Tuesday, March 03, 2015

Why the IRS Should Investigate the ABIM and Its Foundation

This morning, I woke to this remarkable comment to Dr. Robert Centor from Charles Koo, MD on Dr. Centor's blog, Medical Rants.  I republish it here for all to read for it precisely and professionally articulates what many of us have been trying to say to the public about the corrosive nature of the ABIM scandal that has erupted over the ABMS Maintenance of Certification program:
Dr. Centor,

In an email to me regarding the ABIM and the ABIM Foundation financial behavior, Dr. Baron stated in the email that the ABIM has never had any inappropriate financial behavior.  (I can send you the email from Rich Baron if you would like to read it yourself) 

Is that so?  

Myself and folks like Dr. Fisher, Dr. Cutler and legions of other hard working clinicians take great issue with a group of aloof administrator physicians spending vast amounts of money on themselves via Mercedes Limo Service, Condos, and "retreats" to the Four Seasons.  Is it appropriate to pool the fees from graduating housestaff and hard working clinicians so they can reward themselves with nauseatingly gaudy creature comforts?  

How can an organization designed and run by non-clinicians tell the rest of us to "Choose Wisely" and to embrace cost efficiency/austerity while making themselves multi-millionaires off the sweat equity of the everyday clinician and graduating house staff?  Would you trust such an organization?  

Dr. Fisher's point is very, very well taken.  More so since the ABIM and the ABIM Foundation are both registered "non-profit" organizations.  In essence, the American Taxpayer is subsidizing their operational status and their capital budget when in fact the ABIM is totally, hugely, and utterly profitable.  That hypocrisy has never been fully addressed by Dr. Baron or any other ABIM representative.
Can you trust an clinical regulatory organization that is utterly devoid of any contemporary clinicians?  Dr. Cutler pointed out that Dr. Zeke Emanuel is "not certified" by the ABIM continues to be "not certified" and yet remains as a leader for ABIM Assessment 2020.  According to the 2012 Medicare database, Dr. Krumholz has no patient E/M contacts and read a handful of echos.  Yet he is another leader of ABIM Assessment 2020.  

Isn't the lack of inclusion of active, high volume clinicians into the structure of the ABIM and the ABIM Foundation patently wrong?  And yet you trust and "hope" this clubby cadre of "ethical" non-clinical physicians will magically do the right thing when it is clear they been doing it wrong for almost a decade.  The irony of this oxymoronic situation is troubling and sickening.

Even more ironic and more sickening is the ABIM's driving point- that their mission is somehow a product of pure altruism and promoting honesty and integrity to its Diplomates.  If that were to be true, the ABIM leaders should immediately vow to take an oath of fiscal modesty and financial mediocrity.  

Do you think the ABIM leaders would ever take a significant pay cut and promise never to abuse the money from an impoverished senior resident on Mercedes limo service?  When you look at your residents at Morning Report, can you honestly and whole heartedly tell all these young folks that your friends at the ABIM are doing them right?

Do you think the ABIM has the courage to set aside their own financial interests and to show leadership when they are apt to state their financial misbehavior were inherited?  How cowardly is the ABIM to place all the blame on Christine Cassel?

Would you have to courage to ask the ABIM and the ABIM Foundation to take such an oath of modesty and fiscal/financial mediocrity? Or is your sense of cronyism clouding your judgment?

In the end, we have a growing schism between those who are placing their bets on a sclerotic ABIM whose leadership has failed its Diplomates and those who welcome change, competition and Darwinian evolutionary forces in Medicine.  The loss of trust and faith in the ABIM cannot be ignored by their leaders and the proof in the pudding will be when the Diplomates who are sick and tired of the ABIM selling them out will defund this organization and turn to more responsible organizations willing to document their lifelong learning without pricing in a condo, a limo, a retreat to the Four Season, and massive salaries for themselves.

At low tide, everyone will find out who is swimming naked.
It's time the IRS takes notice.



Anonymous said...

The ABIM is made up of 'friends of Obama'. The IRS is not interested.

Unknown said...

Kudos to Charles Cutler, MD for bringing some of this abuse to light. I was unaware of the debate he had with Dr. Baron at PAMED until just last week:


Through the words and actions of eloquent men like Dr. Cutler it would seem we're on the verge of real change. I wholeheartedly agree with Dr. Cutler that the time has come for an alternative vendor to document our ongoing educational activity. Many of the "products" offered by the ABIM have no demonstrable value and seem a waste of educational time and money. Why should educational reading and activity be proprietary? The comments of Paul Tierstein in the NEJM are germane.

