Monday, June 20, 2016

Pennsylvania Medical Society Explains Their Vote of No Confidence Against the ABIM

The Pennsylvania Medical Society just sent this letter to all Pennsylvania physicians explaining their rationale for issuing a "vote of no confidence" against the American Board of Internal Medicine (ABIM):
The Pennsylvania Medical Society (PAMED) believes that continual professional development, lifelong learning, and providing quality patient care based on the best science and evidence to guide medical decision-making is the fundamental cornerstone of what it means to be a physician.

For two years, PAMED leadership has had numerous meetings with senior management at the American Board of Internal Medicine (ABIM) with the purpose of representing our members' high levels of dissatisfaction with the ABIM Maintenance of Certification (MOC) program. Early in this process, we concluded that the reason ABIM leadership was so out of touch with practicing physicians was because nearly every member of the ABIM's board is not involved in the full-time practice of seeing patients. We attempted to work collaboratively with ABIM's leadership to help them better understand that their punitive process is needlessly time-consuming and takes physicians away from their patients. We demonstrated to them that their process is exorbitantly and unnecessarily expensive compared to other continuing medical education activities through which medical knowledge and excellence in patient care can be maintained and demonstrated. Most importantly, we clearly expressed to the ABIM that the content and available medical resources of their secure, high-stakes computer exams bear little to no relevance to the care we render to our patients in our offices and hospitals.

Through their marketing efforts, the ABIM has worked hard to give the impression that their recertification exam demonstrates competency. However, despite numerous calls to substantiate this assertion, the ABIM has been unable to provide reliable independent evidence that a secure, high-stakes exam—taken every 10 years by some and for which others are "grandfathered" and therefore exempt—leads to better patient care. This is because while the overwhelming majority of practicing physicians pass the ABIM recertification secure, high-stakes computer exams, this test and the MOC process have no correlation to how well a doctor can take care of a patient. Shockingly, countless medical leaders, numerous national mainstream publications, and several forensic accounting reviews have published information which suggests that the ABIM's motivation for their recertification process was primarily driven by little more than financial mismanagement.

If true, what makes these actions so deplorable to physicians is that it was perpetuated on all of us by our colleagues whom we mistakenly believed were part of our medical family. In response to the overwhelming pressure being placed on their leadership, the ABIM has begun a public relations campaign with a barrage of emails and blog posts to create an illusion that they have the ability and the desire to correct this problem. As our PAMED Board reviews these emails, we believe that the ABIM's motivation and ultimate program will continue to have as their cornerstone the creation of as financially lucrative a position as possible for their Board and their misguided foundation.

It is for all of these reasons that I announced at the American Medical Association's (AMA) Annual Meeting last week in Chicago that the Board of the Pennsylvania Medical Society has voted a position of NO CONFIDENCE in the leadership of the Board of the American Board of Internal Medicine. We believe that their current leadership is not capable of reforming the process in an academically meaningful and fiscally responsible way. ABIM leadership has issued an apology for instituting their January 2014 MOC program. The ABIM has admitted that all three aspects of the program were improperly designed and deeply flawed. Millions of dollars were spent by the ABIM in preparation for this program. It can be argued that the January 2014 MOC program was the most expensive mistake in the history of medical education.

In keeping with the consensus of PAMED members and physicians across the country who are embittered with the practices of ABIM, we call for the immediate replacement of the entire ABIM Board and leadership with new leadership, representative of physicians actively participating in the full-time practice of clinical medicine. In the absence of this happening in a timely manner, we plan on calling on ALL specialty boards and societies to listen to their members and to work to remove the MOC process from ABIM oversight. Our PAMED Board is committed to aggressively advocating for all physicians on this important issue. We hope to see more meaningful progress in the coming weeks. We will explore every avenue to bring about meaningful MOC reform and will plan on keeping all PAMED members informed on any progress made in our efforts. Most sincerely,

Scott Shapiro, MD, FACC, FCPP
PAMED President
I hope other state medical societies across the country issue similar statements in the weeks ahead.



F Moore said...

I also vote no-confidence in the ABIM leadership. I deplore and condemn their deceit and the misguided self-perpetuation of lucrative MOC schemes. MOC is pure corrupt business practice designed to gratify their executives' own financial and political ambitions.

MOC is costly, useless, time-consuming, and burdensome to the degree of insanity. Having a negative practical value to both clinical and research physicians, MOC actually limits and hinders patient contact, and thereby harms the physician/patient relationship by reducing de facto the quality of care.

Therefore, mandatory MOC must be ended immediately. It is harmful to all. It has been a shameful scheme invented to mask the fiscal irresponsibility of ABIM's leadership. MOC has served to obfuscate ABIM's waste, excesses and overall cash flow problems.

