Friday, May 27, 2016

Baron: "No Robust Evidence" for Maintenance of Certification

With the soft tinkling of gentle piano music playing in the background, Richard Baron, MD, President and CEO of the American Board of Internal Medicine (ABIM) and the ABIM Foundation, published a video on 20 May 2016 2014* attempting to justify the ABIM's high fees and requirement for "continuous" "Maintenance of Certification" (MOC) of physicians despite "no robust evidence" for the measure. Instead, he refers the viewer to the ABIM's "evidence summary" on their website and states "it's not randomized controlled trials but lots of what we do in healthcare is not randomized controlled trials. We do some things on a gut level of evidence, we do other things on a preponderance of evidence." (My detailed review of a portion of their "evidence" base can be found here.)

For $812,000 a year and countless lost hours of patient care and financial mismanagement, you would think he could do better than that.

Instead, Dr. Baron justifies the ABIM's actions on the basis that the ABIM was "preserving and protecting self-regulation at a time of change... otherwise it will be people, not physicians, who drive what all the expectations are for physicians." He claims the ABIM helps physicians "communicate to the public ways in which they communicate to the public that they have skills and that they have knowledge that other people don't have." As if physician's degree and training and countless years of experience and nights on call aren't enough.

According to Baron's own words, it appears the ABIM is little more than an exceedingly expensive marketing team working on our behalf.

But the real evidence of whom the ABIM has been working for can be found in the financial, political, and strong-man tactics used by the ABIM over the past forty years since "continuous" certification was conceived.

Dr. Baron never mentions the ABIM's secret transfer and cover-up of $55 million dollars taken from working physicians' test fees from 1990 to 2008 to create the ABIM Foundation and how the Foundation has moved a portion of those funds offshore.

Dr. Baron never mentions that the ABIM spent hundreds of thousands of dollars lobbying Congress to assure a perpetual money flow to the organization and hid these actions from the IRS to avoid paying taxes.

Dr. Baron never mentions that within all of their propaganda research the ABIM or ABIM Foundation never (once) studied the negative psychosocial effects of failing even one of their unjustified MOC examinations, nor the potential negative effects of cost saving initiatives promoted by the Foundation's "Choosing Wisely" campaign for the individual patient. He never mentions that  13.2% of clinically experienced physicians tested by their unproven metric failed their examination on their first try to the financial benefit of the ABIM and their partner professional societies.

Dr. Baron never mentions the his predecessor, Christine Cassel, MD, earned $10.88 million (nearly $9 million of that amount from ABIM diplomats and an amount that included spousal travel fees) during her 11-year leadership at the ABIM and ABIM Foundation. Nor does Dr. Baron mention Dr. Cassel's long-standing conflicts of interest with Premier, Inc or Kaiser Foundation Healthcare and Hospital system. Nor does Dr. Baron mention Robert Wachter, MD's conflicts of interest with IPC Hospitalist company that is now under federal investigation for overbilling Medicare.

Dr. Baron also fails to mention how serious they are about protecting their monopoly - that they even use Federal Marshals to raid homes and seize assets, call physicians cheaters, then collect an amount estimated to be $3 to $4.5 million in hush money to justify their program that has "no robust evidence." He fails to mention have 139 physicians were sanctioned because the ABIM felt doctors were the one cheating. He also fails to mention that the ABIM continues to track down and hunt physicians from as far away as Puerto Rico some four years later after publishing their one-sided account of details of their raid in the Wall Street Journal for their benefit "as a message and a deterrent."

But not all of the blame for the acceptance of MOC as a facade for physician competency rests with just the ABIM.  The American Board of Medical Specialties (ABMS) and the Accreditation Council on Graduate Medical Education (ACGME) that has quietly insisted on this credential for hospital and graduate training programs just so they can assure they receive more money from Medicare deserves blame as well. Their lack of leadership to expose the egregious behavior of the ABIM is at least as concerning, if not more so, for our profession and society.


* Note, it appears this ABIM video was published in 2014, not 2016 as I first published. I regret the error and have corrected the post. Thanks to the anonymous commenter to corrected the date. Hopefully that same commenter will address the other issues brought up in this blog post as well.


Anonymous said...

Wes...With all due respect the video was posted may 20 of 201*4* 2014

Anonymous said...

you may have to edit or delete.

its from 2014

Ed Rico said...

Congratulations, Dr. Baron, you certainly must be worth that $812K that Dr. Wachter and your other ABIM insider pals rubber-stamped for you. You have grasped what 200,000 other less highly compensated ABIM Diplomates figured out long ago, except for the redundant word "robust". When ABIM's evidence supporting #MOC is as robust as the Diplomates' cash, there might be less resistance in sending that cash to you.

Your nuanced (for ABIM) attempt to justify the ongoing coercion with regard to "self-regulation" is somewhat off the mark. Although you and others of your ilk at ABIM may have once earned a medical degree allowing you to be addressed as "Doctor", there is no mistake that you and your highly insulated circle of elite medical professional politicians ceased any resemblance to practicing physicians long ago. You no longer deserve to be called a "physician" by patients, actual practicing physicians, or the public at large.

