Sunday, April 14, 2019

The Powerful Counterrevolutionaries

There's an amazing thread developing on Doug Farango's Authentic Medicine blog post titled "The AAFP Loves the ABFM and Sleeps Right Alone Side Them." It started with Elizabeth Baxley's "Fact Check" comment suggesting the Family Medicine Certification Longitudinal Assessment (FMCLA) program was not another version of Maintenance of Certification (MOC). Dr. Baxley failed to disclose she served on the American Board of Family Medicine Board of Directors from 2013-2018. Here's the comment from "Steve O'" in response:
April 13, 2019 at 11:04 pm

C’mon. You got to compliment someone for running a shakedown racket, and they got pigeons to pluck who are easily intimidated and got a lot to lose. I like Dr. Baxley’s protest that FMCLA is a different word salad than MOC. She distracts us with irrelevant trivia about the differences.

Here’s what the big picture is. Doctors are worse than nuisances in the new industrial medical chain. They use their accumulated experience and independent principles to decide what to do for the patient. This is – counterrevolutionary behavior. Industrial Pharma makes it, Corporate Pharma distributes it, the Insurance/CME cabal creates the algorithms for every possible treatment. Doctors are the ISIS, the al Qaida of the system. They’ve got to be cleared out at any cost.

Making them memorize the rules and vomit them out on command is what doctors are for. And they should be paid like store clerks. In fact, once the FDA has blessed algorithmic prescribing, Doctor Watson, the driverless car of medicine, will be rolled out. Driverless cars crash. Algorithmically-driven planes have a serious gravity problem. No-brain prescribing will cause countless deaths. But since it’s computers, no more “human error,” right?

You ought to watch the timeline of the Chernobyl disaster. It shows some quite intelligent, experienced and insightful engineers bending to the rules, to avoid getting fired and sent off to Siberia. Only two went to prison for breaking the rules, and a few died. Not a bad outcome, eh? There were at least a dozen times when an engineer couldn’t hold it anymore, and said, “We have to stop this or the plant will blow up!” They were easily shut down by bullying and intimidation. Who can say which possible outcome is better – sticking with the system, or acting like a loose cannon? Mistakes were made – but mistakes happen. Sorry.

That’s the kind of doctors that the machine wants to install in American medicine. Thanks Betsy and Shawn. When the lid comes off, you can always run around like squirrels and say, “Why didn’t anyone let us know?” “It’s not my fault, my support personnel lied to me!” “We were only trying to do the absolute best for patients!” Thanks, comrades.
MOC, FMCLA, CMP, MOCA. The Machine's lucrative alphabet soup.

The physician counterrevolution is growing.


Friday, April 12, 2019

Physicians Are Eagles Who Believe They Are Chickens

Chicken or Eagle?
Image by Wes Fisher MD
(Click to enlarge)
There are 800,000 physicians in America and more than 80% believe the Maintenance of Certification process, known as MOC, has no clinical value for patients. For the first time in the history of our profession, physicians have a fighting chance to topple a Goliath-esque organization, the American Board of Medical Specialties (ABMS).

In a 2018 survey conducted by Merritt-Hawkins, 78 percent of physicians said they experience some symptoms of professional burnout. Physician burnout is a public health crisis which threatens the health and well-being of all patients.

A burned-out physician reminds us of the fable about an eagle who believed he was a chicken.

When the eagle was small, he fell from his nest. A chicken farmer found the eagle, brought him to his farm, and raised him in the chicken coop with his chickens. The eagle grew up living like a chicken, doing what chickens do, and believing he was, indeed, a chicken.

One day, a visitor came to the farm and was surprised to see an eagle --considered the king of the sky-- strutting around the chicken coop, pecking at the ground, and acting like a chicken. The farmer explained that this bird was no longer an eagle, instead he was a chicken because he was trained to be a chicken. The man knew there was more to this great bird than “pretending” to be a chicken. He was born an eagle and had the heart of an eagle, and nothing could change that. The man lifted the eagle onto the fence surrounding the chicken coop and said, “Thou art an eagle. Stretch thy wings and fly.” The eagle looked at the man and glanced down at his home among the chickens in the chicken coop where he was comfortable. He jumped down off the fence and did what chickens do.

