Feldman: MOC is Good For You

It was helpful for me to read this take on maintenance of certification from Wake Forest dermatologist Steve R Feldman, MD, PhD in The-Dermatologist.com. There are so many straw dogs here it boggles the mind, but the piece exposes a level of naïveté by academic supporters that really don't seem to understand the myriad of problems with MOC. Take this quote, for instance:

The provision of medical care is highly regulated. Not all the regulations are to physicians’ liking. Along with our monopoly power, comes controls that are designed to assure the quality of the care we provide. Our education has been regulated, getting licensed has been regulated, and getting certified has been regulated. Now, maintaining that certification has been regulated, too.

Dr. Feldman justified MOC because, well, we need more regulation! He seems to imply we should just get over it folks: the unaccountable member boards of the ABMS can do as they please with your money. Buy a condo in the name of "Choosing Wisely?" Sure. Send some funds off-shore to the Cayman Islands for their retirement fund while you do the dirty work of seeing patients? Sure. Buy a nice pond or purchase a nice car collection with your colleagues testing fees? Heck yeah! And why not run a for-profit real estate management firm with certification funds, too? Why of course! Then you can perform research on your colleagues without informed consent! And best of all, you can make sure your pals on the Dermatology board force working physicians into becoming HIPAA Business Associates to CECity (A subsidiary of the $4 billion hospital Group Purchase Organization, Premier, Inc.) when they sign up for their recertification tests? Man, the digital data party never stops giving!

Poor guy. Maybe Dr. Feldman didn't know about all this. Or maybe he still needs to threaten working doctors to scratch his social justice itch. (Let's hope not.)

But if that was not enough, Dr. Feldman made this suggestion as an alternative to our current re-certification mess:

If the argument that MOC has not been shown to improve quality, claiming a CME requirement assures quality seems suspect at best. What would a serious solution look like? It would have quantitative, representative measures. Perhaps, it could include random independent evaluation of videotaped patient encounters, supplemented by review of treatment decisions made of lesions and rashes based on photographs or on “secret shoppers.” All the really serious means to document and assure quality would be far more heinous than anything being considered now.

Threats of physicians won't dispel the truth about MOC: it is corrupt to the core. It has harmed physicians. It threatens their right to work on the basis of metric that does nothing to improve the quality or safety of patient care.

Dr. Feldman asks for a viable alternative to MOC. Really, the answer is very simple.

End it.

Completely...

... just as the AMA House of Delegates voted to do so almost three years ago.

-Wes

AOA Agrees to Settle Antitrust Claims

According to the court docket, the American Osteopathic Association (AOA) is in talks to settle the anti-trust claim (Case 1:2016cv04644) made against it on August 1, 2016, by four osteopathic physicians. The terms of the settlement are still being negotiated, but the case has been dismissed on an administrative basis without prejudice. Perhaps the evidence of the AOA President's address in July 2017 that attempted to spin the benefits of decoupling AOA membership to certification and the evidence that the AOA stood to lose over $1M in revenue each year as a result of the decoupling made it clear to all that the AOA was caught with their hand in the regulatory capture cookie jar.

US Doctors of Osteopathy deserve to have the terms of the settlement disclosed publicly.

-Wes

ABMS/ACP "Vision:" Specialty Societies To Do MOC® Dirty Work

With the ABIM still holding out on filing its FY 2017 Form 990's for the ABIM and the ABIM Foundation, the newly-formed ABMS "Vision Commission" is serving as a distractor to what's really happening behind the scenes. Instead of ending the corrupt Maintenance of Certification (MOC®) program, the ABMS and its colluding specialty societies are working feverishly to recruit willing doctors to build content so they can take the lucrative MOC® baton from the ABIM. It is abundantly clear to everyone that the ABIM is in a world of financial and legal hurt, and the ripple effects of their corruption are being felt across the ACGME and the US medical subspecialty society infrastructure. Here's a copy of the letter the American College of Cardiology (ACC) and Heart Rhythm Society (HRS) are circulating to carefully-selected individuals:

As you may know, The American Board of Internal Medicine (ABIM) has announced plans to offer new options for Maintenance of Certification (MOC) assessment beginning in January 2018. ABIM’s current 10-year exam will remain available as an assessment option for those seeking to maintain one or more Board certifications. In addition to the two MOC options offered directly, the ABIM has committed to working with three medical specialty societies – the ACC, the American Society of Clinical Oncology (ASCO) and the American College of Physicians (ACP) – to explore development of additional collaborative maintenance pathways (CMPs) through which physicians can maintain board certification. The goal of this effort is to offer board certified physicians additional flexibility in how they can demonstrate to their peers and the public that they meet standards and are keeping their medical knowledge current.

The ACC has proposed an MOC option for cardiovascular medicine that uses enhanced versions of its Self-Assessment Program (SAP) collection (with a formal knowledge assessment function built into the products) as an alternative to taking the ABIM 10-year examination or the 2-year Knowledge Check-In series. The enhanced SAP collection would comprise ACCSAP (general cardiology), CathSAP (interventional cardiology), EP SAP (electrophysiology), Heart Failure SAP (heart failure) and ACHD SAP (adult congenital heart disease). Developing this comprehensive collection of enhanced SAPs that covers all cardiovascular topics with ABIM board certification exams supports the tacit position that the College is the professional home of all cardiovascular specialists.

Dr. Patrick O’Gara has accepted the invitation to serve as the Self-Assessment Program Editor-in-Chief for the SAP Collection. Dr. Joe Marine and Dr. Ken Ellenbogen have accepted the invitation to serve as Co-Editors of EP SAP and Dr. Edward Gerstenfeld as your Topic Editor. On behalf of Drs. O’Gara, Marine, Ellenbogen, Gerstenfeld and the ACC, we are pleased to extend an invitation to be an author on the topic of Pathophysiology in the chapter entitled Clinical Arrhythmias: Atrial and sub-topic Atrial Fibrillation in ACC’s newest offering in line with the EP SAP product. Please review the attached letter and position description. We look forward to your response by Monday, March 26, 2018.

Regards,


Liara

Liara Fredericks-Brown
Digital Content Specialist
American College of Cardiology

This is not about "quality" health care. This is not for "patient safety." This is about one simple thing: the money.

It is also about manipulating their colleagues with rent-seeking for their own political avarice and greed.

-Wes

One Final Push

This weekend, the national multi-specialty survey of US physicians sponsored by Practicing Physicians of America will be closing to allow time for analysis. To date, the response to the survey has been remarkable: physicians from all 50 states and nearly every US territory have participated with 47 subspecialties (both medical and surgical) represented. In case I should forget, I should also like to add a special word of thanks to those who helped spread the word about this survey, especially members of the Pennsylvania Medical Society, the Association of Independent Doctors, and Doximity. The power of social media to reach working physicians has been amazing.

Currently, I estimate the error of the survey will be as low as ± 1 or 2%, depending on the question asked. Obviously, the more (credible) responses we receive, the more powerful the survey since non-responder bias is present with surveys.

So talk it up one last time, share it like crazy, and encourage your colleagues who have not competed the survey to do so. I have no doubt the results of this survey will be eye-opening to all.

-Wes


P.S.: Goodness: Just realized I published this without the link to the survey!  Here it is: https://www.surveymonkey.com/r/PPA_MOCSurvey

ABIM and the ABIM Foundation: Consumer Fraud?

Early Tuesday morning I attended an excellent continuing educational video-conference hosted by Paul Friedman, MD at the Mayo Clinic at our institution. Anyone who knows Paul knows what an excellent educator and mentor he has become for electrophysiologists around the world. The case involved patient that was a CRT failure, the workup of that condition, the decisions made, and how they handled the case using His bundle pacing, with some pearls about that physiology. I attended the conference voluntarily and without coercion because of the excellent educational value it provides me yet I received no continuing medical education credit (CME) or ABMS Maintenance of Certification (MOC®) credit for doing so.