It's time for all mandatory MOC to go and for ABIM's leadership to be replaced.

Unknown said...

To Dr. Fisher, Dr. Cutler, Dr. Shapiro and the good physicians of the Commonwealth of Pennsylvania,

Thank you very much for your courage and your thoughtful words. On behalf of the physicians in New Jersey who share your sentiments, I very much appreciate your steps to mitigate this debacle.

I would like to take this opportunity to formally request that the Medical Society of New Jersey, the NJ Chapter of the American College of Cardiology and the hard working physicians of Monmouth and Ocean County NJ formally support the efforts being put forth in Pennsylvania, New York, Oklahoma, Massachusetts, Kentucky, Florida and Michigan to ask for reformation of the ABIM leadership structure.

Enough is enough.

Unknown said...

For those of you who have not seen or signed this petition, in the name of our Profession and our Nation's interests, please sign this petition.

Appeal to the State AG of Iowa and Pennsylvania said...

Wes, how do we get the physicians and voters of Iowa and Pennsylvania to lobby their AGs to open an investigation into the ABIM and the ABIMF?

Anonymous said...

We need the State AGs to issue injunctions to the ABIM and the ABIMF to cease and desist so then can liquidate the Cayman Island assets. Then the leadership can be replaced by a referendum by the Diplomates. The future leaders of the ABIM and the ABIMF should be voted in. Not appointed by a handful of oligarchs.

WLB said...

The ABIM has involved itself in unseemly activities purporting to serve the public, when in fact the majority--if not all--of ABIM's pursuits have served only themselves financially and politically.
If mandatory MOC is not ended immediately, and the solicitation/coercion of fees in their pay for play scheme, I will initiate legal action and/or add my name and finances to any such endeavor to investigate and prosecute the ABIM and its deceitful actions. I encourage others to participate in/initiate adversarial actions against the ABIM, its executives and board, also.

P Hutchinson said...

It is also important to support Dr. Salas-Rushford's defense as he fights for justice, not just because we believe the case is time-barred, and for fraudulent reasons, but the ABIM has quite dim-wittedly opened itself up for discovery of many behind the scenes illegal police actions against phycians from 2009 to present. Beginning with the investigation and raid on Drs. R K. Arora and Anise Kachadourian's homes, we understand that one of the most atrocious violations of civil liberties, due process, and privacy.

What nobody knew at the time, except the ABIM and legal teams involved, these illicit raids were based on a felon's testimony and one who has knowingly and willfully lied/obfuscated on his CV, employment history and certification applications. Many have verified this. What happened to Drs Arora, Kachadourian, Von Muller, and all the other physicians over an alleged cheating scandal should not have happened--and never should have taken root in the courts.

This highly motivated felon Mannes, a former goon-thug cop thrown out of the DC police force, working on behalf of the ABIM ultimately harmed so many lives. It also blackened the reputation of the ABIM and its leadership irrevocably.

It is time for this action to be exposed for the sham seen and understood for which it was. Just like MOC's scam, the ABIM deals many of its cards from the sleeve. Ariel Benjamin Mannes was their hidden ace up their sleeve. But he was and is a dirty card. His testimony was as dirty and blackened as it gets. Those who perpetrated and aided and abetted this fraud should be investigated and prosecuted to the fullest extent.

This is significant as it is our belief, and many others, who have studied the matter that ABIM committed fraud along with their legal arm Ballard Spahr. This was a bigger crime than we think, because it was perpetrated to protect their MOC cash flow by instilling great fear in physicians. It worked very well. This police action instilling so much fear even may have influenced politics.

I believe this political and personal repression along with the media based demonization of physicians affected healthcare reform detrimentally. Democracy was not served, as this essentially muted a political voice that might have spoken out more loudly against healthcare reform. What's more coordinated insidious bureaucratic requirements were placed on physicians every bit as burdensome as MOC.

This has further curtailed participation in the decision process so vital to our democracy. The fact that the ABIM was a politically active source supporting healthcare reform cannot be ignored. It is a non-profit organization and that is forbidden. Many things the ABIM has gotten away with is unprecedented for a testing company enjoying the benefits of the people's good graces--the tax benefit particularly, which executives could easily just write that check for themselves. It is only a corrupt IRS or a blind DOJ which would see it otherwise. It is fraud and corruption. It is time we stop supporting it?

PH said...

PH cont.

Christine Cassel was paid by physicians to lead her and her cronies' political healthcare reform charge. Were physicians informed of this, or that Dr. Cassel never showed up at the ABIM for the work of protecting the public that she was contracted to do. The lack of fulfilling even her 35-hour workweek qualifies as public fraud, imo.

