Tuesday, January 21, 2014

MOC Goes Mainstream - But Should It?

How should patients determine the quality of their doctor? 

This is an interesting question that has now reached main stream media status as evidenced by the morning's Wall Street Journal "Health and Wellness" article by Laura Landro, a very accomplished veteran health care reporter. 

With the best and brightest going in to medicine, the requirement for more rigorous training than anywhere else in the world by (some might say) "exceptional, world class" medical educators and longstanding ongoing mandated continuing medical education to maintain competency and licensure, why is there suddenly such concern over the quality of doctors in America?  Most Americans have been very happy and trusting of the physician they knew and loved before - why the change?

Is it so that patients who must see new doctors in their new insurance plan can feel good that the new doctor (or nurse practitioner) is as good as the physician that has cared for them before? 


Or perhaps it's because the huge Industrialized Certification Complex that foistied its Maintenance of Certification requirement every two years beginning 1 Jan 2014 upon America's physicians is finding unprecedented push-back from their member-physicians so a direct-to-consumer PR campaign was  undertaken in an attempt to quell the unrest. 


Or perhaps it's because the American Board of Medical Specialties, along with its 24 subsidiary professional organizations, feels there is a need to justify the salaries of the multiple specialty board members that often exceeds that of their physician members and whose salaries are funded in large part by the fees from the MOC process. 


Or perhaps there is a need to justify the difference and numbers of fees different types of doctors have to pay to maintain their certification.


Or perhaps the PR was required to justify the expansion of this certification process to include not only testing doctors, but to making them also perform unproven data collection exercises called "Practice Improvement Modules" that have absolutely no bearing on a patient outcomes or a doctor's intellect and skill as a practicing physician, but typically take many months to complete. 


Or perhaps the article was another effort to deflect attention from the fact that despite publishing a webpage of opinion pieces and articles claiming to substantiate the need for MOC, only 25% (at best) of board members of the various recertification bodies have bothered enough to maintain their own (sub)specialty certification.


How do patients really benefit with the MOC process now being foisted on America's doctors every two years?  Do they get better access to their doctor?  No, for their doctors must take time away from their practices to study, take tests, and collect data for this.  Do they get to keep their doctor as long as they want if their doctor maintains their certification?  No, certification provides no guarantee that a patient can keep their doctor as patients are shunted to insurance company-controlled populations called "Care Organizations." Does maintaining certification guarantee that a doctor will practice better medicine?  No, at least not when the MOC process is compared head-to-head to the knowledge gained by years of close patient-care experience.

Ms. Landro seemed to be writing for the business interests in medicine in her role as a news reporter for the Wall Street Journal because she failed to mention these points and the impact the MOC process has had on hard-working, careful, and ethical clinical physicians in America.  While she does mention the suit filed against the American Board of Medical Specialties by an opposing organization called the American Association of Physicians and Surgeons, her article failed to mention the real reason this suit was filed: because a surgeon with over 30-years of patient care experience refused to "recertify" in his specialty and then had his privleges to practice medicine revoked by his hospital system as a result.

Years of experience and patient care - a measure most would agree is the most important determinant of a quality physician -  lost because a doctor refused to perform these unproven MOC exercises.

It's a classic David vs. Goliath story, really, since millions and millions of dollars annually are at stake for the certifying organizations.  And while the story continues to be played out in court, it is clear that the Davids are getting more upset - especially when Goliath's unproven tests and "Practice Improvement Modules" (and who knows what else in the future) have the potential to affect David's  ability to practice medicine in the future.  Is this really what patients want?

Should a series of tests ever trump clinical experience in determining physician quality?  Should a series of tests be able to void a doctor's lifelong commitment to patient care?

Not in my book.  And if patients think for one second this MOC process is just about having "quality physicians" at their disposal, they should think again.


PS: I continue to wait for the Cardiovascular Subspecialty Maintenance of Certification test results I took 8 November 2013.  The test was entirely electronic, yet the results still have not been reported.   No doubt we'll soon have to pay to get our results in a timely fashion, too.

Reference: Buscemi D, Wang H, Phy M, Nugent K. "Maintenance of Certification in Internal Medicine: Participation Rates and Patient Outcomes." J Community Hosp Intern Med Perspect 2012; 2(4): 10.  Published online 7 January 2013.


ron benbassat said...

Kudos. Another excellent post. I hope you send this to the editors of the WSJ and Ms. Landro.
Left you message at work to call me as well.

medicine for real said...

Amen Wes!

Ellison said...


A bright light needs to shine on this topic, so please send this blog piece to the WSJ. I bet you will find its illuminating and thoughtful content in the coveted op-ed page in Section A.

Anonymous said...


Dr. Kvetch said...

Excellent insights Dr. Wes. I just spent the morning fuming about this and writing on blogs and forums emails, facebook, etc, and to Ms. Landro - and asking her to please investigate any possible financial links - kick-backs from the ABMS to State Boards who would consider this idiocy of tying licensure to Board Cert - as we well know - there's no evidentiary proof of benefit from 'board cert' to anyone but the ABMS $$$ - it was a voluntary, ego-driven, one-up-manship by the academics - that's now blossomed into the Hydra we see today. All I can say is Thank God for the AAPS - as they are the only ones fighting for us. They are right now suing the State of NJ about this MOC restraint of trade.

AAPS Takes MOC to Court