Tuesday, March 08, 2016

Medical Specialty Certification in the US - A False Idol?

For the first time, the history of the ABMS/ABIM board re-certification corruption scandal has reached a peer reviewed medical journal, the Journal of Interventional Cardiac Electrophysiology. I hope practicing physicians here (and others worldwide) take time to read the history and evolution of board certification in the US reviewed in the article and to review the associated references. 

I would like to thank my co-author, Edward J. Schloss, MD (Twitter: @EJSMD) for his contributions to this work and the many helpful editorial suggestions made by the JICE reviewers.

It is time we reconsider the ABMS "Maintenance of Certification" (MOC) program. It is also time to have an independent audit of the financials from 1989 to 2016 from the American Board of Internal Medicine and its Foundation, including full disclosure of the many financial conflicts of interest within the American Board of Internal Medicine (ABIM), the ABIM Foundation, and each of the 24-member boards that comprise the American Board of Medical Specialties. Finally, a full investigation of misleading tax filings and lobbying disclosures of the ABIM as a public tax-exempt 501(c)(3) corporation by the IRS and Department of Justice is long overdue in light of these revelations.


Fisher WG and Schloss EJ. Medical Specialty Certification in the United States - A False Idol? J Interventional Cardiac Electrophysiology doi: 10.1007/s10840-016-0119-4 Mar 8, 2016.


Ventura said...

A "tour de force" review and analysis of medical specialty certification in the US.

Guiding us through ABMS history from the early twentieth century to the present, Drs. Fisher and Schloss document how certification went from being a lifelong prospect to one that is time-limited -- with no proof that the ABMS burdensome recertification process makes better doctors.

We are left with the inescapable conclusion that MOC is not only onerously redundant and costly, but it aids and abets bureaucratic organizations corrupted by political conflicts of interest and ambitious financial arrangements.

With hidden money transfers from the ABIM to the American Board of Internal Medicine Foundation from 1989 to 2007 and increased MOC money flowing from a physician "basket of plenty" into ABIM's bank accounts, we see clear abuses of executive power and non-profit tax law violations.

Highly compensated executives and officers have been the primary beneficiaries of the exorbitant MOC fees - not the physicians' continuing medical education, nor is public safety served.

From its non-profit voluntary beginnings - where specialty board officers worked without compensation until the present day's financial morass - one recognizes and feels compelled express vigorously that the ABMS needs to be held accountable for its actions.

Transparent independent investigations of the medical specialty boards was needed over twenty years ago and a change of culture has been equally long overdue.

ABIM are you listening? said...

You should send an autographed copy of the Journal and article reprint to Rich Baron.

Anonymous said...

Yes! Send him a reprint! Great work Wes! I expect this paper will get a great number of references, will help spread the word and will keep the matter in the forefront.


The ABMS is selling a whopper of a lie in MOC said...

Congratulations. One of the most important features of your publication, Drs. Schloss and Fisher, is that we know it was not conflicted by the pursuit of money/justification of controversial mandates. And it was not paid for with physicians MOC money utilizing highly selective data culled to prove a point or justify false premises unlike the ABIM and ABMS are prone to.

Below is an example of a highly biases ABIM MOC-funded study that has no place in a scientific publication. It is written by ABIM research staff at a time when the ABIM and ABMS are fighting for not only their lucrative positions but their very survival. The "recent" study below is a sad and desperate attempt to dissuade the anti-MOC/call for investigation of finances and relationships movement from growing out of control.

Dr. Baron should know by now Science is not meant to be used for purposes of propaganda. Dr. Lipner and Dr. Baron should be ashamed of themselves for the continued cover-up and endless distractions. The conflicts of interest have not gone away at the ABIM and ABMS, they have only gotten worse.

When I see professional medical bureaucrats like Drs. Baron, Wachter, Holmboe, Cassel, and Nora lying through their teeth to cover the sinister business and legal tactics they continue to employ my body shudders in disbelief that they continue to rake in the money. I am surprised anyone pays them. And the Chicago/Philadelphia gangland approach to surveillance and security at the ABMS still needs to be investigated and addressed. The present and planned financial relationships need to be completely disclosed and made transparent.