Because I wasn't scheduled to start a case after that, I then attended a lecture on pulmonary hypertension and its management delivered by one of our cardiology fellows. That lecture was  sanctioned by the University of Chicago as qualifying for CME credit, but not MOC. It, too, was excellent, and refreshed my understanding of the various oral and intravenous therapies available to treat this disorder. I then traveled to another hospital to perform three procedures.

ABIM Website - Click to enlarge

Later that day between cases, I had a colleague who has been forced to re-certify in April of this year and perform MOC® modules lest he lose his credentials to practice at our hospital, look up my publicly available information on the ABIM website for me, and there I was: certified in Internal Medicine, Cardiology, and Cardiac Electrophysiology, but not participating in MOC®.

I know most of the long-time readers of this blog are probably thinking that I should wear that "Not Participating in MOC" designation as a badge of honor, but I look at this very differently.

This designation on their website does not include my CME credits (which the ABIM co-brands with their MOC product) and suggests to the public that I "don't keep up" in my field. By co-branding MOC® with CME, they suggest they are equivalent, but they clearly are not. Not participating in certain CME offerings can't remove me or my partner from my job, but not participating in MOC® can. And if MOC is so important to the ABIM and its corporate cronies in the ACGME heirarchy (inlcuding the powerful hospital and ABMS lobbyists), how am I advertised as "certified" yet not participating in MOC®? This is confusing to the public and makes no sense, particularly when we see the fighting going on at the state legislative level over the "need" for forced "continuous education" of physicians.

Yesterday, I was also tipped to this (seen at the right): an event hosted by the Jewish

Health Activist Network Announcement
(Click to enlarge)

Healthcare Foundation entitled "Spreading and Sustaining the Choosing Wisely Campaign" to be held on Thursday, April 12, 2018 from 5:30PM to 7:30PM in Pittsburgh, PA. The ABIM Foundation's Executive Vice President and Chief Operating Officer, Mr. Daniel Wolfson is the keynote speaker. "Following his comments, Mr. Mark DeRubeis, CEO of the Premier Medical Associates, and Mr. Jim Coslow, Director of Value Based Care, will share how - and why now - Premier has embraced Choosing Wisely."

We must recall that the ABIM has no money on paper, and all of their remaining assets reside with the ABIM Foundation who is speaking and promoting their marketing campaign at our expense at this program. All of their funds come from working physicians' certification and re-certification fees (with the exception of a few grants from the Robert Wood Johnson Foundation). The ABIM Foundation has nothing to do with physician certification, as evidenced by this notice. They have a different mission than assuring physician competence - rather, to promote the next physician payment model of value-based care for themselves.

The ABIM does not place our continuing education credits on their website, yet lists us as not participating in MOC. They call me "certified" publicly on their website, yet the ABIM and my hospital consider my colleague somehow less qualified because he didn't participate in MOC® and pay his money, but are more than happy to continue billing on his behalf in the meantime. Through regulatory capture, the ABIM forces my colleague to take the ABIM MOC® test in April, while not forcing me to do the same and promoting me as "certified" on their website. If my colleague should fail (he won't, just speculating), then me and my colleagues would have to manage his patients and take call more frequently when he is removed from our staff. In effect, there is a multiplier effect if one doctor doesn't recertify on other physicians.

I know this is a strong statement, but given these realities and given what I know about the ABIM Foundation (especially how it received its funds) and its financial shenannigans that include the purchase of a multi-million dollar personal condominium, off-shoring of funds to the Cayman Islands, its many public tax filing discrepancies, I believe the ABIM and ABIM Foundation are engaging in consumer fraud when they post my MOC® status as they do and claim recertification is about physicians "keeping up." As others are noticing, their monopoly on this lucrative product  should not allow them to be qualified tax-exempt organization either.

I believe MOC® is a shell game that deceives the public about the quality of their physicians on a massive scale. It's time to just say no.

-Wes

Physicians and the Remarkable Power of Social Media

Social media is proving remarkably powerful for physicians across all subspecialties to voice their opinion on US Physician Board certification. Respondents to the Practicing Physician of America survey on US Physician Board Certification circulating via social media channels appears to be reaching all subspecialties in a proportion remarkably similar to the 2016 AAMC published workforce numbers:

Click to enlarge

There is power in numbers. We could not have had such a response without so many dedicated clinical physicians from all specialties taking the 6-minutes or so needed to complete the survey. There's still time to add your voice (and those of your colleagues) to the survey if you have not done so already.

We'll be wrapping up the survey to clean the database in the next few weeks. Please be sure to take the time to make your voices heard.

With heartfelt gratitude to my colleagues -

-Wes

ABMS, Online Testing, and Breaches of a Physician's Right to Privacy

Are the American Board of Medical Specialties (ABMS) and the American Board of Internal Medicine (ABIM) violating US physicians' right to privacy through their online certification process?

Who is in charge of ABMS/ABIM testing security?

ABIM has been advertising Maintenance of Certification® (MOC®) using two-year assessments in the "privacy of your home or office." They are avoiding the obvious fact that they are not ready and the platform is wholly untested for the theft of identity, credit cards, bank accounts, email content, patient information, and the whole gamut of personal and professional information. 

If the American College of Cardiology (ACC) is involved with the ABIM to promote their products, then they, too, are either totally ignorant of this or purposefully turning a blind eye to this reality.

Recall that ABIM's former Direector of Test Security was never formally disclosed to physicians in 2008, nor was his departure from ABIM last year. That individual used an online alias that never hinted at his past nor disclosed his relationship with the shady test security firm, Caveon, with whom the ABIM is using for their (unsecure) Knowledge Check-in's. It was only after a Puerto Rican physician who was sued by the ABIM for possible copyright infringment (a case which they lost), that the true identity and troubling background of ABIM's Test Security Director became known. That Test Security Director's also worked (works?) for Caveon. Caveon uses a former Ballard Spahr (ABIM's legal team) lawyer, Mr. Marc Weinstein, to target test-takers they feel may have cheated. This opens a huge Pandora's Box of concerns for physicians who undergo online "continuous certification." The potential to ruin a physician's hard-earned reputation and professional credibility on the basis of an online proctor's insinuation of an errant keystroke pattern or suspicious gaze during testing without due process is real. And Caveon's system test security system offers no credible safeguards against identity or credit card theft, or mirror-imaging of our computer's files or keystrokes for their purposes.

Are physicians really going to allow such testing tactics to occur in our own homes?

Not only no, but hell no.

This MOC® craziness has to stop. It is now officially violating physicians' civil liberty protections.

-Wes

Medical Subspecialty Societies Rush to Bail Out ABIM

The American College of Cardiology (ACC) and Heart Rhythm Society (HRS) are negotiating with the American Board of Internal Medicine (ABIM) and the American Board of Medical Specialties (ABMS) on how best to preserve the Maintenance of Certification (MOC®) educational product for their mutual interests.

The ACC Board of Governors will be meeting at the ACC scientific sessions in Orlando in early March to decide how best to continue the educational and financial benefits of MOC® for their organizations. Each of these organizations have significant financial and political conflicts of interest with the unproven MOC® "continuous education" program that was foisted on physicians as a quality and patient safety measure above and beyond conventional Continuing Medical Education credits in 1990.

This is not the first time this discussion has occurred. The ACC has had a long history of attempting to provide educational content without having to  resort to the strongman testing tactics of the ABMS Board certification cartel propped up by the much richer and politically powerful member organizations of the Accreditation Council for Graduate Medical Education (ACGME). With ABIM's looming fiscal insolvency thanks to years of waste, fraud, and abuse of physicians' resources, the ACC must now weigh the benefits of maintaining their relationship with the ABMS versus the risk to the organization from ACGME fallout if it abandons their lucrative relationship. One only has to see the many MOC® offerings at this year's Scientific Sessions to see where the decision is likely to fall.

We should recall that the ACC was the organization that quickly came to ABIM's rescue when their financial scandal surfaced, issuing this public statement:

In addition, the ACC's accounting staff have reviewed and discussed the ABIM’s publically available financial statements with an outside accounting firm and have found the statements to be in compliance with Generally Accepted Accounting Principles, as utilized by not-for-profit organizations in the United States.

