642,980.

2) The cost of for participating in the proprietary ABMS MOC program has grown far in excess of the rate of inflation (16.3 to 17.2% annually), without adding any appreciable change to the product delivered to physicians or the public.

3) The ABIM Foundation, which was reported as being created in 1999 on federal tax forms from 2008-2013, has a POSITIVE balance of $77,255,188 on its 2015 Form 990. Much of this balance was secretly transferred from the ABIM physician testing fees from 1990-1999, ten years before the organization was reportedly "created." Furthermore, the Foundation is domiciled in PA, not Iowa, as it was claimed from 1999-2013. With some of those funds, the ABIM purchased a $2.3 million condominium that came complete with a chauffeur-driven Mercedes S-class town car for itself in December 2007.

4) Christine Cassel, MD not only worked as President and CEO of the ABIM and its Foundation from 2004-2014, she also secretly served on the Board of Kaiser Foundation and Hospitals, earning $1,683,221. From 2008 through 2013, she also served on the Board of Directors at Premier, Inc, the largest US hospital procurement firm, earning 230,000 in case and stock in 2013. (Here's the breakdown of her take). None of these conflicts were ever disclosed until she was investigated by Propublica before becoming the President and CEO of the National Quality Forum. From 2010-2014, the ABIM paid a little-known company, CECity, Inc., over $5.5 million to process physician patient survey/practice improvement survey data. Shortly after Dr. Cassel left the ABIM, CECity, Inc was bought by Premier, Inc for $400 million in 2015.

5) Robert Wachter, MD served as a consultant and board member for IPC Hospitalist Company while working as Chairman of the Board of the ABIM/ABIM Foundation in 2014. IPC Hospitalist company was investigated for overbilling Medicare and Medicaid patients and paid $60 million to settle Medicare/Medicaid false claims act violations with the DOJ February 6, 2017.

6) The ABIM has been lobbying Congress for years, but such lobbying has never been disclosed to the public via Form 990 tax forms.

7) The adverse effects of MOC on physicians and patients have never been studied. Yet the ABIM has been conducting research on physicians (see here and here) without their consent or Institutional Review Board oversight, potentially in violation of Protection of Human Subject statutes of the Department of Health and Human Services.

8) The American Board of Medical Specialties (ABMS) and the American Hospital Association (AHA) are both member organizations of the Accreditation Council on Graduate Medical Education (ACGME). Maintenance of Certification (MOC) favors hospitals eager to limit competition.

9) Margaret E. O’Kane is founder and president of the National Committee for Quality Assurance (NCQA). Margaret E. O’Kane is founder and president of the National Committee for Quality Assurance (NCQA). The NCQA is responsible for credentialing insurance companies that must accept ABMS MOC as a condition if their credentialing under the Affordable Care Act. Ms. O'Kane is also a public board member of the American Board of Medical Specialties (ABMS) that actively promotes the ABMS MOC program that benefits the ABMS. In addition, Richard J. Baron, MD, the current President and CEO of the ABIM, served as member of the Standards Committee for the NCQA.

10) The ABMS sells credentialing information on physicians through its wholly-owned subsidiary, ABMS Solutions, LLC, a for-profit corporation based in Atlanta, Georgia.

11) The American Board of Family Medicine (ABFM), one of the ABMS member boards, holds ABFM Realty, LLC, a for-profit real estate company that manages commercial real estate and is funded almost entirely by physician testing fees.

12) The American Board of Pediatrics (ABP) has numerous real estate holdings surrounding its North Carolina address and contracted with its retired CEO, James A Stockman, III, MD to work 8 hours per week for $793,438 in 2014.

These are just a few of the conflicts inherent to the ABMS MOC product. Sadly, there have been many more throughout the years, including cozy relationships with major US academic institutions.


Friday, April 14, 2017

Dear Legislator

Physicians, consider providing the following letter (or a modified version) to every state legislator considering anti-MOC legislation.

Dear Legislator -

Across the country, bills are appearing in state House and Senate chambers regarding a trademarked  educational product owned by the American Board of Medical Specialties (ABMS) called Maintenance of Certification (MOC). No doubt a team of gray-suits representing the insurance companies and hospital systems in your area (aka, lobbyists) will be knocking on your door explaining why this program is so important to assuring the public that their physicians are of the highest quality and competency. They will insist that this proprietary physician continuing educational program is the only integrated system of physician education that assures quality educational content for doctors while also providing a multitude of practice improvement modules to assure the highest quality of care for patients.