This opinion is shared by many on both sides of the political aisle, as well. It is almost universal the more public exposure, the more there are who feel deceived by the ABIM, and that it was used as cash cow for executives the money and time involved rendered the ABIM into little more than a sham assurance show for the public, when in fact it was a political action committee and supported many others PAC of it ilk.

Unsavory people were hired and misrepresented themselves. They were not testing industry experts at all like the felon Mannes. ABIM is fighting for its life right now to suppress as much evidence as possible in court.

I and others follow the case ABIM v Salas Rushford on, but it appears that Dr. Fisher has a link on his blog to donate to the cause, because it will affect physicians for years to come adversely. It is not an investigation of an individual physicians it is about defending the monetary stream of MOC by inflicting fear in everyone's minds and being.

It will get interesting soon with the deposition of ABIM's secret police/investigator and two-time felon Ariel B. Mannes. Mannes had two felonies and pleaded a third charge and conviction away with the court a couple of years before he was hired by the ABIM. Mannes was hired to work directly under Christine Cassel and Lynn Langdon and others involved in a political campaign to demonize as many physicians as possible for political and financial purposes.

The case of ABIM v Salas Rushford is really imo about ABIM's own guilty actions involving ABIM's egregiously conflicted executives and the fraudulent director of investigations who has already potentially perjured himself in several of the past cases. It is apparent his tainted and conflicted testimony was the basis of suits and sanctions that affected thousands of physicians. Mannes benefitted personally financially and his testing/security partners in pursuing the board review course in New Jersey run by Dr. Arora.

As the Pennsylvania Medical Society so aptly stated about the ABIM's financial shenanigans in creating MOC to support financial transgression, but the ABIM executives have not stopped there as you can see from the above narrative.

"Shockingly, countless medical leaders, numerous national mainstream publications, and several forensic accounting reviews have published information which suggests that the ABIM's motivation for their recertification process was primarily driven by little more than financial mismanagement."

I would use stronger wording to describe their motivations and financial activities. Could I have permission of this blog to use the words racketeering and fraud to describe it?

Someone posted about the Teacher in Atlanta who allegedly erased wrong answers on tests for whatever purpose. I was surprised to see that they were indicted, convicted and went to prison based on charges of racketeering. That was Caveon who investigated and Mannes has been involved with their spies and testing security company for years.

This is concerning. Was this fraud also involved in the teachers going to prison as well as the physicians being sued and sanctioned for being students of a course in New Jersey and allegedly exchanging communications.

This is a strange brave new world we have embraced. Or has this corruption just slowly wrapped its twisted malice around us convincing us with trusting whispers that false is true and true is false--organizations like the ABIM who claimed to have served the common good. We know now that is unequivocally false. I shudder as at letting them get so close.

The ABIM is a dangerous entity and they have employed danger as their future course.

Let's Crowd Fund the PAMed Society said...

We to crowd fund the PA Medical Society's legal war chest. I have no idea how to do this and I am not sure if Dr. Shapiro and Cutler will accept the funds. If we can crowd fund Mr. Kroll, we can definitely crowd fund this mission.

Anonymous said...

Grass roots funding is a good idea.

The Whole Thing was Endorsed by a Federal Court said...

To P Hutchinson. Look at the PDF from the Eastern District Federal Court. The ABIM and Mannes successfully lobbied the Federal Court system and got the bench to sign off on the seizure writ. The ABIM posted a $10,000 bond just in case they blew it and spoofed the court. I am not sure anyone can say that the seizure was illegal when a Federal Judge signed off on it. I think for sure the ABIM will be get nailed for many other things

Illegal political pandering as a non profit organization.
The hiring of a thug mercenary ex-felon as head of its enforcement/integrity services.
Monetary losses in the millions of millions of dollars starting with the infamous condo.
Arrogant dismissive statements from Baron, Centor, Wachter, Cassel, Johnson, Emanuel, et al.
Slick accounting tricks including Mr. Kroll's analysis and the transfer of money to the Cayman Islands.
Continued hyperbole, alarmist statements by Baron and Nora for the sole purpose of self preservation.
The list goes on and on and on......

The ABIM just played its last hand. For decades they bluffed their way through but Wes Fisher/Charlie Cutler/PA Med Society and the State of Oklahoma are the ones holding all the face cards.

Lois and Rich went all in with a pair of 5's.
Wes et al are sitting back with a straight flush.

Creole Gumbo said...

On a "confidence scale" of 0 to 10, because a No Confidence vote would be zero, I vote -5.