While I am not an accountant, I am a Board certified diplomate of the ABIM that has worked tirelessly to uncover the financial and political shenannigans of the ABIM in an attempt to understand their motivations and conflicts. If the ACC sides with the corruption uncovered in this blog's pages without addressing head-on the financial benefits to themselves, they risk compromising their reputation as a credible scientific organization capable of transparently managing those conflicts. I would be a shame if they don't care.

ACC Board of Governors should vote to break ties with the ABIM completely and return to CME, lest they fall prey to the same forces that dissolved the ABIM: avarice, politics, and greed.

Early forecasts predict the odds of that heppening are close to zero.

-Wes

Dealing With the Ol' ABIM Soft-shoe

Resolution 607 from the AMA House of Delegates, passed in June 2016, stated:

"Whereas, The ABIM Foundation uses the income of the $56 million for internal salaries, dubious research which consistently publishes data in support of MOC, and approximately $500,000 a year for high-end retreats at the county’s most expensive resorts; and

Whereas, The ABIM paid its President $2,774,000 for her final 30 months of employment (an annualized salary of $1.1 million dollars); and

Whereas, The ABIM President gave her First Assistant a raise of $103,000/year in 2011, $83,000/year in 2014, and a bonus of $313,000 in 2011 for total earnings well in excess of $500,000; and

Whereas, The ABIM purchased a condominium for $2.3 million and sold it for $1.7 million losing $600,000 in cash along with real estate sales and transfer fees adding another loss of approximately $200,000, and chose to house its out-of-town guests in the most expensive per square foot real estate in the city of Philadelphia as well as provide a chauffeur-driven limousine for their use; and

Whereas, The top employees at the ABIM are receiving retirement contributions of 18 percent per year (fully funded by the ABIM with no employee contributions) in contrast to the industry average of five percent; and

Whereas, There may well be many more undiscovered excessive expenses at the ABIM; therefore be it

RESOLVED, That our American Medical Association, prior to the end of December 2016, formally, directly and openly ask the American Board of Internal Medicine (ABIM) if they would allow an independent outside organization, representing ABIM physician stakeholders, to independently conduct an open audit of the finances of both the American Board of Internal Medicine (ABIM), a 501(c)(3) tax-exempt, non-profit organization, and its Foundation (Directive to Take Action); and be it further

RESOLVED, That in its request, our AMA seek a formal and rapid reply from the ABIM so that issues of concern that currently exist between the ABIM and its Foundation and many members of the AMA and the physician community at large can be addressed in a timely, effective and efficient fashion (Directive to Take Action); and be it further

RESOLVED, That our American Medical Association (AMA) share the response to this request, as well as the results of any subsequent analysis with our AMA House of Delegates and our membership at large as soon as it is available. (Directive to Take Action)"

In response to this resolution, the ABIM sent this response to the AMA, skirting the concerns outlined and directing diplomates to its webpage containing only its most recent financials, and to the President and CEO of the American Board of Medical Specialties.

Not only were the concerns raised by the AMA House of Delegates not addressed directly, the House of Delegates were asked to turn to the fox guarding the henhouse for answers.

Currently, the ABIM and the ABIM Foundation still haven't filed their non-profit 2017 Form 990 Federal tax forms for public inspection. We are quite aware they may have squandered over $78 million of our testing fees.

What should be diplomate physicians' response be to this previous ABIM soft-shoe tactic?

I believe the AMA should move to have the Internal Revenue Service investigate the ABIM and the ABIM Foundation on our behalf.

We have tried to be polite and self-regulate our regulators in a responsible, transparent way using accepted channels. It has gotten us nowhere. It's time proper authorities get involved to examine the evidence and, if appropriate, take action to end the years of deception and collusion, and to take corrective action in the name of the integrity of our profession.

-Wes

PS: A survey of Board-certified practicing physicians regarding MOC® is still being conducted. If you have not done so already, please complete the survey here and then email the link (https://www.surveymonkey.com/r/PPA_MOCSurvey) to your colleagues. This is particularly important now that ABMS is performing their own survey that will ignore their conflicts of interest with "continuous certification."

Getting Behind the Iron Curtain

Thanks to all the physicians that have completed the MOC Survey so far. There has been an impressive outpouring of physician responses so far with many thousands of physicians responding to date. But we are not done.

As most of us are aware, numerous errors can occur with surveys. For instance, sampling error and coverage errors are two of the most commonly cited, but measurement and non-sampling error (those who choose not to complete the survey) can be sources of error, too.

To improve the reliability and acceptance of the MOC survey we're collecting, it is imperative that we obtain as many responses from as many physicians in different geographic locations and practice environments as possible. This is especially true when trying to collect responses from "Behind the Iron Curtain" of hospital employment. In my view, this is an especially important group of physicians to survey, but also one of the most challenging to sample. Any and all assistance we can garner from those who have already participated in the survey would be greatly appreciated. Once again, all practicing US physicians from all subspecialties are invited to participate. Here's the link to share with your colleagues: https://www.surveymonkey.com/r/PPA_MOCSurvey.

Thank you all -

-Wes

Vetting the ABMS "Vision Initiative Commission"

"Society cedes to the medical profession the privilege of self-regulation based on 3 assumptions: the assumption of expertise, altruism, and self-scrutiny. Among other responsibilities, self-regulation requires the profession to establish the means of setting and maintaining standards of education and training, entry into practice, and practice. Integral to effective self-regulation is the responsibility and obligation to ensure that these standards are met."

From: David H. Johnson, MD
Member of the American Board of Internal Medicine Board of Directors 2007-2015
and Board Chair 2013-2015,
"Viewpoint: Maintenance of Certification and Texas Senate Bill 1148 - A Threat to Professional Self-Regulation"

In his article, Dr. Johnson describes the process of "self-regulation" quoted above. Most practicing physicians have no idea that the ABIM and ABMS's definition of "self" includes nurses, lawyers, and executives, yet with the appointment of its new "Vision Initiative Commission," it seems it does.

It is ironic that after years of controversy, the ABMS finds itself embroiled in a desperate fight to regain legitimacy lost amongst practicing U.S. physicians since the ABIM Foundation condominium/Choosing Wisely debacle surfaced in late 2014. As a result of ongoing pressure and the admitted short-comings of their self-imposed time-limited Board certification, the ABMS recently initiated a "Continuing Board Certification" proposal called "Vision for the Future." They described the "initiative" as:

"A collaborative process, the Commission will bring together multiple partners to vision a system of continuing board certification that is meaningful, relevant and of value, while remaining responsive to the patients, hospitals and others who expect that physicians specialists are maintaining their knowledge and skills to provide quality specialty care."

But by structuring the commission this way, they immediately invalidate Dr. Johnson's "assumption of expertise, altruism, and self-scrutiny" integral to "self-regulation."

The list of selectees to the ABMS Vision Initiative Commission was recently released. While the Commission thankfully includes long-time Maintenance of Certification (MOC) critic Charles Culter, MD from the Pennsylvania Medical Society, it also includes numerous non-physicians poised to help doctors understand ourselves and the ABMS's version of "professional self-regulation." These include Ms. Catherine M. Rydell, CAE - the executive director of the American Academy of Neurology, Jann T. Balmer, RN, PhD a self-described nurse "clinician," Ms. Carol Cronin, Executive Director of the "Informed Patient Institute" (that receives government grant funding from many in the Quality Cartel, including AHRQ and has close ties with AARP), Ms. Patricia (Patti) Davis (I'm assuming that Ms. Davis is Ronald Reagan's daughter - physicians are supposed to know who she is, it seems), and two lawyers: Donald J. Palmisano, Jr., JD (Executive Director and CEO of the Medical Association of Georgia and Medical Association of Georgia Foundation) and David J. Swankin, JD (President and CEO of Public Citizen and Board Member of the Accreditation Council of Continuing Medical Education). Finally, there's the Big Daddy of them all: William Scanlon, PhD, a "Consultant" to the National Health Policy Forum, a group most physicians have no clue about, but appears to have helped the government determine how doctors should be paid (and now no longer exists)and was funded (in part) by Blue Cross Blue Shield, the Robert Wood Johnson Foundation, and the Josiah Macy, Jr. Foundation.