Please don't be fooled. As your life-time certified ABMS Board certified doctor, I have seen the implementation of "continuous" MOC in 1990 and watched it grow into a cottage industry costing physicians nearly $1 billion and 32.7 million hours away from patients annually (over $23,000 per doctor every 10 years) without proven benefit to patient care. ABMS MOC product replicates Continuous Medical Education we already are required to do to maintain our license in each state and does not permit physicians the freedom to chose the education they need for their practice, but rather forces them to comply with an unnecessary, expensive, and repetitive mandated computer-testing exercise. Imagine having to retake your high school trigonometry final examination to continue to practice your trade today. This is the equivalent to what physicians must now endure every 10 years.

The ABMS MOC program grew from a financial need of the ABMS and their 24 member boards, especially the American Board of Internal Medicine (ABIM) which "certifies" one quarter of all US physicians. The  ABIM is currently $50.6 million dollars in debt (according to its most recently-available 2015 public tax returns) while their executives earn three- or four-times the salaries of the average working physician, enjoy complementary spousal air travel, and purchase luxury condominiums complete with chauffeur-driven town cars for themselves - all at working physicians' expense. They then sell our testing information for profit to ABMS Solutions, a for-profit corporation based in Georgia.

The ABMS and their lobbyists say that a computerized test or a continuous question-and-answer barrage fed to our cell phones or laptop computers is superior to direct patient care experience for maintaining our competency to practice. I would hope you can see through their propaganda.

Finally, the ABIM and the ABMS have been involved with highly irregular financial dealings, including falsifying tax forms and transferring many our our testing fees to the ABIM Foundation in the Cayman Islands. They also perform "research" on physicians and their practices without informed consent or Institutional Review Board oversight - potentially in violation of federal law.

For these reasons I would ask that you strongly reject the importance and value of the ABMS MOC program to practicing US physicians. We have carefully researched the financial and political dealings of this conglomerate of independent non-profit agencies that are pushing for MOC and would ask to have them investigated by the appropriate authorities, including the Federal Trade Commission and Internal Revenue Service before siding with their lobbyists' demands.

Such an action would be in the best interest of our patients and US healthcare, not the endless ABMS MOC testing of physicians who struggle to serve as patient advocates in our increasingly regulatory healthcare environment.

Your caring physician -

Wednesday, April 12, 2017

An American Sickness and the ABIM

Thanks to Elisabeth Rosenthal, MD for the mention of the ABIM/ABIM Foundation controversy in her new book, An American Sickness: How Healthcare Became Big Business and How You Can Take It Back.

Sadly, the financial troubles and numerous financial conflicts of interest at the ABIM persist for reasons Dr. Rosenthal articulates well: it's a "testing Ponzi scheme."


Monday, April 03, 2017

Attention Tennessee Physicians and Physicians Everywhere

Attention Tennessee physicians and beyond:
As you may be aware, the (anti-)Maintenance of Certification legislation (see House Bill HB 413) and Senate Bill (SB 298) is on the calendar on Tuesday at 1:30 p.m. in Senate Commerce and at 3:00 p.m. in House Health Subcommittee. This legislation is highly contested and being opposed by both hospitals and insurance companies. TMA is working hard to get this legislation passed, but they need your help!

We need you to come to the hearings on Tuesday to show legislators that PRACTICING physicians are firmly AGAINST making the unproven, time-consuming, and distracting ABMS Maintenance of Certification program a requirement to practice medicine in Tennessee. Having physicians in the hearings may mean the difference in what happens with this bill in the committees on Tuesday. As the bill is highly contested, the outcome is unknown. It may be amended and passed out, or it may be put off until next year. Without physicians in the hearings, they will not go well. The legislators need to see physicians present supporting this bill and following it closely.