I say this because after they issued their apology letter I asked for a refund of the money that I had sent to them for MOC under the mistaken belief that I would be required to do this. This was my second or third refund request, the first having been sent one month after paying.

In spite of their apology and the fact that I never took any MOC exams Dr. Barron sent a letter telling me that it was my fault if I sent them money and did not take the exam. Their apology means nothing.

P. Pepper said...


The 4 videos on the future of MOC are all thumbs down. Here's my impressions:

They have an incredibly boring tone; if I had to label it I call it dead-pan sophistry ala big brother! Its as though the speakers were trying to deliver a pep speech at an 'alcoholics anonymous' meeting, while talking to and empty room.
And that is quite literally their status and condition. It all just turns one off.

Everything 'Baron and company' says and does is painful to listen to, especially knowing that any relationship one has with them is going to burn like hot gunpowder on the skin and lungs. Look at what they have done; the latest skinny. The criminality of hiring a convicted felon to cheat Americans out of their constitutional guarantees. The latest revelation of temerious horror amidst the financial scandals involving deferred accounting and a killer cash burn rate.

Look at what they have done behind our backs with their nefarious legal arm Ballard Spahr since 2009. Nothing that that thug/con A Benjamin Mannes gathered in his phony "ongoing investigations" for ABIM should have been allowed by a judge--it was not credible nor should it have been admissible. No salt in that man's moral fiber. What kind of judge or magistrate is it that does not do his or her homework on ABIM's key witnesses and signatories. The latitude given to a presidential advisor with ties to arguably the most powerful law firm in the state of PA.

Let's look at the facts of this test writing company that spend more time in court than in creating questions. In ABIM v. Arora Board Review you had a CEO with egregious conflicts of interest forced to resign board positions. Cassel was guarantor of factual admission of evidence. What a joke. You had an ABIM editor, who knows more about dogs than ABIM's testing questions, and a twice convicted felon as their director of investigations. Cassel and her cronies pulled the same scam on the president of the United States and the American people with her healthcare advice. She promised the world and gave us the austerity of Greece.

Everything they do at the ABIM is evil through and through. I'm sorry it is no use anymore listening to their lies. The ABIM is a house of binge drinkers and everyday alcoholics trying to convince working physician that they have stopped their MOC addiction.

As far as I am concerned they have two choices. Stop mandatory MOC altogether or they face the risk of pissing away 80 years of ABIM's legacy down the honey bucket. Choosing door number two is looking a more likely scenario with the possibility that some of the ABIM directors, executives and board members will be urinating into a sterile toilet in a maximum security cell. And that will suit me just fine.

I have had it up to the brows with these high brow bobble heads who can't get it right. They can design/invent all the damn MOC they want, but like the proverbial tree that fell in the forest, who will be there to hear it?

Baron has one leg sloshing in the bog looking for butter, and the other struggling defending MOC drowning in the quicksand.

Jeanette Harris said...

I support vote no-confidence concerning the ABIM leadership as well. I blame and convict their fraud and the abnormal conduct. I think that MOC is all about venal business practice made to satisfy their executives' own financial and political views.MOC is expensive, worthless, operose, and onerous to the extent of frenzy. Despite multiple calls to peove at least something, the ABIM wasn't unable to provide solid independent evidence that a secure, high-stakes exam—taken every decade by some and for which others are "grandfathered" and therefore exempt—leads to better patient care. The ABIM is a dangerous entity and they have employed danger as their future course which we should change ASAP.

RCR said...

To: The Whole Thing was Endorsed by a Federal Court said...
"I am not sure anyone can say that the seizure was illegal when a Federal Judge signed off on it. I think for sure the ABIM will be get nailed for many other things."

The ABIM misrepresented the facts and the need for an ex-parte writ. In seeking an ex-parte (one-side only) writ to seize and impound property, one must realize that this is an extraordinary form of relief for the plaintiff and there will be no fair and level playing field from the start as a result. A sealed order means that Dr. Arora is not to see it or know what is coming, totally blindsided. I would call it the worst kind of cheating you can imagine inflicted on an old man. It was heinous and violent. Arora was not allowed the courtesy of retaining an attorney to be present for ABIM's raid.

A raid is just that. It is total surprise. We hear about it rarely, because it is not granted easily, it must bear the burden of legal definition and test, and usually only in egregious pirating of copyrighted material that is being sold illegally for a profit on a mass scale, substantially undermining your sales as a plaintiff.

To induce a judge to order a seizure without giving the other side a chance to tell its side of the story, you have to persuade the judge that there is no other side to the story, and that the defendants are essentially crooks. History of Arora's compliance over wording in his newsletter was satisfactorily resolved amicably with a letter. What changed with Dr. Arora's course? Nothing.