It is remarkable that out of 176 applicants from across the United States (many of whom were doctors), the ABMS chose 27% non-physicians (7 of 26) to help doctors define "self."

Frontline practicing physicians want to know many basic things before anyone embarks on a replacement for the ABMS MOC program. Where's the data that Continuous Certification is needed for anything other than padding the coffers of these unaccountable non-profits who define "self" with non-physicians? More to the point: why have our recertification funds been off-shored to the Cayman Islands? Why do the executives of the American Board of Internal Medicine earn four times the average internist's salary but only work 35 hours per week and are allowed to hold lucrative board positions with Kaiser and Premier, Inc.? Why is Christine Cassel listed as the Chief Financial Officer for the ABIM on the 2012 Form 990? And where are the 2017 tax filings for the ABIM and ABIM Foundation? It seems hypocritical for us to have to complete our recertification by a deadline and risk losing our ability to practice medicine, yet the ABIM can't even file their federal taxes by the appropriate deadline for public review. It is time to start talking about the money. Because if re-certification is about our education and "professionalism," it should NEVER be tied to our ability to retain hospital privileges or insurance panel participation, especially since "continuous certification" has never been independently shown to improve patient outcomes or patient safety. Finally, why haven't the adverse effects of "Continuous Certification" on physicians and our patients ever been studied? Would we introduce a new treatment to our patients without testing its side effects first?

The "ABMS Vision Initiative Commission" should step forward and answer these basic questions before embarking on a new "Continuous Certification" pathway. Because without addressing and understanding the real problems with MOC that we've uncovered, doctors will have a hard time believing anything proposed by this commission is being done for our good or the benefit of our patients.

-Wes

PS: A survey of Board-certified practicing physicians regarding MOC® is still being conducted. If you have not done so already, please complete the survey here.

Addendum: Seems others in Texas feel the MOC Commission is a Stacked Deck, too.

ZDoggMD Interviews Paul Teirstein, MD on MOC®

Great fun! (With a purpose.)

-Wes

PS: A survey of Board-certified practicing physicians regarding MOC® is still being conducted. If you have not done so already, please complete the survey here.

How Family Medicine Physicians' MOC® Data Are Used Without Their Permission

James Puffer, MD, the President and CEO of the American Board of Family Medicine (ABFM), gives an account of some of the ways the ABFM uses diplomate data collected from various sources, including their "continuous certification" program in the Winter issue of the American Board of Family Medicine's newsletter, The Phoenix. Not only are data being used without diplomate consent, they are being merged with other databases in uncertain ways. In one case, it appears the data are used to publish data on burnout rather than serving as a potential cause for the phenomenon.

Here's an example from the newsletter:

We have rapidly expanded the data sets that we are gathering to provide us with additional information about the specialty. These have included the Milestones data that we receive from the Accreditation Council for Graduate Medical Education (ACGME) for every single family medicine resident in training, and data from the Resident Graduate Survey, developed and administered in collaboration with the Association of Family Medicine Residency Directors (AFMRD), that characterizes the work of recently graduated family medicine residents. Important examples of the use of these data sets include recent data that we have published on burnout among family physicians, the changing nature of the scope of practice of recently graduated family physicians, and the powerful and long-lasting imprinting that occurs as a function of the environment in which family medicine residents train.

Read the whole thing (Highlighted text mine.)

-Wes

PS: A survey of Board-certified practicing physicians regarding MOC® is still being conducted. If you have not done so already, please complete the survey here.

MOC® and the Gaslighting of America's Physicians

For the past several years as I (and others) have uncovered the corruption and the profit-driven nature of the American Board of Medical Specialties' (ABMS) Maintenance of Certification® (MOC®) program, I've had a growing sense of professional ennui and self-doubt concerning my effort and wonder if my efforts over all of these years will change anything and ever be worth the time and effort I've expended.

No matter how hard I've tried to expose the theft of millions of dollars of our testing fees to purchase an expensive $2.3 million condominium for the ABIM Foundation, the millions more for real estate purchases (see here and here), exorbitant salaries and use of our dollars to hire felons and legal teams as a "Test Security" division to strong-arm physicians, expose the undisclosed financial conflicts of interest ignored in our most esteemed medical journals, discussed with main stream media, appeared in person at AMA House of Delegates meetings and before state Heath Committees to testify on this corruption, nothing seems to change.

Instead, I have been called an 'unhinged' and 'virulent' critic by American Board of Internal Medicine lawyers or threatened with allegations of defamation by Wall Street attorneys as verifiable findings are tossed aside, ignored, or new Vision Commissions created to continue the manipulative (and financial) status quo. Despite everything exposed by myself and others regarding the harm imposed on physicians by this program, MOC® remains strongly supported, promoted, and (more importantly) mandated by our largest bureaucratic professional medical organizations and hospitals - all members of the Accreditation Council on Graduate Medical Education (ACGME) - as if the corruption regarding MOC® didn't happen, isn't true, and not that serious.

After a much needed vacation away from my clinical demands, I now understand why I feel the way I do.

Practicing physicians are being "gaslighted."

Gaslighting is a malicious and hidden form of mental and emotional abuse designed to plant seeds of self-doubt and alter physicians' perception of reality. It is my belief that by supporting MOC® in spite of the evidence against it, the ACGME and their member organizations (chief among them the American Board of Medical Specialties (ABMS), the American Medical Association (AMA), and the American Hospital Association (AHA)) use gaslighting to establish power and control over physicians on the front line of patient care and state legislators that are being encouraged to support it.

I encourage physicians to review this brief video on the origin of the term "gaslighting," and how it is used to manipulate the narrative on MOC®:



What to Do About the Gaslighting

A second interesting Ted Talk (video) by Ariel Leve gives tips on how to deal with the gaslighter. I encourage those interested to view it. In the video, Ms. Leve, a journalist who endured gaslighting by her mother for years, suggests four ways to deal with the gaslighter that have applicability to physicians and politicians at the forefront of the anti-MOC® movement today:

1. Remain defiant.


2. Recognize there will never be accountability.


3. Let go of the wish for it to be different.


4. Develop healthy detachment.

Given this reality, broad-based physician defiance and non-compliance with MOC® remains our most potent weapon against it. Understanding the psychological manipulation caused by gaslighting by the ACGME in promoting MOC® is the first and most important step in overcoming this damaging program (and others that will likely be developed in its place) in the future.

-Wes

PS: A survey of Board-certified practicing physicians regarding MOC® is still being conducted. If you have not done so already, please complete the survey here.

MOC Survey Update

The MOC survey, sponsored by Practicing Physicians of America, continues to be completed by a wider and wider physician group across the United States and US territories. Every single state and US territory have physicians who have contributed so far, but more are still needed to improve the credibility and statistical significance of the survey. Many physicians and state medical societies have worked diligently to assure frontline physicians voices are heard.

ALL physician voices are welcome. The average time to complete the survey has been about six minutes. Realize that all physicians will not see all questions on the survey due to logic contained in the survey. For instance, physicians who have not recieved their initial board certification will be have to complete questions on MOC (or Osteopathic Continuous Certification (OCC)).

I would encourage all doctors to share this survey with their colleagues and continue to circulate if as far as possible. I hope to be able to present these data at the AMA House of Delegates meeting in June 2018.

Thanks to everyone who has contributed so far. 

-Wes

Survey link: https://www.surveymonkey.com/r/PPA_MOCSurvey

Collecting Practicing Physician Perceptions of Board Certification

An important new survey was launched today to gather information needed to provide strong, data-backed, counter arguments to the American Board of Medical Specialties and the American Osteopathic Association that continue to advertise their lucrative Maintenance of Certification® (MOC®) and Osteopathic Continuous Certification (OCC) products. Thanks to social media, this survey has the potential to be the largest and most authoritative of its kind, but not without your help.

As the MOC® controversy continues, I encourage all practicing all US ABMS and AOA Board-certified physicians to share the survey with your colleagues and include your names and email addresses (not required) to improve the survey's integrity.