When: Tuesday - Senate Commerce at 1:30pm in LP 12
House Health Subcommittee at 3:00pm in LP 30

If you have any questions about this or if you are able to attend, please let me know, and if you haven't already, please contact your representative and senator and let them know you support this bill. https://www.votervoice.net/TNMA/campaigns/50846/respond

Thank you for your help,


Nikki Ringenberg, MPA
Senior Director of Membership and Grants
Nashville Academy of Medicine
3301 West End Ave, Ste 100
Nashville, TN 37203
615-712-6236 office
615-712-6247 fax

It is time to turn your gaze away from that computer screen and rise up!

Practicing physicians' right to work is being compromised by the inclusion of the ABMS MOC requirement in state legislatures across the country.

Physicians need to alert their colleagues in Tennessee and elsewhere about this effort to restrict the practice of medicine by the American Board of Medical Specialties and Federation of State Licensing Boards. Practicing physicians are not against continuing education, but against the corruption that the ABMS Maintenance of Certification program represents and it's anti-trust implications it has to the practice of medicine.

It is time to save the practice of medicine and physicians' ability to act autonomously on behalf of our patients without the threat of unnecessary corporate intrusions into health care delivery.

There is not much time for us to mobilize. Please spread the word.


Addendum: Thanks to Meg Edison, MD for her letter to circulate: http://us10.campaign-archive2.com/?u=5a9a08b64c48d493e89cb8192&id=5fb2b96d5c

Friday, March 31, 2017

ABIM Gets It Wrong Again

On Wednesday, the American Board of Internal Medicine (ABIM) quietly announced their much-anticipated "modifications" to their Maintenance of Certification program on their blog. As expected, rather than ending the MOC program, ABIM has decided to double down and justify their unproven process using an edited video of Skype sessions from their most fervent (paid) supporters.

The ABIM reportedly conducted invitation-only "listening sessions" accross the nation. On the basis of those sessions and months of focus groups and navel gazing, the ABIM unilaterally decided that an "open-book" examination that physicians must participate in every two years could serve as an "alternate pathway" to "maintain" a physician's (previously lifetime) Board certification. They then had the gall to say these were the changes we requested. They weren't.

In actuality, those "listening sessions"were invitation-only. (Yes, I applied to attend the one here in Chicago but was never granted an "invitation.") Selection bias of diplomates was the order of the day. And as their legal fees mount, ABIM has yet to mention what they plan to charge recertifying physicians for their new "pathway." Rest assured it will be plenty.

By now, practicing physicians understand what MOC is really about. It is NOT about making money, physician ongoing education, assuring physician competency, care quality, or patient safety.

MOC is about the control of physicians.

Control doctors and you control health care delivery. Control doctors and you can shape them to corporate ways. Don't like it, dear doctor? Then leave. We'll find someone else to take your place and your patients.

But replacing experienced physicians is not so easy. It takes years to gain credible experience in medicine. MOC is not about experience, it is about rote memorization and data entry. And what the ABIM doesn't get is referrals are still not always guided by who your employer is, as much as corporations and the government try to make it so with their consolidation attempts. They can "innovate" all the new ideas they want, but doctors are not fooled. Tie MOC to credentials or to insurance company payments if you want, but extortion is extortion, no matter how you color it. Because ABIM has not taken accountability for their serious financial transgressions and strongman tactics used to protect their monopoly, they will remain a pitiful example of corporate greed to practicing physicians (the people they claim to "help") and little else.

The Accreditation Council of Graduate Medical Education (ACCME) and their powerful member groups (The American Board of Medical Specialties, American Medical Association, American Hospital Association, the Council on Medical Subspecialty Societies and American Osteopathic Association) know billions of other reasons MOC is important, too. MOC generates about $2 billion in revenue annually for these organizations when one considers the endless board review classes and registration fees for their members. Condos, limo rides, first class airfare, gym memberships, and multimillion dollar golden parachutes are dependent on this program.  All done without proof of value to doctors OR their patients. All done without any assessments of MOC's potential harms. The fact that our bureaucratic academic leadership in medicine will not address the many problems uncovered on this blog's pages and what this means to patient care in America is more even concerning than the ABIM's missteps in my opinion.

Doctors have had it with the outright dishonesty and scandal that has plagued MOC from the beginning, especially when they're dealing with much more important life-and-death issues every day. The only realistic and honorable revision for MOC is to end it, or for every practicing physician to refuse to participate and allow MOC to wallow in it's own avarice and greed.