The farmer shrugged and said, “I told you he is a chicken.” The visitor returned the following day and tried again to convince the farmer and the eagle that he was not a chicken. He took the eagle to the top of the farmhouse and said: “Thou art an eagle. You belong to the sky and not to the earth. Stretch your wings and fly.” The large bird looked at the man and then glanced down at the chicken coop. He jumped onto the roof of the farmhouse and returned to the place where he felt safest.

The visitor asked the farmer to let him try one last time.

The next morning, the visitor returned and took the eagle and the farmer to the foot of a high mountain. They could not see the farm nor the chicken coop from this new place. The man held the eagle on his arm and pointed into the sky where the bright sun beckoned and said: “Thou art an eagle! You belong to the sky and not to the earth. Stretch your wings and fly.” This time the eagle stared skyward into the bright sun, straightened his body, and stretched his powerful wings. His wings moved, slowly at first, then surely and confidently. With the mighty screech of an eagle, he flew.

Because he was an eagle.

This past December 2018, four brave internal medicine physicians --recognizing they are eagles-- filed a lawsuit against the American Board of Internal Medicine, the largest ABMS member board, for harm they endured from the Maintenance of Certification process. Practicing Physicians of America has set up a fund to support our colleagues who are fighting this battle and need the support of fellow physicians.

Merely 1324 physicians, out of 800,000 in the US, have contributed to the legal fight against the onerous MOC process, despite the fact that it is reviled by the majority of doctors. Physicians members of the American Board of Radiology and the American Board of Physical Medicine and Rehabilitation have filed lawsuits of their own regarding violation of anti-trust laws.

Why are so few of our fellow physicians standing up when given the chance?

Unfortunately, physicians often choose consistency over happiness. If you’re used to being abused, ignored, or exploited, it’s strangely comforting to remain in the chicken coop and peck at the ground. These physicians are just like the eagle who believed he was a chicken.

Maybe physicians prefer the devil they know to the devil they don’t know. Maybe physicians are terribly uncomfortable at the prospect of failure. Maybe physicians believe it is better to control failure than be blindsided by it. Physicians are standing on the mountain and being asked to spread their wings and fly. What is stopping us?

The possibilities for the future of our profession are endless if we can win against the American Board of Internal Medicine. If there were ever a time to join the fight, it is now. Surely $100, $200 or even $500 is not too much to contribute to support our talented physician colleagues who have been harmed by MOC.

Now we are asking every physician in America, are you a chicken or are you an eagle?

- Niran Al-Agba, MD and Westby G. Fisher, MD

Drs Niran and Fisher and unpaid board members of Practicing Physicians of America.

Wednesday, April 10, 2019

Schulman: End This Maddening Waste of Time for Rhode Island Doctors

From an opinion piece published earlier by internist Howard Schulman, MD in the Rhode Island Providence Journal:
"I am writing to give the physicians’ perspective on bill H5247/S301 that gives physicians a choice, by medical staff vote, on “maintenance of certification.” (MOC) The organization that sells this certification says it is voluntary, but in fact, for most physicians, is mandatory. Maybe 100 years ago, when this testing began and there was absolutely no supervision of physicians, this “certification” served a purpose.

But that is not the case today. We have the Department of Health, Department of Medical Licensure, malpractice attorneys, the health-insurance companies, the newspapers, social media and the Internet, and hospital credentialing and specialty departments waiting to pounce on any mistake or misstatement we make, never mind ever more informed and empowered patients and families.

Until recently, physicians tolerated the initial certification as just another traditional “hoop” to jump through, but this recent attempt at “maintenance” of certification went overboard. Being a doctor is much more than filling in the dots on a computer screen. We find the huge number of hours of read-a-paragraph and fill-in-the-dot testing a huge waste of time. Physician burn out is already a problem, and this testing is just one more straw on the camel’s back.