Please take about 10 minutes of your time to complete this survey to provide us with the data necessary to defend practicing physicians at a national level against regulatory capture and third party intrusion into our profession.

-Wes

In JAMA: MOC® Denounced

This week in JAMA, the ABIM and the entire ABMS member board structure received scathing repudiations in letters from Carlos J Cardenas, MD, President of the Texas Medial Association, and Bradley D. Freeman, MD from the Department of Surgery at Washington University School of St. Louis in Medicine. Here's a snippet from Dr. Cardena's letter:

As Dr Johnson pointed out, self-regulation is a core attribute of the learned professions. It encompasses the responsibility and authority to establish and enforce standards of education, training, and practice. Physicians routinely defend that responsibility and authority in advocating against the intrusion of all third parties (such as government, private insurers, or hospital administrators) into the practice of medicine.

However, as evidenced by their comments at the Texas Medical Association and American Medical Association House of Delegates and at the committee hearings on SB 1148, many physicians today simply do not acknowledge the certifying boards as “self.” They are, instead, profit driven organizations beholden to their own financial interests. The MOC process is too expensive, requires physicians to take too much time away from their patients and families, and, most importantly, lacks sufficient research to document the benefits to patient care. Many physicians say the information studied and tested has little applicability to their day-to-day practice.

Thus, the certifying boards, for all their talk of ensuring physician competence in a world of rapidly expanding scientific and clinical knowledge, are not “self.” In fact, they are one of the outsiders intruding into the practice of medicine.

Until and unless the boards acknowledge their position as outsiders and completely overhaul their processes, finances, and lack of transparency, physicians in Texas and across the nation will have no choice but to continue to seek statutory defenses against these third-party intrusions into the medical profession.

In reply, Dr. David H. Johnson, former member of the ABIM Board of Directors from 2007 to 2015 (and its Chair from 2013-2015) and author of the original JAMA article entitled "Maintenance of Certification and Texas SB 1148: A Threat to Professional Regulation" attempted to defend ABIM's actions. He parroted these tired ABIM talking points while referencing the ABIM website or blog:

• 800,000 physicians "choose" ABMS Board certification (as if they have a choice if they want to get a job)
• The reorganized their personnel to assure "more than 70% of current ABIM governance members spend more than half their time in clinical care." (as if that addresses the ABIM's actions)
• How they "rolled out" every 2-year "Knowledge Check-Ins" (so we could be distracted from patient care even more frequently)
• And most of all, assured physicians of ABIM's transparency by referring the reader to their website and "Guidestar Platinum designation" (which they pay for and create themselves), calling this the "good faith effort certifying boards are taking to address the concerns of Cardenas and Freeman."

We should not be surprised that a massive $2 billion dollar a year industry would do MANY things to protect its income stream and avoid responsibility for its actions against practicing US physicians. Here's a short list of EVEN MORE things Dr. Johnson failed to mention the ABIM and the ABMS member boards have done since the MOC controversy arose over five years ago to cover their tracks:

• Sold the ABIM Foundation's luxury $2.3 million dollar condominium at a loss
• Offshored millions of our dollars to the Cayman Islands
• Authorized Cristine Cassel, MD a $1.2 million golden parachute as she left for the National Quality Forum in 2013 under Dr. Johnson's leadership
• Said goodbye the Eric Holmboe, MD, the unlicensed physician "Medical Director" of the ABIM now works at the ACGME.
• Changed the ABIM Foundation webpage to erase the fact that they had claimed it was created in 1999 for the purpose of "defining medical professionalism" while giving our money to their favorite institutions and causes without generating revenue for itself (other than investments).
• Claimed that the ABIM "only" took $55 million from ABIM diplomates to create their ABIM Foundation from 1990-2007, when, in fact, they took well over $78 million for their personal and political purposes.
• Fired their long-time auditor because of the tax fraud that has taken place for years.
• Ended their contract with their long-time lobbyist (reported as a "consultant") after this improper expenditure for a 501(c)(3) organization was exposed.
• Said goodbye to their much-loved felonious "Director of Test Security" that helped organize a "sting" operation against vulnerable residents attempting to study for their board examination and closed his division in the organization
• The ABMS member boards are making even more changes now, creating a whole new "Vision Commission" that plans to spend countless hours creating the next bureaucratic boondoggle for themselves at our expense.
• Thanks to the entire ABIM Board of Directors' lack of leadership and oversight, the ABIM is likely insolvent (video).

Dr. Johnson should know all of these points, but chose to ignore these details in his reply letter in JAMA. He would likely claim he was constrained to add these points by a word count given to each respondent. Yet by failing to mention the past and current financial and political transgressions of the ABIM that he helped direct, Dr. Johnson, the ABIM, and all ABMS member boards represent the antithesis of what credible professional self-regulation should embody and should remain responsible for their actions going forward.

-Wes

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

As we say goodbye to 2017, we say goodbye to a year of unprecedented exposure of the interconnected workings of the Accreditation Council for Graduate Medical Education and its member organizations, the American Board of Medical Specialties (ABMS), the American Medical Association (ABMS), the American Hospital Association (AHA), the Association of American Medical Colleges (AAMC), and the Council of Medical Subspecialty Societies (CMSS)  that continue to ignore the corruption inside their walls.

Money does that to people. We should not be surprised.

In keeping with the reviews from 2015 and 2016, here is the wrap-up of some of  key events concerning Maintenance of Certification® (MOC®) for 2017:

4 January 2017 - Richard Baron, MD and Clarence H. Braddock,  III, MD publish a promotional article for ABIM in the New England Journal of Medicine and given the comments, probably wish they hadn't.

20 January 2017 - Stationary sidebars can be revealing: The interconnected conflicts of interest with University of California, San Francisco, MOC®, the New England Journal of Medicine, and the ABIM/ABIM Foundation are disclosed.

6 February 2017 - Practicing Physicians of America, Inc is born and requests IRS investigation of the ABIM at the Library of Congress in Washington, DC.

6 February 2017 - TeamHealth eats the Department of Justice's $60 million judgment for Medicare fraud, but is swallowed quietly by Blackstone Group.

17 March 2017 - Federal judge dismissed ABIM's copyright infringement suit against Puerto Rican Dr. Salas Rushford. Salas Rushford's countersuit to proceed.

21 March 2017 - Wallstreet lawyer attempts to attack the integrity of the investigative reporting on this blog concerning the ABIM's Director of Test Security. Rebuttal appears in Pennsylvania Medicine Magazine and becomes the most read blog post of 2017 thanks to the Streisand Effect.

31 March 2017 - ABIM announces their much-anticipated "modifications" to their MOC program, gets it wrong again.

3 April 2017 - State legislative anti-MOC® battles continue in Tennessee

12 April 2017 - Elizabeth's Rosenthal's book An American Sickness appears on the New York Times best seller list, includes reference to the ABIM $2.3 million condo story.

29 April 2017 - The state legislative battle continued in Texas.

3 May 2017 - Journal of the American Medical Association devotes an entire issue to conflicts of interests in medicine, but forgets to disclose its own.

26 June 2017 - Antitrust suit against American Osteopathic Association is allowed to proceed to the discovery phase

30 June 2017 - Anti-MOC legislation in Texas passes with some concessions, goes into effect 1 Jan 2018.

3 July 2017 - Practicing Physicians of America, Inc starts fund drive to assist with anti-MOC legislative efforts.

1 August 2017 - Research letter detailing the costs and fees for Maintenance of Certification® appears in JAMA.

6 Aug 2017 - ABMS responds to JAMA article on MOC® costs as "crucial to sustain and evolve."

18 October 2017 - Why the IRS needs to investigate the ABIM and its numerous corporate conflicts of interest.

11 October 2017 - Ohio legislature receive my testimony and an evidence packet on anti-MOC House Bill 273 regarding the corruption of the ABIM before the Health Committee.