Tuesday, March 21, 2017

Fact Check on ABIM's Director of Investigations

On 9 February 2017, I received a note from the editor of Philadelphia Medicine magazine requesting that I respond to a letter they received from Sidney Baumgarten, Esq, a friend and counsel for Ariel Benjamin Mannes, the American Board of Internal Medicine (ABIM)'s Director of Investigations, whom I had mentioned in their publication dedicated to the ABIM that was released in December, 2016. Yesterday, Mr. Baumgarten's letter and my rebuttal appeared in the Spring 2017 issue (5 Mbytes) of Philadelphia Medicine magazine.

I have reproduced the contents of Mr. Baumgarten's original letter regarding Mr. Mannes and my rebuttal to his letter below:

December 27, 2016

Philadelphia Medicine Magazine
c/o Philadelphia County Medical Society
Alan J. Miceli, Editor
2100 Spring Garden St.
Philadelphia PA 19130

Dear Mr. Miceli,

I am writing this letter hoping that you will give it serious consideration and make it available to the members of the Society as well as those who read your publication.

I have been a friend and counsel to Ariel Benjamin Mannes, the Director of Investigations (formerly Test Security) at the American Board of Internal Medicine (ABIM), for many years. I must say, candidly, that with over 50 years of law practice I have never before seen the likes of the repeated attempts by Dr. Westby G. Fisher to malign a person based upon an 11-year old “blip” in his long and successful career of public trust. It is, to be sure, unconscionable, to be using invective to shame the ABIM and, along the way, destroying the career and good name of a very honest, competent person, I know that if a member physician were similarly treated you would be mounting the ramparts to obviate its harm to his/her career.

First, Mr. Mannes was a member of the DC Police Department with a very fine record of service. He had been on a leave of absence and was awaiting reinstatement to duty while working part time at a DC restaurant when the incident in question occurred. That night, Mr. Mannes intervened in an altercation and himself called the police for assistance and was in possession of a legally licensed handgun from Virginia where he lived, but not technically permitted then in DC. His arrest and conviction was solely for illegal possession of the weapon; one felony, not two as Dr. Fisher alleges.

Interestingly, Ben’s employment appeal was won and he was reinstated to the DC Police, and was ordered prior to the incident and was successfully reinstated, our legal view was that he was a de facto police officer at the time of the incident. It should also be noted that the very law Mr. Mannes plead guilty to was later declared unconstitutional by the Supreme Court.

Second, Ben had served with the US Department of Homeland Security on a TSA-led rail inspection team with a security clearance, even on the night of the incident. He had also held roles before moving to DC with the US Federal Protective Service in New York following the first World Trade Center bombing trials and the CAT Eyes program where he trained police instructors on anti-terrorism in multiple jurisdictions. Even after the aforementioned incident he worked as a contractor on homeland security technology initiatives in Los Angeles, Ohio and the Philadelphia region. In multiple instances, Mr. Mannes was able to assist me in my role as Chief of Staff of the Army Division of the New York Guard after 9/11. In fact, his intelligence gathering enabled us in New York to be forewarned of serious threats.

Third, because Ben was a resident of New York for many years, he was able to obtain a Certificate of Relief from Disabilities issued by the State of New York several years ago, which relieved him of any impediments to employment, etc. as a result of his plea and conviction.

Finally, our laws here in New York (where Mr. Mannes’ certificate was issued) prohibit discrimination against a person who has one criminal conviction. It is codified in our Human Rights Law and our Correction Law. Both are designed to prevent the stigma of one arrest from interfering with future employment.

As you can see, the one incident revealed nothing that would even suggest any form of dishonesty of other reason for the ABIM to reject his services. Mr. Mannes’ position was designed with a myriad of checks and balances and his casework, to include the one cited in your publication, have been upheld in courts of law on numerous occasions. Mr. Mannes is a consummate professional, active in the federal and local security community, who has made the appropriate disclosures in both his pre-employment background check at ABIM and the vetting process for appointments he has held since, to include his elected Governorship at Infragard, a public private partnership coordinated by the FBI.

