Tuesday, January 15, 2019

Council of Medical Specialty Societies Weigh In on Their Vision for MOC

Just in the nick of time, the Council of Medical Specialty Societies (CMSS), another (smaller) member of the Accreditation Council on Graduate Medical Education (ACGME) that represents medical specialty societies, issued its public comment on the ABMS Vision Commission Draft Report on Maintenance (and Continuous) Certification on the last day the Commission is taking comments.

What is important is not only what the Specialty Societies said in the statement, but what they did not say.


  • That initial certification and continuing certification are two separate products offered by ABMS and their member boards and have "different purposes."
  • Specialty societies are in support of initial certification and the value of a secure examination for that purpose.
  • The recognition that boards have a responsibility to "inform organizations that continuous certification should not be the only criterion in these decisions" and further "encourage hospitals, health systems, payers, and other health care organizations to not deny credentialing or certification to a physician solely on the basis of certification status."
  • They had "serious concerns" with four issues:
    • Use of high-stakes, summative examinations as part of continuing certification
    • The practice improvement component
    • The role clarity between certifying boards and specialty societies
    • The timeline for implementation.
  • They likened the issue of trying to improve ongoing assessment of physician competence to "trying to change the tire on a moving car."
  • It was clear the specialty societies wanted to divorce themselves from the "assessment" side of continuous certification to the kinder and gentler "learning" side of "continuous certification."
  • And it looks like the specialty societies want to leverage the ABIM's earlier definition of "professionalism" created by the ABIM Foundation to leverage their own social justice imperative to participate in continuous certification, rather than just that needed by ABMS.
  • They acknowledge the high degree of physician burnout and the need to implement their recommendations in a timely manner.
  • They raised the "grandfather" and "grandmother" issue and voiced strong wording that the ABMS better not to mess with that exclusion, less the "grandfathers" at the specialty societies have to participate in continuous certification, too.
  • They thank the Commission and "require further collaboration and discussion prior to implementation."


  • They do not mention the finances of the ABMS member boards and the $5.7 billion dollars physician spend annually to participate in continuous certification.
  • They do not mention how the data collected from computerized testing of US physicians is used to ration their patients' care by insurance companies.
  • They do not mention how certification data are used to dovetail clinical registry data, physician data, and electronic medical record data, and the money earned by specialty societies for that collaboration.
  • They insist in continuous certification even though it has never been independently shown to improve patient care quality or safety over participation in independent physician-driven continuing medical education.
  • They do not address the excessive salaries and perks offered to the board members and officers of the ABMS Board system or the ACGME itself. (Should the head of the National Board of Medical Examiners really earn $1.2 million annually, for instance?).
  • No mention is made of the many conflicted parties that have benefited financially from the continuous certification process, including, but not limited to, PearsonVue, Premier, Inc., state medical societies (like Massachusetts Medical Society - owners of the New England Journal of Medicine), specialty societies (like ACC), medical publishers (like Wolters Kluwer and Elsevier), and the finances collected by AMBS Solutions, LLC.
  • Finally and most importantly in this CMSS comment letter, there was no mention (or acknowledgement) of the harms caused to physicians by "continuous certification" in terms of financial and psychological hardship, decreased patient access to physicians, strongman (coercive) tactics used to force participation, political motives that benefit these organizations, and the limitations that such a highly restrained and controlled educational product like "continuous certification" places on working physicians who must also deal with their overriding responsibility of caring for patients every single day.
In my opinion (as I've said all along), Maintenance of Certification was a clever shell game used to force physician purchase of a product created by American Board of Internal Medicine (ABIM). That product is far beyond any imposed by states to maintain licensure and requirements for Continuing Medical Education. MOC was rebranded and modified on multiple occasions by ABMS and its member boards to generate continuous cash flow to the ABMS member boards (and now specialty societies) without proof of its value to patients.

Without acknowledging and dealing with the corrupt realities of the MOC (and continuous certification), the recommendations issued by CMSS in their comment letter should be rendered moot.


Please give generously to our legal fund to end this corrupt educational product nationwide.

Sunday, January 13, 2019

Physician Online Gaming for MOC Points

This email was forwarded to my inbox from a colleague who was invited to play this "8-week online computer game and clinical care competition" with colleagues for 4 MOC® points from the University of California San Francisco in collaboration with the Accreditation Council for Graduate Medical Education (ACGME):

From: "Trever Burgon, PhD"
Date: January 12, 2019
To: *************
Subject: CME/MOC Online Clinical Competition: You’re Invited
Reply-To: "Trever Burgon, PhD"

Dear Dr. *************,

You are invited to participate in Quality IQ, an 8-week online game and clinical care competition with primary care providers across the country. Each week, you’ll have a chance to compete against your colleagues, with prizes available for the winners.