I’ll soon change to the distinguished clinicians and academicians of the NBPAS to document my ongoing education. These unsalaried physician / scholars truly seem to understand real world medical practice. As importantly the NBPAS has stated that they will honor any ACCME accredited activity and has made no attempt to sell or copyright material.

The ABIM - well they've disparaged our colleagues, wasted our time, and proven themselves poor stewards long enough. Had I known they were compensating administrators near seven figures, and purchasing multimillion-dollar villas, I wouldn't have sent them that last check.

Although the MOC process has no outcomes data to support its continued educational use the one thing it unquestionably supports is the largesse of ABIM administrators. Although the recent public apology by the ABIM may be sincere, one has to question its timing.

I think its time for the NBPAS and other such organizations to compete with the ABIM. Choice is good.

Michael Gilbreath, MD

Anonymous said...

The ABIM's relevance may be further diminished by the recent Supreme Court ruling in North Carolina State Board of Dental Examiners vs. Federal Trade Commission (FTC). The Court ruled that state medical and dental boards are not exempt from federal antitrust laws. Not surprising, the American Association of Nurse Practitioners filed a friend of the court brief on behalf of the FTC because they saw this as the opening they need to level the playing field with physicians. Game over. As expected, ABMS and ABIM were MIA on this one.

Anonymous said...

In understanding a closed organization with an ingrown system, like ABIM, it is important to know who reports to whom. Who all the key players are and what tasks and activities they engage in on a daily basis.

Do they report to leaders/agencies, whether past and present, outside the ABIM?

Who advises whom?

It is useful to know what their actual job descriptions are. Have individuals over-stepped the boundaries of their job descriptions and for what reason?
In what ways are they not fulfilling their educational obligations to the original mission of their incorporation.

It is important to be familiar with the history of its incorporation up to the present time.

What are the officers obligations to their clients and their fiduciary duties to the organization.

Have they seriously over-reached in their activities letting emotions and zealous ambitions cloud their judgment.

The policies and procedures are tedious but interesting to explore, but necessary.

How and why have all of these things mentioned above changed? The mission. The articles of incorporation.

Every page and every signature tells a story from the beginning. The entire body of paperwork, especially the later active years with lucrative tax filings; the organization starts to speak and explain its story and who the key players are. It is like a sensitive membrane, something like the stock market's historical timeline on a graph. They say you can read history on that graph.

So that articulated graph I see in my mind in the form of a timeline with historical points has the history of the individuals and what they were thinking at the time. It is a complex web. But the past can be sensed and felt not just intellectually surmised.

For instance, when the organization decided to make some changes in 1965 and become active again, one document that had some parts scratched out was duplicated and registered again and again with the state of Iowa for some reason. I sense nervousness for the first time about their identity and who they were as an organization. Then comes what appears like yet another filing of the exact same document. Why repeat it? Obsessive personality or a nervousness over the absolute necessity of legality and some traces of tense emotion for the first time.

Were there conflicts within the organization. Moral struggles. Or just a status quo club ingrown from the start. We don't know, but the façade is apparent that much was going on.

Again in the context of the people and the story everything fits and we have impressions that reveal men like Thomas Brem who signs his pen to the amended articles and registration of the ABIM in Harrisburg. Yet again Brem tells a story about men using a specialty society's good reputation to hide behind and to use for darker purposes that before.

But what is the story. We have to look at the articles and registration documents and make a clear timeline with who, what and why clearly defined. The picture forms a picture of the organization and the people who steered the ship.

What is ABIM's purpose and mission now, and does it in any way violate the original articles of incorporation and mission? Of course, we see that the articles and mission have been altered, tampered with, or expanded over time?

I wrote a letter which shows my level of involvement in the story. My activism to reveal the harm done to physicians, which is egregious harm. I mentioned the COO and the unsound advice given to the CEO and others to pursue yet another physician.
This is morally wrong and reprehensible. It is a waste of life and money.

No one is completely evil in any story, but they some individuals in the organization have proven that they do the profession of medicine no good.

The activity that harms is the activity that I believe must cease.

Anonymous said...

The only way to win this is to boycott the ABIM, do not give them any money, do not take the exam.