To put it bluntly. Mr. Mannes is being unfairly pilloried to serve Dr. Fisher’s own differences with the ABIM. It is especially unseemly for the member of a highly respected profession to undertake the willful destruction of another human being for his own motives. Mr. Mannes has worked extremely hard over the last 11 years to undo the unfortunate incidents of one night and surely does not deserve to have his family, friends, and colleagues read disparaging, inaccurate things about him in the pages of your publication. I am sure Hippocrates would blush.


Sidney Baumgarten, Esq.
Former Deputy Mayor, City of New York
Brigadier General, NYG, Retired
Cc: Hoffman Publishing Group

* * *

Mr. Baumgarten's understanding of Mr. Mannes' background conflicts with publicly available information regarding Mr. Mannes' past. To the best of my knowledge and belief, Mr. Mannes' prior background, responsibilities, "intelligence gathering" tactics, access to ABIM diplomate personal information, law-enforcement connections, and salary at ABIM have never been disclosed to ABIM diplomates despite Mr. Mannes' important public role in the organization. Here is the response I sent to Phildelphia Medicine magazine regarding some of the verifiable facts I have found regarding his history (They requested I limit my response to 500 words):
"Contrary to what Sidney Baumgarten, Esq. claims, Ariel Benjamin Mannes does not have a 'fine record of service with the DC police department.' In 2003, Mannes admitted using his access as an officer to obtain Washington reporter Jason Cherkis's personal records and posting the information on a law enforcement website advocating reprisals. The disciplinary board decided unanimously to fire Mannes for conduct unbecoming, but took more than 55 days to notify him.

While on involuntary leave from D.C. Police pending investigation, Mannes began working for the TSA Railroad Division and moonlighted as a bouncer at the “Diva nightclub.” Mannes assaulted a Diva nightclub patron while carrying a loaded unregistered pistol and claiming he was a police officer. Mannes was charged with aggravated assault, impersonating a police officer, and carrying an unregistered firearm.

Per D.C. Court records (felony #006438), Mannes pleaded guilty on December 2005 to two charges from the nightclub incident: (a) impersonating a police officer and (b) carrying an unregistered firearm, and was sentenced to pay fines for each conviction and to probation. He lost his weapon and TSA employment because of this incident.

Police Chief Cathy Lanier was forced to rehire Mannes in November 2008 due solely to the notification issue, but then suspended him. The Department moved again to fire him because of his weapons charge.

Mannes lost his appeal of his two convictions on 10/21/2008, the same year he began working as Director of Test Security for the ABIM.

While at the ABIM, Mannes’ declaration before a federal judge was instrumental for the ABIM to obtain a temporary retraining and seizure order in ABIM’s investigation of the Arora Board Review (ABR) course on December 2, 2009. Mannes, ABIM lawyers, and U.S. Marshals seized materials from Dr. Arora’s home days later. Using emails from Arora’s computers, ABIM retaliated against 139 physicians and sued others and then issued a press release June 9, 2010 accusing physicians of unethical "brain dumping"  before due process could occur.

In summary, Mannes was disciplined by the D.C. Police for abusing his position of authority to access confidential information to retaliate against an innocent citizen. Such conduct was not acceptable to the DC Police, and yet it appears to be acceptable to ABIM while it falsely accuses physicians of acting unethically. ABIM's double standard should be exposed as long as it continues to harm physicians.
These kinds of threats and attempts to discredit me are a dark example of organized medicine's ethics today. It is also a stark example of the tactics members of the American Board of Internal Medicine (ABIM) will deploy to control the narrative about them.

I take no joy in disclosing the misdeeds of a fellow human being. While the writer of the letter to Philadelphia Medicine magazine seems to be concerned about his "friend and client" and describes his friend's past employment history as a mere "blip," he misses the point that 139 vulnerable physicians (and thousands more who received "letters of concern") had their entire careers threatened by the ABIM's strongman tactics using his "friend and client's" investigation techniques and connections. Those actions resulted in untold personal and professional anxiety, legal fees, and public humiliation before proper due process could occur. In many cases, physicians were forced to undergo ethics training and pay hefty fines to reinstate their board certification on the basis of the ABIM's felonious employee's carefully organized "investigation" so the leadership of the ABIM could maintain their monopoly, power, and lavish executive lifestyles. To then intimidate a person who tries to disclose the truth via a letter to a medical publication is a last-ditch tactic when there is no ground left to stand on.