31 October 2017 - ABIM joins the Human Diagnosis project

4 December 2017 - A key meeting of State Medical Societies, ABMS and ABIM leadership, and numerous medical specialty societies convenes to discuss problems with MOC®; admits the MOC® process is "problematic."

13 December 2017 - ABMS and "partners" from other ACGME organizations including the AAMC and CCMS, alongside some select medical specialty societies, announce new "Vision Commission" to re-brand MOC®. More coverup seems inevitable.

13 December 2017 - Federal judge in the Northern District of Illinois dismisses the antitrust suit by the AAPS against the ABMS using a curious timeline, but leaves a door open to "file an amended complaint that cures the deficiencies discussed in this Memorandum Opinion."

* * *

Today is New Year's Eve. Whether ABIM is solvent or not is uncertain. We will likely have to wait until May of 2018 to know for sure, since 501(c)(3) corporations can file a request to delay publishing of their Form 990 for Fiscal year 2017 until then. But the financial trend toward collapse of the ABIM and ABIM Foundation, legal troubles, and the unannounced closure of divisions within the ABIM, like the Division of Test Security and the Division of Policy in January 2017 give some hints to what is (and has been) going on there.

Bit by bit, real clinic doctors are making a difference in fighting MOC®. I encourage all readers of this blog to consider joining or donating to Practicing Physicians of America or to become certified by the National Board of Physicians and Surgeons to help continue this fight.

Together practicing physicians can make 2018 a successful and prosperous anti-MOC® new year for those of us on the front line of patient care.

-Wes

AAPS To File Amended AntiTrust Suit Against ABMS

From the January, 2018 AAPS Newsletter:

AAPS Has Leave to Amend ABMS Anti-Trust Suit

The federal court in the Northern District of Illinois has granted leave to AAPS to provide more detail as to how Maintenance of Certification (MOC®) harms patients in AAPS v. American Board of Medical Specialties, 14-cv-2705-ARW (N.D. Ill. Dec. 13, 2017). Because antitrust laws exist to protect consumers, not competitors, the court is requiring further specificity as to the harm to patients that is allegedly inflicted by MOC®.

In addition, the court wonders whether the American Board of Medical Specialties (ABMS) and other MOC-related organizations have any control over insurance companies to require MOC® as a condition of participating in their plans. To the extent anyone is aware of a specific relationship between ABMS and insurance companies, or a mechanism by which ABMS may have some influence with insurers, then please let AAPS know.*

AAPS plans to add to its allegations ways in which representations made by ABMS and board-certifying societies harm physicians who decline to participate in MOC®. (emphasis mine) In the past some board-certifying societies have posted disparaging statements about physicians who do not waste the substantial time and money on remaining current with onerous MOC® requirements. For now, the court considers some of these pro-MOC® statements to be mere opinion, which is not actionable, but AAPS can submit stronger examples of unfair disparagement with its upcoming amended complaint.

This legal struggle is far from over, and AAPS observes that earlier this year a district court in New Jersey held there is a valid claim for an antitrust violation by how membership in the American Osteopathic Association is required as a condition of maintaining certification by D.O.s.

The AAPS case was initially filed in New Jersey in 2013 (https://tinyurl.com/ycndp3rx), and the courts have not acted until now, except to grant an ABMS motion to change the venue to Chicago. In dismissing the case as pled, the Court focused on the “voluntary” nature of MOC®. It had not been demonstrated that ABMS has sufficient market power to restrain trade, decrease output, or raise prices. “Antitrust laws protect competition, not competitors” (https://tinyurl.com/yapc4no5). Patients can supposedly find another doctor, or another hospital — somewhere.

-Wes

* AAPS should look no further than Blue Cross/Blue Shield of Michigan's disenrollment of Meg Edison, MD from several insurance panels and then sending her patients letters about the disenrollment solely on the basis of her failing to pay her Maintenanance of Certification fee. Their near instantaneous electronic collusion with an ABMS member board (American Board of Pediatrics) is damning and is facilitated by the for-profit wholly-owned subsidiary of ABMS, ABMS Solutions, LLC (domiciled in Atlanta, GA) selling Board certification status to third parties. AAPS should also be interested that Margaret O'Kane of the National Committee on Quality Assurance (that sets credentialing standards for insurers) is also a public member of the ABMS Board of Directors.

The Curious Timeline of the AAPS vs ABMS AntiTrust Ruling

It was almost Christmas, and you could hear the collective sigh of relief rising from the leadership at the American Board of Medical Specialties (ABMS). The antitrust suit brought against them by the Association of American Physicians and Surgeons (AAPS) was dismissed without prejudice on 13 December 2017 with one small caveat, "AAPS will be permitted an opportunity to file an amended complaint that cures the deficiencies discussed in this Memorandum Opinion."

Whether the legal team of the AAPS will decide to amend the complaint remains to be seen, but much has been learned about the anti-competitive nature of the ABMS Maintenance of Certification (MOC) program since the time that suit was filed. No longer is the coordination of effort of the MOC program limited to an arrangement between the Joint Commission of Accreditation of Hospital Organizations and the ABMS member boards, but its tentacles extend to most of the membership organizations of the Accreditation Council for Graduate Medical Education (ACGME), the huge medical publishing companies (Wolter Kluwer and Reed Elsevier), many of the state medical societies like the Massachusetts Medical Society and their NEJM Group, the IPC Hospitalist Company (later purchased by TeamHealth, that was later bought by the mysterious Blackstone Group after the DOJ found them guilty of Medicare fraud), the international medical community in far-away places like Qatar and Venice, Italy (which have separate "standards" for Board certification), and even influence on our own local state legislatures.

This is because we now understand that nearly 20% of our nation's economy (and much of our current academic medical system, each with their lucrative medical subspecialty societies) depends on ABMS MOC program succeeding. MOC is one of the critical keys to unlocking the data mine of physician behavior, purchasing, and influence via a HIPAA Business Associate Agreement that supplies the digital data fuel for the economic engine of health care today. An alternative to MOC without such an agreement would hurt this digital gravy train.

But working physicians subject to the demands of MOC saw the program for what it was: a sickening power play using threats and intimidation to fund the ACGME monopoly and the ABMS Member Board largess at their expense.

So those same working physicians took it upon themselves to start their own competing board, the National Board of Physicians and Surgeons. They took their concerns to state legislators and won a few key battles. By doing so, they exposed how insurance companies and hospital systems didn't really like that competition. They especially didn't like how physicians were coordinating their efforts. And somehow, along the way, those efforts have now piqued the interest of a few lawyers from the Federal Trade Commission.

But the inner political workings of our court system need scrutiny, too.

Recall that the 2013 AAPS suit was moved from New Jersey to the Northern District of Illinois (the AMA's back yard) in 2014 at request of lawyers from the AMA. Once there, the case docket had plenty of activity until January 2015, but then laid dormant for years.

This did not stop the ABMS from declaring victory in the case on their website October 2, 2017. How did they know? More than two months before the Memorandum Opinion was issued by Judge Andrea R. Wood, it seems the ABMS knew something the AAPS lawyers did not. The court docket also revealed how the court dismissed the case before the Memorandum Opinion could be reviewed by AAPS attorneys. Perhaps this is usual and customary behavior by the courts, but given the gravity of the ruling and its implications to working physicians nationwide, working doctors want to know how the ABMS leadership knew of the case's outcome before the ruling was even issued. Do the tentacles of MOC extend to the courts, too?

While the ruling is disappointing to most working US physicians, all is not lost. Not by a long shot.

Thanks to the work of a committed group of working physicians who have raised the interest of federal regulators, MOC suddenly appears "problematic" for the ACGME. A new "Vision Commission" for "Continuous Board Certification" is being organized by the ABMS comprised of the same cohort of conflicted medical bureaucrats that created MOC in the first place.