* * *

I urge fellow physicians to contact their legislators and the Rhode Island Medical Society to tell them to vote in favor of bill H5247/S0301. I also urge our legislators to talk with their own physicians to understand the negative impact this required maintenance of certification testing has had."
Rhode Island physicians can also help by supporting the litigants who filed a class action lawsuit against the American Board of Internal Medicine because of MOC.


Tuesday, April 02, 2019

What Do Working Cardiologists Really Think About the ACC's CMP Pathway?

What do US cardiologists and electrophysiologists REALLY think about the American College of Cardiology's (ACC) heavily-promoted collaboration with the American Board of Internal Medicine (ABIM) to create their "Continuous Maintenance Pathway" (CMP) for continually maintaining their ABIM board certification?

That's a question I wanted to know, so I helped create a quick 5-minute survey on the matter open to US cardiac electrophysiologists, cardiologists, and heart failure specialists.

I hope to have the results compiled by the Heart Rhythm Society in May, 2019.

I look forward to your responses and thoughts. Additional comments regarding the CMP program not covered in the survey can be left in the comments on this blog post.



Monday, April 01, 2019

From MOC to CC: Neurosurgeons Fed Hopium

Even the physicians who we trust to do brain surgery can't be trusted to determine their own education or the skills they need to dive into a patient's skull. Instead, the AANS Neurosurgeon says they need is a "paradigm shift" to pay the American Board of Neurological Surgery (ABNS) much higher fees and do meaningless bureaucratic busywork annually:
"Obviously, by moving from a 10-year process to an annual process, there will be increased costs to diplomates in order to comply with the new ABMS directives; however, neurosurgery, as a smaller specialty, benefits from having a Board that is revenue neutral, thrives on volunteerism and has worked hard to keep costs as low as possible. These newborn costs are hopefully offset by the CME credits gained and the increased benefit to our patients gained by maintaining best practice standards."
The Maintenance of Certification (MOC) to Continuous Certification (CC) sleight of hand is being sold to neurosurgeons as "hopium." Thousands of dollars in fees must be paid the the ABNS so that neurosurgeons can "hopefully" offset their costs by the CME credits they receive and feel good those dollars benefit their patients.


Welcome to the fight, neurosurgeons.


Wednesday, March 27, 2019

Physician's Week

William Osler

"When schemes are laid in advance, it is surprising how often the circumstances fit in with them."

"To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all."

"The philosophies of one age have become the absurdities of the next, and the foolishness of yesterday has become the wisdom of tomorrow."

"Common sense in matters medical is rare, and is usually in inverse ratio to the degree of education."

- William Osler
"Physicians Week" has begun but you might not have known it. I suspect most physicians were busy seeing patients and many didn't stop for lunch, or ate what they brought to work while staring into a computer screen, trying to catch up on patient and staff messages, wiping a bleary-eyed tear from the corner of their post-call eyes, and clicking on hundreds of electronic orders placed by others on their behalf. Such is medicine now: an isolating, mind-numbing, depersonalizing series of clicks. It's hard to get excited about a week devoted to you when you can't get all the finger work done. How far we have traveled from the days of Osler's teachings!

Officially, March 30th marks "National Doctor’s Day" in the United States. National Doctor’s Day was started by Eudora Brown Almond in 1933. The date was chosen to mark the date that Dr. Crawford Long, in 1842, first used ether to anesthetize a patient and painlessly excised a tumor from his neck. Mrs. Almond, the wife of a doctor, wanted to create a day to recognize physicians. She did so by mailing greeting cards to doctors and placing flowers on the graves of deceased doctors. The day was later expanded to "Physicians Week" in March 2017 by Drs. Marion Mass, Kimberly Jackson, and Christina Lang who applied to officially have "Doctor's Day" changed to "Physicians Week."