One case weekly: Every week you will work-up, diagnose and treat one virtual patient on your phone, tablet or computer. Each case should take you less than 10 minutes.
Compete: See how your care compares with your peers on a weekly leaderboard.

CME and MOC: Earn up to 4 Category I CME credits and 4 Part II ABIM MOC credits for completing your 8 cases.*
Prizes: Amazon gift cards for top performers.
Free: There is no charge to participate in this competition.
The competition is part of an evidence-based medicine study being conducted by academic researchers at UCSF, QURE Healthcare and CE Outcomes.
Your individual responses will be kept confidential, but the overall results are expected to contribute to improved patient care and to be submitted to a national journal for publication.

We will only enroll individuals who meet the specific study requirements below and will discontinue recruitment when the desired sample is achieved. You will qualify to participate if you:
    * Are board certified in internal medicine or family medicine
    * Have access to the internet
    * Read and understand English
    * Care for a panel of at least 1,500 patients

Follow this link join:
Signup and Access First Case

Or copy and paste the URL below into your internet browser:

If you would like to recommend a colleague for the study please reply with the name and email address and we will send them an invitation to participate.

If you have any further questions about the study, please don’t hesitate to call 415-678-5328 or email support@qurehealthcare.com.

*CME and MOC Accreditation and Designation: This activity has been approved by The University of California, San Francisco School of Medicine (UCSF) which is accredited by the Accreditation Council of Continuing Medical Education to provide continuing medical education for physicians. UCSF designates this enduring material for a maximum of 4 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Successful completion of this CME activity, which includes participation in the evaluation component, will also enable participants to earn up to 4 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity.

Thank you for your participation.

Trever Burgon, PhD
Vice President
450 Pacific Ave, Suite 200
San Francisco, CA 94133
Office: 415-321-3388 ext 102
Mobile: 650-465-5982

Several interesting points to note:
  • This gaming research is being conducted by a QURE Healthcare that shares the identical address of two law firms, the San Francisco office of Thompson Welch Soroko & Gilbert LLP and JRA Law Partners. Is this company just a shell for data collection?

  • QURE Healthcare shares data with another company, CEOutcomes.com. From their website: "CE Outcomes is the premier independent evaluator trusted by CME providers and pharmaceutical/biopharma companies. Impact evaluations are cost effective and produce level 5 outcomes data."
Looks like the American Board of Internal Medicine Maintenance of Certification (MOC®) Product 3.0 is evolving to little more than a bizarre form of "Quality Hunger Games" on a computer between doctors.

You can't make this stuff up.

Please give generously to the PPA legal fund to support of our physician colleagues who have sued the ABIM to end this nonsense.


Saturday, January 12, 2019

Proposed Maintenance of Certification Changes Ignite Controversy (Again)

From MDLinx' PhysicianSense blog:
Dr. Westby Fisher, a vocal critic of MOC who has been investigating ABMS finances, referred PhysicianSense to this blog post when asked for comment. Fisher argues that public comment on the future of MOC is moot when there is no plan to end MOC outright.

You can't negotiate with a Spider when you are forced to be a Fly.

Instead, you have to exterminate the Spider.

Please give generously in support of our four colleagues. It's time to end this abusive MOC nonsense.

(Unless, of course, you want to do unproven, costly forced testing the rest of your career.)


Tuesday, January 08, 2019

The ABMS Spider and the Fly

Mary Howitt

“Will you you walk into my parlour, said a Spider to a Fly;
'Tis the prettiest little parlour that ever you did spy.
The way into my parlour is up a winding stair,
And I have many pretty things to shew when you get there.
Oh, no, no! said the little Fly; to ask me is in vain:
For who goes up that winding stair shall ne'er come down again.

Said the cunning Spider to the Fly, Dear friend, what can I do
To prove the warm affection I have ever felt tor you?
I have within my parlour great store of all that's nice:
I'm sure you're very welcome; will you please to take a slice!
Oh, no, no! said the little Fly; kind sir, that cannot be;
For I know what's in your pantry, and I do not wish to see.

Sweet creature, said the Spider, you're witty and you're wise;
How handsome are your gaudy wings, how brilliant are your eyes!
I have a little looking-glass upon my parlour-shelf;
If you'll step in one moment, dear, you shall behold yourself.
Oh, thank you, gentle sir, she said, for what you're pleased to say;
And wishing you good morning now, I'll call another day.