Since you're interested in "self-regulation", you could start by self-regulating ABIM's activities with all of the shady financial transactions, malicious prosecution of practicing MDs, and lobbying activities aimed at influencing legislation. When you're serious (I'm not holding my breath), come back to Dr. Wes' blog and there will be plenty of guidance for you. Don't wait too long though; once the indictments are handed down, it will be too late for you and ABIM.

Anonymous said...

I'm the anonymous commenter and I read every word you post and am a big fan.

I agree with you 100%

Its a shame you cant force Baron and his illegal gang to answer.

And notice Baron hasn't posted a you tube video for 2 years....SPINELESS WEASEL.

DrWes said...

Anony 07:08PM-
Thanks for the correction...

Anonymous said...

My wife says it's all BS when you see wrinkling of the forehead (which you see through out the video.)

Anonymous said...

Get those ABMS schemers AND THEIR SCHEMES out of the EU. They are trying to harm my practice and my patients! My patients are telling me to take them off their prescriptions or saying they don't need to treat their chronic disease. Choosing Wisely is confusing patients and physicians. Hypertension is the new normal? High cholesterol not a problem? Are these people nuts?

"There is an incentive for GPs to treat certain conditions, like high blood pressure or high cholesterol, when research shows many of these treatments have not impacted on mortality and premature death rates.'"

james gaulte said...

Another lame attempt for the ABIM rulers to try and save their Phony Baloney jobs.

Anonymous said...

There is evidence that MOC hurts pts and docs. To say there is no robust evidence is ABIM-speak for internal studies that it does harm.

Any thinking person sees that it hurts all who is not brainwashed by their mass media.

In The Days of MOC said...

Lord Baron created the earth and heavens in his own image and it was bad.
The good failed, sent back for their uprightness until the final judgement came.
All the rest were made to creep upon the Baron earth with weeping and gnashing of teeth.
And after the third day of every week the Lord Baron rested, because his measure was greater than the rest.
The sun no longer lit the day; and the moon was commanded to be dark at night.
The world dwelled in darkness in the name of the Lord Prince of darkness -- ABIM.

Anonymous said...

Fraud upon fraud. The public was sold a certification and then re-certification based on deceit. Physicians pick up the receipt for Baron/ABIM's greed and political deceit.

Anonymous said...

Did ABIM executives and others abuse the organization by promoting partisan political agendas and advancing corporate special interests?

FREDDY said...


Claudagh said...

Huge financial self-interests, creating onerous policies to serve themselves, corporations and a politically powerful few. They use propaganda, intimidation, and outright lies to maintain control of it all.

Does it resemble the original ABIM -- a voluntary non-profit organization serving physicians and the public to organize and certify specialists in an honorable time-bound mission of five decades or less?

Or does it sound like a form of greedy artificial government with an elite autocratic society in charge that we want to avoid?

Rich Baron admits that it is not a humanitarian mission or scientific organization any longer. Dr Baron understands this more than anyone, yet he sits on the only precise knowledge in their possession -- that the ABIM does actual harm to physicians and the public.

James O'Brien, M.D. said...

Rich "Robber" Baron is the Lloyd Blankfein of American medicine.

Do nothing, collect huge salary, extort money, and lecture to all the peons why they should be happy about it.

Anonymous said...

Radiology Board Plans to Drop 10-Year MOC Exam
Ken Terry
June 01, 2016
The American Board of Radiology (ABR) has announced that it plans to eliminate the requirement that radiologists take an examination every 10 years in order to maintain their board certification.

In a May 18 press release, the ABR said that in the second half of 2018, it will pilot a continuous testing approach that could replace the 10-year exam. If all goes well, the new system will be rolled out to all ABR diplomates "as early as mid-2019," the board said.

According to an article in, an ABR spokesperson confirmed that "the exam is going away."

Although this change will affect only radiologists, it represents another crack in the wall of the maintenance of certification (MOC) regime that the American Board of Medical Specialties (ABMS) and its constituent specialty boards impose on board-certified doctors. In September 2015, a task force of the American Board of Internal Medicine (ABIM), the board that spearheaded the adoption of MOC, released a report calling for major changes in the ABIM's approach.

The task force recommended replacing the ABIM's 10-year MOC exam with "more frequent, less burdensome assessments." These short tests could be taken at home or at the workplace and would be designed to assess competence in "essential contemporary knowledge." The focus would be on cognitive and technical skills rather than on more difficult-to-measure areas, such as communication, teamwork, empathy, and quality measurement, that are part of the current MOC program.

Similarly, the approach that the ABR outlined in its email would focus on weekly emails with links to questions that are relevant to radiologists' areas of practice. The questions can be answered one at a time or in small batches. Radiologists will get immediate feedback on the accuracy of their answers, along with a critique of the answers and educational material.

