Medscape Issues a Non-Private Privacy Update

With physicians increasingly turning to news aggregators to keep up with medical news and developments, physicians' eyes have become Big Business.

So has sharing their information.

Medscape (a division of WebMD) recently sent all of its registered users an update of their "privacy" policy (By the way, check to see if a "cookie" considers you already "logged on" when you view this policy webpage).

Here's my summary take:

Nothing physicians do with Medscape/theHeart.org/WebMD websites is private and, in fact, our data (including license information) is being shared with just about anyone willing to pay for the data.

Medscape, ironically the same institution charged with managing continuing medical education for the Health and Human Services HIPAA policy, wants to collect physician license information from "third parties," track what doctors are viewing and interacting with on their website, then share this data to anyone willing to pay them a pretty penny.  In fact, we should take special notice of the section entitled "Disclosure of Your Information to Third Parties."

I was particularly interested in the the Companies and People Who Work For Us subsection:

In addition, if you are a healthcare professional, we may request that a third party validate your licensure status and other information against available databases of healthcare professionals. In order to provide these services, we may provide these other companies with Personal Information we maintain about users of our Services. We require that all such companies agree that they will limit their use of your Personal Information to fulfilling their responsibilities to us. (Emphasis mine)

Such a friendly two-way give and take of our information! (Remember that practice information you were recently asked to supply to the American Board of Internal Medicine?)

Privacy?  What privacy? 

-Wes

h/t Mr. Larry Husten

Mission Impossible V: The MOC Exam

"Place the palm of your hand on the palm scanner," she said.

 He complied and watched the computer screen in front of her read "Verified" in bold green letters.

With that, she looked up at him, shrugging her shoulders.  "In my time here at the testing center, I'm still waiting for someone's identity to change between where you scanned your hand around the corner to here, just 10 yards away!" He smiled and she chuckled to herself.  "Now pull out those pockets and let's seem 'em."

He complied.

"And the back pockets."

He turned. "Nothing.  See?" he said.

"Now roll up your sleeves..."

Secretly at this moment, he was hoping a rabbit would appear, but complied again.

She handed him back his driver's license, rose from her computer, and said, "Follow me."

She led the way through a high security door toward a testing cubicle and quietly sat him at a screen that contained an image of his face shot earlier during his check-in process.  She logged him in and there before him was a computer screen with a large American Board of Internal Medicine logo on it.  She pointed out the silver headphones for to the left of the screen.

"Those are for audio, in case there's any of that on your test.  And these to the right are noise-cancelling headphones if you prefer to wear them.  Here's a white board for your use.  Remember we are audio and videotaping everything.  Whatever you do, don't raise your hand at any time unless you need us.  Got that?  We will come get you.  Don't raise your hand otherwise.   Any questions?  Good luck..."

With that the escort left the room.  He sat before the screen and placed the noise headphones on his head.  The screen asked if he wanted to take a tour to familiarize himself with the features available on the software before starting his test.  He clicked the "Yes, tour" button.

With that, the screen flickered and went black. He could hear the noise cancelling headphone suddenly begin to make sounds.

"Good morning, Dr. Phleps."

A picture appeared on the screen as the mysterious voice continued: "This is Dr. Richard J. Baron, the mastermind and ring-leader of the American Board of Internal Medicine that supports the security and secrecy procedures that you have just endured.  He and his many well-paid collaborators have conspired to create a series of time-consuming and anxiety-producing tests and questionnaires designed to frustrate and instill fear in their professional membership. It has become clear that their processes are being promoted as a measure of physician excellence, when in fact, it sets a floor of performance standards for physicians while assuring the continuation of their administrative positions. Your mission, should you decide to accept it, is to pass your test so you can continue to demand accountability for the high salaries of these physician admistrators and the expense of this process that are soon to be imposed on physicians every two years. ... But remember, if you fail to pass, the Secretary will disavow and knowledge of your actions and perhaps your ability to practice medicine...  Good luck.  (This program will self-destruct in five seconds)..... * bbbbzzzzaaaaaaaappppppp *"

And with that, a small puff of smoke arose from computer and the screen went black briefly before it returned to the ABIM logo screen. The menu there again asked if he wanted to start the test.  He clicked the "Yes, start the test" button on the screen. A contract screen appeared reminding him that he'd only be able to take the test if he agreed to be disavowed and reported to credentialling agencies if he divulged any test content or materials to anyone at anytime.