The following ABIM study does not persuade, it just makes a physician and the public angry at the attempted assassination of scientific fact in favor of propaganda. This puppet government at the ABMS confounds me over and over the more I inquire into their highly conflicted cartel-like activities. They serve up a meal of propaganda and call their brand of scientific filth good for us. The ABMS buys the lowest forms of science for their franchise. Good luck to anyone who buys into their current endeavors to shove the next Baron-esque/Nora-ish Happy Meal or Whopper down our throats.

I am sick to my stomach of the lies and expensive colorful packaging.


ABIM governance needs to Transform. said...

The governance of the ABIM needs to change immediately. It is an opaque, closed company with no accountability and terms of office in perpetuity. We need a movement to call for an election based leadership with fixed terms and transparency. Rich Baron should not have this job indefinitely. In fact, one can argue his level of willful ignorance is oxymoronic to the ABIM's claim that they are "listening".

Get rid of the status quo. Open the candidates up to those who actually care about the profession- Cutler, Wes, Teirstein, et al.

Anonymous said...

Hurrah! Some movement on the AAPS vs ABIM lawsuit!


Are ya hearing us yet Rich?

Anonymous said...

Yes there needs to be completely new governance at the ABMS and all of the medical boards. MOC needs to go as the first order of business.

Objectively speaking if the ABMS went away today the entire practice of medicine would be better off immediately. A lot less red tape for everyone.

Anonymous said...

Outstanding ! As stated , hope this goes viral ---- cyber links !!

ethics committee said...

ABMS accountability. There is none. They have no ethics and no ethics committee either.

Did anyone notice that the ABMS advertises that it is working on its accountability?
At least that is what they appear to claim. But what kind of accountability and to whom?

Online searches reveal that the ABMS has hired high powered attorneys/risk managers using physicians' fees/ABIM membership dues (all physicians' money) to find ways of giving the appearance of accountability. But in fact the accountability is not to physicians or the public at all! Many of the ABMS employees that we can find nowhere in the 990's or on the ABMS website speak of their work related activities and "accountability" only as a lip service to bolster their job descriptions and self-advertising.

When you look at what they are actually doing with a bead on the details, they are only building up their global franchise/mergers with other organizations and capacity to grow their bank accounts. This is an unfortunate fact. The ABMS and ABIM are hunkering down with no plans of ending MOC or paying anything except lip service to physicians. The ABMS has a great PR portfolio comprising stall tactics and distractions like "we are listening to you." Or they give out completely false press releases giving the façade of change, integrity and morality.

What does it mean when highly paid risk managers advise Richard Baron to say, "we got it wrong." It means nothing. I am frightened by the fact that many physicians have even bought into the lie or give them the benefit of the doubt. The truth is Baron and Nora cannot even go to the bathroom without being watched and monitored. They are kept under a tight corporate lock and key. They are bought physicians.

So while feign, "we got it wrong," they were really busy screwing every patient and physician in the United States using the anti-MOC movement to their favor.
What do I mean? The ABMS to survive financially must have steady annual streams of payment. So anti-MOC advocates only give them a reason to shave off costs by jettisoning the ten year recertification testing in favor of annual monitoring/testing - with even greater time demands and cost to physicians. They understand deferred accounting will not be possible going forward as physicians flee the specialty boards over MOC.

Ending the 10-year test will give the ABMS opportunity to have at-home tests proctored by third party vendors who will give themselves (medical board security insiders) or the AMBS a kickback. Good luck when these third party vendors take your facial recognitions/iris impression/ID over your computer and monitor your every move with their own "low paid" live proctor. These tests will be given by the same folks who spy on you most likely watching for irregular behavior. Remember that the pledge will be updated to include any "irregular behavior" will be punishable with civil or criminal prosecution.

accountable to no one said...

The anti-MOC movement better "get real" and get high powered attorneys and their own risk assessors and advisors to scrutinize and fight the whole ABMS and their operations.

ABMS is on a growth trajectory and they are being accountable only to that trajectory - disregarding the primary mission, which is to serve the public.
The only relationship the ABMS has with the public is when they refer to patients in one of their "studies" where they insert false data under the catchword "patients say" or "patients want to know that their physicians are" or "patients tell us that continuous education and certification is...."