The Spider turn'd him round again, and went into his den,
For well he knew that silly Fly would soon come back again.
And then he wore a tiny web, in a little corner sly,
And set his table ready for to dine upon the Fly;
And went out to his door again, and merrily did sing,
Come hither, pretty little Fly, with the gold and silver wing.

Alas, alas! how very soon this silly little Fly,
Hearing his wily flattering words, came slowly fluttering by.
With humming wings she hung aloft, then nearer and nearer drew.
Thinking only of her crested head and gold and purple hue:
Thinking only of her brilliant wings, poor silly thing! at last,
Up jump'd the cruel Spider, and firmly held her fast!

He dragg'd her up his winding stair, into his dismal den,
Within his little parlour; but she ne'er came down again.
And now, my pretty maidens, who may this story hear,
To silly, idle, flattering words, I pray you ne'er give ear;
Unto an evil counsellor close heart, and ear, and eye,
And learn a lesson from this tale of the Spider and the Fly.

~By Mary Howitt, 1829

* * *

If you do Maintenance of Certification, you are just a silly little Fly.

It is chillingly apposite: for the American Board of Medical Specialties (ABMS) and their 24 member boards' to live, autonomous independent-thinking physicians must die.

Spiders can never stop being Spiders.

"And now, my pretty MOC maidens, who may this story hear,
To silly, idle, flattering words, I pray you ne'er give ear;
Unto an evil ABMS counsellor close heart, and ear, and eye,
And learn a lesson from this tale of the Spider and the Fly..."

... then donate to Practicing Physicians of America's expanded legal fund drive.


Monday, January 07, 2019

Giving Credit Where Credit Is Due

Why does a physician who is strong-armed into participating in Maintenance of Certification (MOC®), pays for MOC®-eligible educational materials, studies and performs the online testing to receive "MOC®-points" from the American Board of Internal Medicine, not get credit for the work completed?

I received a threatening notice from the American Board of Internal Medicine (ABIM) with the loss of my ABMS board certification credential in November 2018 via mail if I did not acquire 100 MOC points by 12/31/2018.

Given the ramifications to my ability to retain credentials at my hospital system that requires "ABMS Board Certification" for its credentials, I did not feel I could risk the implications of this change to my original understanding of MOC® when I originally purchased the product in 2013. Consequently, I tried to find enough educational materials with sufficient MOC® points to meet that requirement in the short time I had left to complete this requirement that was appropriate for my subspecialty. Unfortunately, only the ACCSAP-9 had enough MOC® points (at about $10 per point) to reach that goal, so I spent $1600 to purchase their product.

I began working on ACCSAP9, spending hours reading and answering the questions provided so I might be able to acquire enough "points" to reach 100 by the deadline. Needless to say, because of clinical and family demands, I didn't reach that goal.

I never received "credit" for rounding at four hospitals before 12/31/2018.

I never received "credit" for spending time with my kids and only remaining father-in-law before 12/31/2018.

I never received "credit" for trying to balance work and family life before 12/31/2018.

And despite completing 100 points on 1 January 2019 (the day after they were due), I now find I didn't received "credit" for the hours spent completing even more questions on the one day I had off from work on 1 January 2019:

Documentation of work performed for MOC® 1 Jan 2019
Documentation on ABIM Physician Portal that no credit was received for MOC®
points earned on 1 Jan 2019, despite itemized list above.
Nor did my family receive "credit" from the ABIM for my time spent in front of my computer at home on New Years' Day 2019.

But at least I'm still "certified" by the ABIM and "participating" in MOC® despite their threats and not completing 100 MOC® points by 12/31/2018!

* * *

It is clear to me by all that has transpired in this latest shakedown of physicians by ABIM, that they could care less about MOC® points, they just want our money will stop at nothing to secure funds for themselves and their collaborating professional societies.

That's why I'd like to give "credit" to the four physicians who bravely filed suit against the ABIM in December.

I'd like to give "credit" to the one Puerto Rican physician who still has a pending countersuit against the ABIM that still has not had a chance have his case heard in court.

I'd like to give "credit" to the 750 physicians, many of whom remain "anonymous" out of fear of retribution, and helped fund the investigation that led to the antitrust suit filed against the ABIM in just over four months.

And I'd like to announce that an additional $250,000 is being sought to continue our investigation against the ABIM to consider additional claims against them (see "Update 18").

It's time to give credit where credit is due: to the working physicians who continue to try to do their job caring for patients without coercive education tactics for funds that result in no credit of any kind to them.

Please give generously to our new campaign to end this corruption.

It is time to end, once and for all, the deceptive ABMS "continuous certification" scam for all physicians nationwide.