Realizing his wife would kill him for wasting thousands of dollars if he refused, he clicked "I Agree."

The first question appaered while the clock in the upper right corner of the screen began counting down. (A familiar theme song began playing in the background)

-Wes

(Epilogue: Yes, dear reader, Dr. Phelps recently learned that he accomplished the impossible.)

Doctors' 2012 33% Tax Hidden Tax Hike

Physicians were the subject of a 33% tax hike that most of them weren't even aware they received this year. 

That's right.   Thirty-three percent. 

Couched as "only five additional dollars each month" by the government, it passed because doctors don't make the Federal Register part of their weekly reading list and because our professional lobbying organizations were either asleep at the wheel or distracted by the whole health care reform mess.

You see if you want to get more money for government programs, you should tax the "rich" doctors - the very same doctors that are enjoying (and have experienced the delays in payment caused by) the joys of the annual congressional cat-and-mouse game of a threatened 30% pay cut wrapped up in the fiscal cliff negotiations.  (Don't worry docs, *wink wink* it really won't happen).

The "tax" I'm speaking of?  Why it's the new $731 DEA registration fee.

Until 2011, the three-year fee was $551.  Now it's $731.

You do the math.

And why were the fees against doctors increased?

Because the DEA needed more money.  According to the FDA Law blog, the DEA cited a number of factors justifying the fee increase including:

•Expanding the use of Tactical Diversion Squads comprised of DEA diversion investigators and special agents, state and local law enforcement and regulatory officers conducting criminal investigations;

•Increased scheduled registrant investigations and inspections;

•Increased drug scheduling actions;

•Responding to the expanding number of synthetic substances such as synthetic cannabinoids and synthetic cathinones; and

•Establishing and maintaining information technology systems for registrants.

That's right, in addition to paying ever-higher taxes, licensure fees, credentialing and continuing education fees, doctors are footing a larger and larger tab of the nation's drug war while simultaneously trying to fight it on the front lines.

Brilliant.

And people wonder why doctors are burnt out and fed up.

-Wes

PS: For more excuses captivated reading, visit http://www.deadiversion.usdoj.gov/

The Cost of Our Medical Licensure Complex

You could see the frustration in his eyes as he spoke to his fellow resident.

"I had to fork over eight hundred and thirty five dollars," he said slowly in a disgusted tone, "... and that doesn't even include the $300 state license fee we have to pay later...."

So much for starting our EKG conference on time.

The comments continued. No one could understand why medical school licensure has become so expensive in the US. I thought I'd look into what medical students can expect to pay these days for licensure since it had been a while since I had gone through the gauntlet. Here's what I found out:

A good overview can be found on the Wikipedia website. I'll direct readers there who want specifics as a starter. What I was more interested in were the sheer numbers of organizations and people involved in this process of verification of credentials and managing a series of tests that have become known as the US Medical Licensure Examination (USMLE).

First, there is the National Board of Medical Examiners. Then there's the Federation of State Medical Boards. Then there's the Education Commission for Foreign Medical Graduates. And let's not forget the Foundation for the Advancement of International Medical Education and Research, whom the US medical students support, in part, so tests can be administered to foreign medical students in an effort to advance international medical education and research. It's a veritable cornucopia of testing services for the whole world!

So no wonder the resident was frustrated. He's been paying into an industry that's getting quite expensive: over three thousand dollars expensive.

How can that be?

Well, the toll is paid gradually by medical students and residents - it's easier to pay in "steps," it seems. Here's the breakdown for 2011:

USMLE Step 1: $525
USMLE Step 2, Clinical Knowledge (CK): $525
USMLE Step 2, Clinical Skills (CS): $1120 (Oh, if you're not from Philadelphia, PA, Chicago, IL, Atlanta, GA, Houston, TX or Los Angeles, CA, then please add hotel and transportation fees, since this part is offered only in those cities.)

... and then you have to check with you local state licensure board for the fees associated with USMLE Step 3. For Illinois (pdf) (from where the disgruntled voices rose):

Fee for Continental Testing Services, Inc.: $105
Fee to the Federation State Medical Board: $730
Total USMLE Step 3 Fee in IL: $835

And that doesn't include the later $300 IL state medical licensure fee to be paid later. (Other states are likely to be different)

Which leads to the Grand Total for licensure for an Illinois-based US medical student today:

$3,305.