Healthcare today is more complex than ever before. Our role as working physicians is critical to families, individuals, and their loved ones. It is an incredible privilege and responsibility. Yet, we are faced with new and growing challenges, many caused by greed and "the foolishness of yesterday." Much of the last five years of mine has been spent educating other physicians about this issue on this blog's pages.

Despite these efforts, the American Board of Medical Specialties (ABMS) Maintenance of certification (“MOC™”) requirements and costs continue to grow. They sap our time and resources, making us less available to our patients as we increasingly must "study books without patients." Meanwhile, the organizations behind MOC™ and their substantial resources remain unchecked.

The American Board of Internal Medicine (ABIM), the largest ABMS member board, has recently filed a motion to dismiss the case challenging MOC™ and similar motions are expected in the cases against the American Board of Radiology (ABR) and the American Board of Psychiatry and Neurology (ABPN) in the next month or two. The boards have legions of attorneys lined up to defend their conduct and millions of dollars with which to pay them. Your contributions, thus, remain critical in our fight.

So take a moment and really reflect on Osler's words above.

In honor of National Physicians Week (and National Doctor's Day), I ask you to help me by donating now to get us to the next stage of the lawsuits against MOC™. If you have already given, please consider giving again, as I have done. And please promote our cause to your friends and colleagues. If each one of us can invite just two or three new donors to read about our fight and contribute, we could reach our latest goal, which is to have 1,000 new donors contribute $200 each. These contributions will go directly to continuing our legal fight against MOC™. 100% of your contribution goes toward funding the lawsuits (less third-party credit card processing fees).

Many have had concerns of repercussions to themselves should they contribute. If you wish to keep your participation private, you can designate your contribution as anonymous too. As before, you also have the option to add a “tip” to help GoFundMe maintain its platform. Any “tip” is entirely voluntary, goes directly to GoFundMe, and will not be applied to our goal.

For those wanting to send a check in lieu of using the GoFundMe page, please earmark your check for "Legal Fund" and send it to:

Practicing Physicians of America, Inc.
876 Loop 337, Building 101
New Braunfels, TX 78130

We could not have reached this point without you, and I hope you will continue to help in the fight to take down MOC™ -- for your own benefit and the benefit of your patients.


(aka, Westby G. Fisher, MD
Member, Executive Board
Practicing Physicians of America, Inc.)

Sunday, March 24, 2019

Suddenly, Some Specialty Societies Might Be Listening

From the American College of Radiology blog:
"In response to a recent request from the American Board of Medical Specialties (ABMS), the (American College of Radiology) ACR created a work group to comment on a report on the status of (Maintenance of Certification) MOC® across all specialties. That group worked tirelessly over the winter holidays to prepare a detailed comment letter (ed. note: a portion of which is highlighted here):"

(Click to enlarge)
The blog post continues:
"The ACR also signed on to a letter from the Council of Medical Subspecialty Societies (CMSS), which represents approximately 800,000 physicians from 43 medical subspecialty societies.

Both the ACR and CMSS letters call for an immediate moratorium on MOC® until many programmatic deficiencies are corrected.
. . .

These important ACR member issues have recently been amplified by the backdrop of various ABMS member boards coming under intense scrutiny and even legal actions for financial practices, lack of transparency, non-democratically elected leadership, high-stakes non-validated psychometric testing and concerns about monopolistic behavior. The American Board of Radiology (ABR) was named as a defendant in one class action suit and a “co-conspirator” in another.

Our Task Force is studying these issues and preparing to make recommendations to the BOC and CSC at both the ACR 2019 and ACR 2020 annual meetings."
Mind you, these cases have not been brought before the court yet, but there now appears to be a serious level of introspection and concern at the highest level of some specialty societies as to what transpired to get us where we are with "continuous" ABMS Board certification.

Colleagues, now is not the time to back off our funding campaign to support the litigants in this anti-trust battle. In fact, we need more physicians from ALL specialties frustrated with the current MOC® status quo to join us to keep the pressure on ALL of the ABMS member boards.