Disclosing facts cannot be defined as "pillorying." In addition to the facts I outlined in my response to Mr. Baumgarten, it appears to me that Mr. Mannes used his experience with the Arora Board Review investigation to promote his test security techniques to the board members of the American Board of Medical Specialties (ABMS) in a course called "Building a Bulletproof Exam Integrity Case: Tools of the Trade" in 2012. Should physicians blindly permit the wanton breach of their civil liberties by individuals with Mr. Mannes' background and connections so other medical certifying boards can also profit using similar techniques?

Mr. Mannes had other conflicts of interest while an employee at ABIM: he worked for the test security firm, Caveon, teaching techniques of "responding to and investigating test-security incidents" to others. Mr. Mannes even created his own corporation, Exam Integrity Services, LLC, in Florida in 2015. How much more profit did Mr. Mannes hope to gain at the expense of ABIM's physician reprisals while working as their employee?

Recently, we have come to learn that the ABIM sued one physician more than two years after the statute of limitations had expired on the 2009 Arora Board Review copyright infringement case that Mr. Mannes investigated under the direction of ABIM officers. The court recently dismissed the claim after the physician (Dr. Salas Rushford) was forced to endure years of stress and expense inflicted by the ABIM. For reasons that are unclear, Mr. Mannes' deposition in that case (for which I serve as an expert witness on behalf of Dr. Salas Rushford) has been kept under seal to the public, yet the deposition of Dr. Salas Rushford has not. Why? It seems the ABIM is an entity that has grown disproportionate authority over physicians without any meaningful accountability or transparency, and which we now see can abuse its power to inflict untold harm against physicians who are trying to serve patients.

How, where, when, and why unaccountable physician certifying bodies can retaliate against or sue physicians by intruding upon their personal property and civil liberties on the basis of an unproven promise of assuring "patient safety and physician quality" is one of society's most delicate and grave decisions. Certainly ABIM knows this but seeks to reduce working physicians' many concerns about their conflicted financial and investigational activities to a name-calling problem. While I admire the cleverness of this strategy, the genie is out of the bottle. Their attempt to make their reality a personal issue against me is deceptive. Tens of thousands of US physicians have my same concerns and want answers from the ABIM and the American Board of Medical Specialties.  In addition, an entire state medical society has issued a vote of no confidence against the ABIM at the House of Delegates meeting in Chicago in June 2016, and the entire House of Delegates voted to end Maintenance of Certification (MOC) on the basis of lack of evidence of the need for MOC and the ABIM's financial and strongman actions. Despite this, the leadership of the American Medical Association has still not ended the ABMS Maintenance of Certification (MOC) program. Consequently, practicing physicians are mobilizing nationwide to enact state-level legislation to end the corrupt MOC program that is tied to hospital credentialing and the ability of physicians to receive insurance payments in many states and, therefore, to practice their trade.

French philosopher Foucault's work on power helps us understand why the physician certification industry, and Maintenance of Certification in particular, is so important to the US medical education system and for policy makers today:
Discipline, according to Foucault’s historical and philosophical analyses, is a form of power that tells people how to act by coaxing them to adjust themselves to what is ‘normal’. It is power in the form of correct training. Discipline does not strike down the subject at whom it is directed, in the way that sovereignty does. Discipline works more subtly, with an exquisite care even, in order to produce obedient people. Foucault famously called the obedient and normal products of discipline ‘docile subjects’.
Mr. Baumgarten's letter and the ABIM's strongman actions demonstate how the overreach of our US physician credentialing system can adversely affect the very people they pretend to protect: physicians and their patients. To limit a physicians' ability to think critically and care autonomously for their patients creates dangerous consequences for both caregivers and their patients. Health care administrators and policy makers would be wise to assure physicians continue to be able to speak independently and on behalf of their patients lest they fall prey to the same forces when they become patients themselves.

It is unacceptable to continue the half-truths and false representations of physician certification (and recertification's) value to our health care system. The ABIM and ABMS must take full accountability for their actions and reform the methods they are willing to employ to assure their revenues at the expense of the personal liberties of practicing physicians and stop using individuals like Mr. Mannes as their strongman and fall guy.