No patient in the US knows what the ABMS is. CNBC will try to keep it that way. Their archived documentary must be some form of exploration of what physicians know about the inside workings of the ABMS. Well now they know, but whoever pressured CNBC not to air the story has power. That tells us how powerful they are and what that power structure is - corporate/government and media.

More regulatory capture is coming.

More regulatory capture through lobbying and political alignments/financial arrangements with the medical societies and quality assessment bureaucracy. All done in secret meetings; all without showing their books and relationships to anyone outside a closed circle of executives, officers and attorneys.

The board of the ABMS and special boards' members should be held accountable for the kinds of financial and political manipulation they practice behind the scenes. If they are not held accountable they will continue to walk all over passive/overly-burdened physicians.

So, the accountability is only to their own strengthening business model and service to their corporate cronies. The ABMS has an eye on productivity and revenue growth like any other profit-oriented corporation. They do not want to fix anything except their bottom line.

Anonymous said...

Ruthless and immoral are the key words to keep in mind when dealing with the ABMS or any of the 24-member medical specialty boards. The opaqueness spoken about here concerning finances and day-to-day operations is frustrating. We have not made much progress there from asking for transparency and access to documents. That is highly suspicious, imo. Most of the information comes from 990's and court documents and the former - tax filings - withheld through legal proxies. Only a governor's office intervention got results and they turned over documents with sections missing according to Mr. Kroll.

The stifled efforts to peek at the operations of this cartel from the inside is similar perhaps to the FBI trying to see from the inside and understand a syndicate family in Chicago or Philly. We do know one thing, however, the ABMS in Chicago is completely connected to the ABIM in its financial operations and aggressive testing security. The general public knows nothing of this. The ABMS is like a "Godmother/Godfather" in that they have total control over the member boards and partnership through MOC and revenue streams from certification status. The parts work as a whole and the parts talk and plan together.

Physicians and institutions pay big (certification verification and MOC)for the privilege of their umbrella of protection.

The FBI should get some ears and eyes on these "guys" and infiltrate the organization with someone on the inside and they would quickly see what the corruption really is and how deep and far it goes. The ABMS has close dirty ties with key Washington figures including fallen corrupt Senate and House leadership.

If any physicians are still naïve to the point that they think the ABMS cares about them or the general population, then I suggest they read Wes Fisher's blog and Kurt Eichenwald's Newsweek articles. Read about the Dennis Hastert case (online ABMS documents and Hastert's lobbyists/office staff reveal financial or other relationships between the two - more than just hints). Read about the Jerry Sandusky/Penn State scandal (there are relevant players involved with the ABIM). Or study any other child prostitution investigation to see how our officials and bureaucrats get easily enticed and compromised into doing bad things which compromise at the same time the security and welfare of our country and general populations. Bad things that affect physicians directly as well.

If any of those writings do not convince, then consider this: Why is it that real physicians (or patients) don't have any eyes or ears inside the ABMS and the "Sanctum Santorum?"

What could the ABMS and their corporate/government cronies possibly be doing that they need to hide from public inspection except ruthless activities involving financial corruption, shady business practices and the inference of immorality when we see respectable actors balking at the thought of telling the truth?

That is what happens to the mind and heart when we don't get straight honest answers from our public servants. We doubt them and we investigate their workings and doings. We see no conspiracy, just a bunch of unlikeable, morally questionable people who are involved in politics and money and power too deeply to get out or afraid to reveal the truth about themselves.

K Murray Leisure MD Infectious diseases MA USA said...

Congratulations Drs Fisher and Schloss, and the J Interventional Cardiac Electrophysiology March 8, 2016, for publishing this critical report on " Medical Specialty Certification in the US -- A False Idol". Thank you for exposing the controversial, wasteful, and exploitative private medical professional testing industry and its ABMS- MOC (TM) testing programs. No apologies or excuses are acceptable from multimillionaire health care executives here other than a complete elimination of all these MOC operations from U S healthcare. As stated by 19 state medical societies and numerous medical organizations since 2010, remove and bury MOC from all hospital credentialing, medical licensure, and medical health insurance payment operations completely. -- K Murray Leisure, MD, Infectious diseases/ Internal Medicine, Plymouth MA. USA.