Look at that "planning group's" membership:

• Jo Buyske (adademic surgeon) who served on the Board of Directors at ABMS
• Sandra Carson (academic Gynecologist, Vice President of the ACOG, and Secretary of the Board of Directors of CMSS)
• Joyce Dubow (a thinly veiled National Quality Forum "public member")
• Larry Green (former American Board of Family Medicine Chair)
• Thomas W. Hess, Legal Partner Dinsmore Shohl of Columbus Ohio and ABMS Board Member
• Lynn Kirk (academic internist)
• Graham McMahon (academic endocrinologist and President and Chair, ACCME)
• Thomas Nasca (academic nephrologist and bureaucrat of the NHPF)
• John Prescott (academic Emergency Medicine and bureaucrat at the AAMC)
• Stephen Wasserman (academic allergist, and President of the American Board of Allergy and Immunology)
• Steven Weinberger (academic pulmonologist and former CEO and Executive Vice President of the American College of Physicians)
• Lois Margarent Nora (ex officio President and CEO of the ABMS)

Nowhere in this list of "planners" are real frontline working physicians. And given this, nowhere is there likely to be any real change to the MOC system going forward.

Lipstick on a pig by another name is still a pig. And no matter what this commission has planned as they delay and distract from the corruption that has occurred with MOC for the past 30 years when they issue their "findings" in 2019,  MOC will remain a corrupt, broken educational product with serious conflicts of interest that needs to end now, not later.

-Wes

ABIM Promotes Nurse Practitioner As Quality Physician

Things must be really bad for the American Board of Internal Medicine (ABIM).


Since the organization has completely lost the trust of frontline working physicians, they are now now turning to nurse practitioners to promote their certification products - all at real working physician expense!


Spend a moment and watch the good "doctor and nurse practitioner" Susan Apold, PhD, ANP promote nurse practitioners as equals to physicians on national TV:



Caveat emptor.

-Wes

It's Official: MOC® is Dead. Let the Cover-up Begin

It's official: MOC is dead.

You heard that correctly doctors, the American Board of Medical Specialties' Maintenance of Certification® (MOC®) program is over, finished, kaput.

The one thing that resonated loud and clear from the December 4th meeting in Chicago of the multiple specialty societies and state medical societies that were in attendance was "the current MOC® process is problematic."

But don't get too excited.

In a remarkably Orwellian twist of fate, a new "vision initiative" to reinvent "Continuing Board Certification" was just announced by the original MOC® creators serving as the "Planning Committee."

The Planning Committee is comprised of representatives from the Accreditation Council for Continuing Medical Education (ACCME), Accreditation Council for Graduate Medical Education (ACGME), Coalition for Physician Accountability, Council of Medical Specialty Societies (CMSS), Council on Medical Education (CME) of the American Medical Association (AMA), the public, and the American Board of Medical Specialties (ABMS).

Jo Buyske, MD, ABMS/ABS
Sandra Carson, MD, CMSS/ACOG
Joyce Dubow, Public Member
Jack Evans, Public Member
Larry Green, MD, ABMS/ABFM
Thomas Hess, JD, ABMS
Lynne Kirk, MD, AMA CME
Graham McMahon, MD, ACCME
Thomas Nasca, MD, ACGME
John Prescott, MD, AAMC & Coalition
Stephen Wasserman, MD, ABMS/ABAI
Steven Weinberger, MD, CMSS/ACP
Norman B. Kahn, Jr., MD, CMSS, ex-officio
Lois Margaret Nora, MD, ABMS, ex-officio

You just can't make this stuff up.

We now see the ABMS and their sycophants at the ACGME, AMA, American College of Physicians, CMSS, and American College of Surgeons taking nominations for 21 to 25 individuals to serve on the planning Commission. This Commission will "bring together multiple stakeholders to assess the current state of continuing board certification and vision its framework for the future. ... Specialty societies, state medical societies, academic medical centers, hospitals and health systems, other health care systems, consumer organizations, patient advocacy organizations, ABMS member boards, and other groups are encouraged to submit nominations."

This is not rebranding.

This is not just a "pivot" to a new model.

This is an attempted cover-up.

Unless and until there is a full investigation of wrongdoing of these institutions regarding MOC®, including, but not limited to, potential tax fraud, misuse of physician testing fees for personal use, civil liberties violations, strongman tactics, and even possible racketeering, the current "vision initiative" should not be allowed to go forward, lest it happen again.

After all, medical professionalism demands accountability and many, many doctors want to see justice served.

-Wes

Addendum: Nice to see at least one medical society voiced concerns regarding MOC at the December meeting.

We Believe the Working Physicians

Lately, it seems we can't go another day and not hear about another individual, once held high as an icon by their adoring followers, falling from their elitist pedestal in shame when revelations of their lewd and morally reprehensible behavior are ultimately exposed. As Elizabeth Nolan Brown of the New York Times astutely observed in response to the prevailing zeitgeist:

Social media takes a lot of punches for enabling sexual harassment. But the past two months have shown that it has also provided consumers with an unprecedented power to make their market preferences heard loud and clear. And right now, the market is demanding that companies do something about sexual predators and pests in their midsts.

I believe a similar movement extends to the regulatory world of academic medicine, too. The anti-MOC (Maintenance of Certification) movement, facilitated in large part by social media unconstrained by medical journals owned by self-adoring academic medical societies, is unlocking the self-locking doors of the Accreditation Council for Graduate Medical Education (ACGME).

This is not to say that all academic physicians are bad people. On the contrary, just like not all journalists and actors are sexual predators, not all individuals in positions of power within the ACGME construct or medical societies are bad people. But power and money do things to even nice people. Some people see how easy it is to take advantage of those less prominent, yet no less important, than they are. The blinding influences of money and power permit morally reprehensible behavior to be ignored by others who also benefit from that behavior but don't say anything. Soon, given an inch, a few influential people in positions of power take a mile and before long, they quietly become pests in US medicine's midst too.

Such has been the story of the ABMS and their member boards since the introduction of time-limited board certification. Using highly respected members of the medical community as their work-a-day pawns, these leaders stroked the egos of their revered physician educator colleagues by providing them first class air fare, accommodations at five-star hotels with dinners at the fanciest restaurants with exquisite wine samplings for test writing junkets as their network of carefully-chosen collaborators grew. In return, the leadership of these organizations were held high as moral icons above reproach as plans were hatched for the next test-writing retreat in Costa Rica. Black tie events at the Four Seasons (or similar venue) reinforcing their behavior for the "common good" of medicine become commonplace. Using these respected adademics as self-adoring apostles of the ABMS  leadership, more like-minded individuals were recruited using this simple formula based on avarice, narcissism, and greed: give economically disadvantaged academic physicians a glimpse of what they could have if they worshipped the materialistic world of the ACGME and these riches could be theirs, too. The host of corporate interests like testing companies, publishers, single payer advocates, pharmaceutical and insurance companies, and every medical supply chain company wanting the selling/purchasing power of physicians in their back pocket would make sure of it.

Soon, ABMS Board certification went from a lifetime credential to a time-limited one quite easily: by the threat of "uncertain consequences" by the boards and their medical society sychophants. Dazed and confused, unsuspecting working physicians were dragged into the PearsonVue testing back offices for "recertification" testing using threats to their character and intellect. Those threats became real as practicing doctors realized their "voluntary" board certification process was no longer voluntary, lest they lose their job if their once specialty certification expired and was no longer considered valid by their employer.

And so it has been for years until a few brave souls came forward and questioned the status quo. Thanks to social media, scores of hardworking physicians are waking to their own #MeToo moment as subjects of extortion, strongman tactics, civil liberty violations, and being used as research subjects without their consent. None of this was done to benefit patients they now realize thanks to social media, but to line the pockets and fund the political agendas of a few influential members of the untouchable medical credentialing cartel.

This new movement has even shown that intimidation of a vulnerable physician work force won't hold back the truth.

It's a new time in corporate America, just like it's a new time for the ACGME.

Not only do we believe the women, we believe the frontline working physicians, too.

-Wes

On the December 4 Meeting of the Untouchables

From the invitation-only December 4, 2017 meeting on Maintenance of Certification (MOC®) practicing physicians were not allowed to attend, came this synopsis from Ohio:

Fellow Council members,

The following are my thoughts following the long-anticipated MOC® meeting in Chicago. An official report that will be distributed to the general membership will follow.

