Saturday, December 07, 2013

When Scientists Accept "Flawed" as "Reassuring"

A recent essay entitled "Understanding the Customer and the New MOC Changes" by David May, MD, PhD, chair of the Board of Governors and secretary of the Board of Trustees for the American Board of Cardiology, was published online and tugs at our heartstrings by describing the Maintenance of Certification (MOC) secure examination in Cardiovascular Diseases as "flawed but reassuring measure of our competence for the real customer here … our patients and their families who trust us with their very lives."

I read this piece after recently completing the MOC process in both cardiology and cardiac electrophysiology for the third time.  After devoting hundreds of hours preparing for an impersonal timed computer test yet again, I couldn't help but wonder if physician scientists should ever accept a "flawed" process as acceptable for our ourselves or our patients. Imagine the implications to scientific inquiry and the process of challenging (and thereby improving) the educational process if we did:  we might have to accept media reports to justify the process so we can make it even bigger.

Patients deserve transparent quality metrics of care provided by their doctors and the American College of Cardiology (ACC) has been a unique leader in bringing measurable care metrics to the public with the development of their NCDR databases. Yet instead of turning to these real life metrics of care delivery, it seems the leadership of the ACC also feels compelled to sell a "flawed" educational testing construct to its members too. Is this decision based on a self-imposed imperative to dispense social justice at the bedside or more for the direct financial renumeration received by the officers of the College or it's parent, the American Board of Medical Specialities?

I believe there is merit to becoming Board Certified in a subspecialty once. A baseline of knowledge is assessed by this process. But the move to the current model of "maintaining" certification through complicated, costly, and unproven methods of survey completion, administrative and academic busy-work, followed by a timed multiple-choice computerized test overreaches into unproven areas of quality assurance.

To me, a better measure of physician competence and quality would be this: Board Certification once followed by disclosure of the total number of patients treated or the total number of procedures performed pulled from databases akin to the NCDR databases in development.  Such a method would align with current documentation requirements for assuring quality patient care and would avoid alienating busy physicians already faced with unprecedented regulatory scrutiny, steep pay cuts and loss of autonomy.

Pretending that the MOC process is a better method to assess competence rather than one's clinical experience in delivering real, live, clinical care feeds unrealistic expectations and may even promote a false sense of security to our patients.
What patients and their doctors deserve (and need) is verifiable data, not propaganda.



Art Fougner MD said...

Follow The Money!

Anonymous said...

Art Fougner MD said it best. To his comment I would only add the word, Always.