What nobody knew the ABIM hired an ambitious felon without experience in testing security created a civil nightmare for the courts and physicians and this should be understood how and why it occurred so that it does not happen again. Physicians must also understand what kind of dirty tricks attorneys the ABIM hires. They need to be watched like a hawk and brought up before their boards for manipulation of the courts and other people's lives.

Ballard Spahr attorneys must respect their oath to uphold and defend the constitution. To expose the ABIM and their attorneys is important for many reasons. The legal techniques and dirty secretive tactics are similar to how MOC was implemented. Secretive tactics and dirty tricks.

A strong steady light needs to be pointed at the ABIM and Ballard Spahr at all times. 200,000 physicians and millions of patients need to know how corrupt and self-complacent they are about it. It is time to stop them from harming others. The ABIM should voluntarily seek to compensate those people they have harmed. They should look at the ABIM Foundation as a big insurance fund to pay back physicians for all the damage they have caused through the greed and arrogance of their executives.

Dr. Arora was in good standing with the ABIM, ACCME accreditation, ACGME approval, and had an exemplary course with a money back guarantee and presumably a good rate of success that program directors coveted to send their residents to attend his course.

RCR said...

Ask this as a lodestar: Was Arora a good citizen or a crook in the eyes of the program directors, ACCME, ACGME, students? Obviously he was a good citizen and nobody every considered him a "crook."

Therefore, a judge was misinformed and I would say lied to by six responsible ABIM related individuals that the only way that they could resolve any issues that they had with Dr. Arora's competing class, was to use extreme intimidation and not allow warning or to have the right to a lawyer fighting for him in a discovery process. We did find out that the ABIM never attempted to contact Dr. Arora with a letter or any other means of communication other than to plant a spy and secretly record his New York course in 2009.

Furthermore, Dr. Kachadourian, who is named in ABIM's motion as a defendant had her house raided also. This was a violation of her civil rights. In fact she was confused to be an employee of Dr. Arora by ABIM, which she was not, so the ABIM got a great deal wrong in their presentation of "facts" to a federal judge.

Then we come to the 50 John Does named as defendants, who were totally unknown, that ABIM tacked on to their motion and writ in their fishing expedition to go after individuals who took Dr. Arora's course. And they too had their dignitary and constitutional rights violated by misrepresentations told by a felon looking to make a name and lucrative business for himself after essentially being unemployable in his current profession. After being thrown off the police force and then getting in even more trouble with felony convictions involving a violent beating he inflicted on a citizen of the United States of America. This man had rights also. He had the right not to be assaulted and kept from getting medical attention at the point of a loaded gun. Real police intervened and threw the book at Mannes charging him with violent assault, impersonating a police officer and felony gun violations. Mannes has lied on his CV's and to others involved in certifications and employment.

So, my point is that the ABIM's Christine Cassel, Ariel Benjamin Mannes, Rebecca Baranowski are being put on notice that what they have done is reprehensible and violates dignitary and constitutional rights. There are criminal charges that can be advanced against such misrepresentation to a court. We are just discovering these things out. In such a situation of misconstruing and presenting selective facts, the onus is on the plaintiff to get the facts right, which they did not.

Real honest facts told to a judge would have made the judge balk and justice would have been served in leveling the playing field for Arora, Kachadourian, John Does 50, which turned into thousands of individuals. All this is illegal and improper. Whether a judge was coerced, fooled or otherwise influenced it is still, objectively speaking, a violation of many fundamental civil and criminal laws. Lying to a judge is worse than obstruction. If anyone disagrees about their worth as an individual in a free society, then we have a problem about the value we place on civil liberties and privacy. Only collectively can we uphold the constitutional rights and civil standards that we deserve.

Why is this important? Because the rights of 200,000 physicians will be at the mercy of the ABIM and easily stripped of their rights at any time over any slight issue or accidental or incidental act that they feel harms their testing empire. Dr Arora was an old man and should have had the right to a vigorous defense and taken the ABIM to court for violations done to him, his family and all the other thousands of sanctioned physicians. These rights are priceless. You know this to the fullest extent of personal suffering when they are taken away.

Unknown said...

Thanks for thumbing down. Wes is right. Shaming the ABIM is useless. Only legal action and gutting them by prohibiting credentialling and pay to be associated with certification will work.

Unknown said...

Well done Wes and company. It's about time this industry was exposed for what it really is: wholly self serving. Over the last 30 years education has become nothing more than a pretext for the ABIM / ABMS; its all about the money.