The meeting was hosted by the American Society of Anesthesiologists in Schaumburg, IL. The auditorium designed to hold 150 people, was filled to standing room only.

A bit of background, this meeting was the brainchild of Donald Palmisano, Jr., CEO Medical Society of Georgia, and Hal Lawrence III, MD (Executive Vice President and CEO) ACOG. (Editor's note: The American College of Obstetrics and Gynnecology (ABOG) are subcontractors for "Test Development" with the ABMS.) During the interim and annual meetings at the AMA, the state and specialty societies meet. It was during this meeting in Chicago that the idea for today's meeting was formed.

Dr. Lois Nora, current President and CEO of the American Board of Medical Specialties spoke first. In her 20-min remarks, she acknowledged each of the points raised in the letter penned by the state and specialty societies. Dr. Nora's term ends on December 30, 2017. Her successor is Richard E. Hawkins MD, who is leaving his position as Vice-President of Medical Education at the AMA to take this position.

Her Key Points:

1. Committed to improving continuing certification
2. Add state society representation to the Committee on Continuing Certification
3. Admits that the current MOC® process is problematic
4. MOC® should not be used as the only criteria for state licensure, credentialing, or employment
5. Agrees that professional self-regulation is valuable
6. Asked that the states not support anti-MOC® legislation (citing possible unintended consequences)

Summary of the comments from state and specialty society representatives:

1. Physicians insist on trust, input, transparency, and improved communication from the boards
2. Create a process that is developed with us not forced upon us
3. Process should not be punitive. Use the carrot and not the stick
4. MOC is an irrevocably tarnished brand
5. Following initial certification, the high stakes exam should be only one of several options
6. Create a process that is fair to physicians holding more than one certification
7. Several specialties have already implemented processes that offer ongoing demonstrations of competency as an alternative to the high stakes exam.
8. Two specialty societies (Family Medicine and Psychiatry) stated that they were considering up thir own boards as a solution
9. Anesthesia was the only specialty that admitted that reducing the burden on physicians had a negative effect on their bottom line
10. Multiple states vowed to continue legislative efforts until tangible efforts in the MOC® process can be seen
11. Need for dur process for physicians whose ability to work has been adversely affected by inappropriate use of MOC®
12. The hospitals (AHA) and insurers (AHIP) should be invited to the discussion as they are the entities most likely to use MOC® inappropriately.

Please note that I spoke personally to the organizers of this meeting to request that Ohio be included in future discussions regarding MOC.

Respectfully submitted,

RF Chatman MD, MPH
President, Ohio State Medical Association

It appears the thrust of this "meeting" was to try and get states to NOT pass anti-MOC legislation. It didn't take long for an analysis of the Ohio synopsis to appear in my inbox from one observant physician (printed here with permission):

It seems to me as though this debate has now been quietly and cleverly re-framed in terms of retaining and "improving" (compulsory) MOC®.

Remember, it is only made "compulsory" through collusive "enforcement" by those twin paragons of virtue, the insurance and hospital corporations.

"No more high stakes exams we promise" they cried. The implied subtext being that the obligatory ABMS MOC parasite will remain Ebola-like, in some mutated and quiescent form, and continue to infect us all.

Debating the "character" of MOC® was four years ago. Pretty please. That didn't work. Now the issue is not MOC® but the utter and complete repudiation of ABMS lock, stock, and barrel. (Editor's note: Recall the AMA House of Delegates already voted to do so in June, 2016. We now see the AMA's answer to that resolution: to place physician puppets in position of power at the ABMS to assure their lucrative international medical data mining project grows ever stronger and more valuable.)

MOC® should be in reality just another innocuous and palatable Continuing Medical Education (CME) option, but has become a forced and toxic one. A most profitable and poisonous bubbling brew concocted and fed to us by our "peers in leadership positions." The ABMS have become the very caricature of witches on MacBeth's "blasted heath."

The ABMS and their 24 specialty lackeys should now go off and hawk their wares like any tawdry CME street vendor in the chaotic for-profit "medical education" bazaar. Through their grotesque avarice the ABMS have irreparably tarnished their brand. No physician will ever respect them again. Ever. They are done.

Why on earth does anyone even stoop to converse with the ABMS anymore? It is too late for that. As Texas Medical Association President Carlos J. Cardenas, MD said "Physicians in Texas and across the country... do not see the certifying boards as 'self.' They are, instead, profit-driven organizations beholden to their own financial interests. In fact, they are now one of the outsiders intruding into the practice of medicine."

States should pass their anti-MOC laws, the ABMS and its apologists should be disregarded, and we all should move on.

Why did the state medical societies, which (with very few exceptions) also lack any standing amongst rank and file doctors, even bother to meet with the ABMS?

It is a total charade, a Jersey boardwalk puppet show populated by unrepresentative and self-aggrandizing narcissists lobbying each other. What on earth were they doing, imploring the ABMS on a bended knee to change their wicked ways?

"My" state medical society (sadly not one of the exceptional ones and one having less than 5% of state physicians as members) has no right to negotiate the character of MOC® on my behalf. It is too late for that. The state medical societies have become little more than the mini me's of the hated and corrupt AMA.

The single demand going forward should be to break up the ABMS monopoly and open up the market to competing boards like the NBPAS, recently delineated in an article by an FTC member. Let the physician marketplace decide which boards truly represent their interests. Period.

The hospital and insurer enforcers should be met head on now. Forget the disgraced ABMS. The MOC® debacle has catalyzed the onset of a transformative phase in medicine, one we physicians must be the first to recognize and guide.

Somehow, I didn't think I could improve on this cogent analysis.

-Wes

When Medical Subspecialty Societies Do Harm

Pediatrician Meg Edison, MD gives her take on her "MOC failure:"

I am a diplomate of the American Board of Pediatrics against my will. I find it morally reprehensible to financially support an organization that harms fellow physicians. I find it demoralizing to know my money supports their lobbying efforts against our state MOC legislation. Yet I paid in order to see my patients. I paid so I could still be a doctor. The American Board of Pediatrics could ask for another $1500 next year, and I’d have to pay again. There is no choice.

Is it possible I was targeted for being so outspoken on MOC? Possibly. My initial letter to the ABP has over 100,000 views. My medical society has used me on the cover of their magazine and their website dedicated to fighting forced MOC. The ABMS Senior Vice President knows me by sight, and has watched me testify against forced MOC in our state capitol on multiple occasions.

But I’ve been contacted by countless quiet Michigan physicians threatened and decredentialed for simply refusing to pay for MOC. It doesn’t matter who you are, an outspoken physician with a state medical society behind you…or a solo practitioner quietly trying to stay afloat…you must comply.

I don’t know the solution to this problem. It seems like every legal, logical, and ethical boundary that should prevent a certifying company from gaining such absolute unchecked power has been ignored, and every professional organization that should help us is impotent.

My state medical society has held clear policy opposing board certification, let alone MOC, for insurance plan participation for 20 years. They’ve been negotiating for 20 years, yet aggressive MOC discrimination continues. The AMA has strong policy opposing MOC abuse, but refuses to do anything. The FTC should see this monopoly as a clear anti-trust violation. They are waking up, but still not acting. I am baffled the IRS doesn’t question the million dollar salaries raked in by these “non-profit” organizations. It seems like this would be a slam-dunk class action lawsuit for some smart law firm, but no one is interested in the case. State legislation is likely our best bet, but the lobbying power of insurers, hospitals, the billion dollar ABMS certification industry and their codependent specialty societies is nearly impossible to fight.

If nothing is done, ABMS will win, because their entire coercive business model relies upon our professionalism. As physicians, we take an Oath to “Do No Harm”. We promise this to our patients.

My first emotion when I heard my patients were forced to receive care in the ER was not anger at ABMS. It was gut-wrenching guilt. I dared to speak. I dared to fight. I underestimated their power. I was stupid enough to think MOC was a physician issue. It never crossed my mind that my patients would be harmed. I know better now. The next time they ask for another check, I will comply, and they know that. I just hope something is done before then. Primum non nicer.

Read the whole thing.

-Wes