Radiologists who are due to take their 10-year MOC exams by March 2, 2017, will still have to complete them this year, according to the email. For other ABR diplomates, the exam requirement will be deferred until the new MOC process is available in their discipline, the news release said. But diplomates must continue to meet the board's other requirements for MOC.

Still, "The design of this pilot is a work in progress, and some details, including the launch timeline, may well change over the next year," according to the ABR release.

Rebellion Picked Up Steam

The ABMS and its constituent boards have been under increasing attack over the MOC exams in recent years. The Association of American Physicians and Surgeons in 2013 filed a lawsuit against the ABMS and its member boards, including the ABR, claiming that the boards were using MOC to generate tens of millions of dollars in revenues. That suit is ongoing.

In 2014, the ABIM introduced changes to make MOC activities more continuous, rather than just once-in-a-decade preparations for the recertification exam. Internists rebelled, demanding that the ABIM base recertification solely on the MOC exam.

2020 views said...

Who and what do physicians serve?

Any mandated recertification "program" from the ABIM/ABMS (or any medical society tied at the hip to the ABMS) is simply lighting up the original good old boy's corporate cigar and putting lips to the same butt for the rest of your life.

Only fools would not recognize current ploys as simply manipulation. One must see reality and not rush in to any such unhealthy involuntary relationship with a corrupt partner. One cannot call any involuntary recertification program from tricky corporate sponsors progress. Unfortunately all the medical societies are so convoluted with disinformation and misdirection that one can simply no longer trust any of their leadership with rare exception -- and no medical society can be trusted as a whole organization. Their are deeper elements that control from within. As John Kerry our Secretary of State recently said corruption is pandemic in the world. I think that we can trust that statement!

Why do the ACP and AMA come to mind by association -- the parent organizations of the ABIM and ABMS. Who do all these organizations serve today? Certainly not the patient or physician.

Who wants to keep getting burned by these professional medical bureaucrats at the ABMS, their associates, affiliates and their sponsors? It has all become a sick 'dance macabre' coerced by corporate insurers and techno fascists...who put up smokescreens and drop their slippery ash all over you. And our government is often compromised of compromised "sickos" on the take like Dennis Hastert. And he and other pedophiles are considered to be societal menaces unless one ascribes to current psychological trends that would try to categorize pedophilia as a "sexual preference."

Physicians will be looking down from their knees bowing to special interests all the rest of their lives -- or pinned to the floor until special interests and their "crony bureaucrats" have complete control over the United States medical industrial complex and all their "medical workers".

Physicians should imo serve the patient and not corporate special interests. Who would believe and act contrary to this, except by a sick coercive politico-corporate mandate from above? Look around at the corruption of our society. Medical science is no longer a trusted science, but a mix of science and semi-corporate bullshit and a stuffed with government propaganda. Study the history of insurance companies and "evidence based" revolution and you will see how medical science became corrupted -- and so easily at the level of the corporation in cahoots with the ABMS and ACGME. Even a cursory historical purview of so-called evidence-based medical science can readily see what newspeak it all is. Our Orwellian 1984 scenario has slowly sprung to life in our own free society and the masses even recognize it but are powerless in the grips of a nouveau big brother system. The ABMS is a model for such a corrupt corporate dominated fascist state.

Government in our democracy should serve the people and not the other way around. We have a twisted relationship all the way around. Take a hard look at the ABIM and all the rest. I would suggest we snuff out that sick cigar of corruption. It is all ash upon ash heaped on our heads.

Anonymous said...

Medicine is run by powerful and rich cartels. This is not a cartoon. It is real actual life. And these cartels are harming patients and physicians. It is one of the greatest cover-ups since the VA scandal was buried under the grasses in Arlington. It co-existed with the VA problems and persists. But there was no shake up. No one lost their job or prosecuted. No fines handed out by regulatory bodies.
That is because the ABMS hides under corporate protection and is exempt from prosecution as it supposedly receives no federal money. But it does receive illegal tax boons from the federal government. I say they are illegal because the ABMS and especially the ABIM are profit-seeking corporations. And they make millions and billions depending on one's time view of the corporate bodies. It is time to end these cartels. The executives in charge are accountable to no one and must be fired replaced by a democratic society of clinical physicians who can do the job voluntarily without pay as it was in the beginning -- just a board to make some prudent decisions meeting a few times a year. No more professional political schemers in charge.

Anonymous said...

No more MOXATION. It is corrupt and illegal. Sue the ABMS for a return of funds stolen and a cease and desist order placed on MOC. Have all ABMS accounts frozen until the illicit money overcharged is returned to physicians and the federal government. Seek damages from the associated organizations such as the AMA, ACP and ACGME. Include insurers and hospitals -- any that lobbied for or helped create such Ponzi scheme.

Unknown said...

yes i think that if we take legal and political action against ABIMS then only will these manipulators will straighten up.we all can put a class action suit and pay for it