This on top of how much medical school debt?

No wonder the resident was upset.

(Good thing I didn't mention his upcoming board certification fees.)

-Wes

In the mail: "Dr. Wes, internists aren't 'fleas' any more, they're the dogs from which the fleas suck."

Letting the World Know About Me

I just completed the mandatory online physician database required by the Illinois Department of Financial and Professional Regulation. Haven't heard about this? Well here's a few of their recent frequently asked questions and answers:

1. Who is required to complete a Profile?
Amendments to the Illinois Medical Practice Act require all physicians and chiropractors licensed in Illinois to complete a Profile as part of a public information database maintained by the Department of Financial and Professional Regulation.
2. What if I don’t complete the Profile?
Your participation is mandatory and therefore failure to review, verify and complete your profile could result in fines or other disciplinary action being taken against your license. Additionally, licensees will not be allowed to renew their license in until he/she has completed the profile.
3. Who will able to see the Profile data I enter?
Beginning in 2008, all Profiles may be viewed and printed by the public using a Profile Search link which will be accessible from the Department of Financial and Professional Regulation website.
4. What profile information is required?
Primary office location(s), Hospital Affiliations (if you have any), Medicare acceptance, Medicaid acceptance, Illinois AllKids participation, current Board Certifications, Medical School and Post Graduate Education. All other required profile information, such as full name, license origination date, license status and disciplinary data are retrieved from the DFPR Licensing system and cannot be modified in the Profile.

Now I'm happy to provide the information for licensure to our state, but the general public? Lord knows there have been several instances of physician imposters described in the press, and armed with enough information for the public, one wonders if other instances will arise. And armed with this information, what assurances for my personal and financial security will the state of Illinois supply in return? Will they pay for an Equifax acount to protect my credit report to solicitous attempts at stealing my identity?

Scary times are ahead in 2008 as government intervenes more and more on the practice of medicine.

-Wes

Ima Fake, MD, PhD

P = M.D.

That was the most important formula in medical school. If you passed your course work and clerkships, did it satisfactorily, and made the grade, you’d get to place those initials after your name.

But the path was not easy: countless hours of study, testing, ward rounds, sleepless nights and call. The day a student of medicine graduates from medical school is one of the proudest days of their lives: it culminates years of disciplined study and hard work.

A PhD designation after one’s name is equally (and some would argue even more) arduous, requiring years of study, a long dissertation, oral examination, and peer review process that is daunting.

But for those who want to put the initials "MD" or "PhD" (or both) after their name, there’s an easier way: push-ups, sit-ups, and payment of a $5000 “fee” to the Illinois Department of Professional Regulation:

(NYT) Dr. (Ronald M.) Klatz and Dr. (Robert M.) Goldman are not afraid to take on their critics. In the last few years, they have been embroiled in legal disputes — with the State of Illinois, over offshore medical degrees they received in the late 1990s, and with professional critics whom they sued for giving them a “silver fleece” award in 2004 for promotion of questionable anti-aging products. (That suit was settled last November; its terms are confidential.)

…

Through his lawyer, Dr. Goldman said that he had received two doctoral degrees from “distance learning programs,” which he said had required “work with a mentor, textbook reading and testing.” A fitness buff, he says in a biography posted on www.worldhealth.net that he has held world records for one-armed push-ups (321) and consecutive sit-ups (13,500).

Both men received medical degrees in 1998 from the Central American Health Sciences University in Belize, without, they acknowledged, ever having studied in the country. Dr. Klatz and Dr. Goldman say through their lawyer that they earned their medical degrees with transfer credit from previous academic work and a year in clinical rotations in Mexican hospitals.
Licensing authorities in Illinois did not recognize the Belize degrees, and in 2000 fined the doctors $5,000 each for adding M.D. after their names. They agreed to a cease-and-desist order with an exception: books already printed or being reprinted with the contractual requirement that they be identified as M.D.’s. They were also allowed to continue using the M.D. designation on their résumés.

It seems Dr. Goldman gets to use the PhD designation, too.

I’m so glad the medical licensing body in Illinois is so careful to protect our medical profession – never mind the patients subjected to the questionable practices of Drs. Goldman and Klatz in the use of human growth hormone injections as a fountain of youth.

But then I better not say anything else. I might get beat up.

-Wes

Drs Klatz and Goldman are licensed doctors of osteopathy (DO) in the State of Illinois.