Wednesday, January 02, 2019

Happy New Year, MOC!

As many of us head back to work to start a New Year, let's not forget that physicians have until January 15, 2019 to "comment" on the ABMS Vision Commission's (un-editable) Draft Report.

While Paul Teirstein, MD and his colleagues at the National Board of Physicians and Surgeons (NBPAS) did a nice job dissecting many of the problems with the Vision Commission's report and made it easy to "comment" to the Commission's Draft Report using SurveyMonkey, I would like to add a few important observations about the Vision Commission's report (and the response by NBPAS) that are not mentioned and remain stumbling blocks for me.

First of all, should physicians be bound by an adhesion contract (seen here) with Board Certification and MOC (or whatever "continuous certification" becomes called) that can change on the whim of the ABMS and their member boards "from time to time?" This gives unilateral control to ABMS and prevents appropriate checks and balances. How is this helpful to anyone except the ABMS member boards and their collaborating corporate entities - all of whom already enjoy a substantial position of power and monetary influence. Remember the history of MOC reviewed in the antitrust complaint (starting on Page 5) filed five days before the Vision Commission's "Draft Report" appeared.

Also, those corporate entities that collude with MOC are not mentioned and are extensive. A partial list includes ABMS Solutions, LLC, hospitals and the ABMS Multispecialty Portfolio Program, publishers like the Massachusetts Medical Society and Wolters Kluwer, Pearson LLC, CECity, Premier, Inc, PriceWaterhouseCooper, and subspecialty societies like the ACC and ACP - all who stand to benefit financially from MOC. Remember, a significant portion of the ABMS Vision Commission are not practicing clinical physicians and are deeply conflicted with corporate entities.

And let's not forget that the Commission's report leaves the harms already experienced by physicians and their families unmentioned (for obvious reasons) - again, see the recent antitrust Complaint filed. MOC was always about money and power for the ABMS and their member boards. The ABMS fully intends for MOC (soon to be rebranded as CertLink®) to shift from a desktop platform at a PearsonVue testing center to a mobile platform in the palm of our hands as "MOC pilots" become permanent in 2019! This translates to more distractive screen time for physicians away from patients and a lucrative life-long money stream to ABMS and their collaborators.

I would encourage physician to consider copying the content of this blog post and morph it into your own "comment" to the Vision Commission if you feel it would be worthwhile.

Also, consider donating to Practicing Physicians of America's legal fund. I believe you'll get more for your hard-earned money that protects your interests that way.


Sunday, December 30, 2018

My Example of ABIM's Deceptive Trade Practices

As I work to complete my first 100 "MOC points" suddenly due 12/31/2018, I think my readers should be aware of the deceptive trade practices that have impacted me since I paid for the American Board of Internal Medicine's (ABIM) Maintenance of Certification® (MOC®) program in 2013.

First of all, after realizing my Board certification in Cardiovascular Diseases would expire in 2013, I paid for my Maintenance of Certification product to qualify to take my recertification examination in Cardiovascular Disease the Fall of 2013. At that time, I was subject to the ABIM's "double jeopardy" situation - if I did not pass my Cardiovascular Diseases re-certification, when it came time to re-certify in Cardiac Electrophysiology, it too would expire since the Cardiovascular Disease requirement was a pre-requisite for sitting for my Cardiac Electrophysiology re-certification examination. (This "double jeopardy" requirement was removed in 2015).

After paying for the ABIM MOC® product, this flier was sent to me explaining "Maintenance of Certification at a Glance."

On page 2 of the above flier, we can clearly see that I purchased the ABIM MOC® product that required only "100 points of Self-Evaluation of Medical Knowledge and Self-Evaluation of Practice Performance credit" to be in good standing with the ABIM for 10 years.

After completing the secure examination in the Fall of 2013, I received this letter on 22 January 2014 notifying me that I had passed the Cardiovascular Disease examination. It stated by Board certification "will remain valid until 2023." Also on that letter, I was told that "requirements to maintain certification will be changing in 2014."

Little did I know that after 2014 they would require twice as many MOC points (100 "points" every five years) to keep my time-limited ABIM board certification in good standing.

I did not agree to this change when I purchased my MOC® product from ABIM. As a result, I have now spent an additional $1675 purchasing continuing education modules from the American College of Cardiology to meet this new requirement.

While I am not an attorney, I believe changing these rules for the MOC® product that I had already purchased in 2013 from ABIM represents deceptive trade practices and will not rest until the ABMS MOC® product and its requirement for continuous certification (with its continuous payments to the ABMS member boards and their supporters) comes to an end.


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?


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.


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.