Sunday, August 14, 2016

American College of Physicians Stands By ABIM MOC Program

Like the co-dependent spouse of a raging alcoholic, the American College of Physicians (ACP) continues to support the completely corrupt and untrustworthy American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program.

In a carefully crafted e-mail to its members, Steven E. Weinberger, MD, Executive Vice President and Chief Executive Officer of the ACP recently stated:
"We're aware that serious concerns remain about issues related to MOC, expressed most recently in a statement of no confidence in ABIM by the Pennsylvania Medical Society, ACP, along with others, was asked to sign on to the statement. We chose not to because we believe the ACP should continue to press ABIM to improve the MOC process as quickly as possible to make it more relevant, efficient, valuable, and affordable to internal medicine specialists and subspecialists. Although we understand and respect the concerns of the PA Medical Society and others, ACP's priority is improving the process by which physicians demonstrate ongoing competence, and we believe we can have the greatest impact by taking a collaborative approach to making change rather than getting involved in other aspects about ABIM as an organization."
Despite the exposed corruption, illegal lobbying, financial malfeasance, strongman tactics, conflicts of interest, and illegal research performed on physicians for monetary gain, the ACP still choose to side with the Medical Industrial Complex rather than practicing physicians. Rather than siding with their own senior members who are Masters of the ACP, (i.e., Charles Culter, MD, MACP, who has been a outspoken critic and well-respected leader in exposing the ACP's own conflicted role in the physician education and credentialing cartel, among others), the ACP basically is telling their own membership they know what's best for them: MOC.

Then, like a frog leaping from the boiling bath of physician discontent regarding the corrupt and financially-conflicted ABIM MOC program, Dr. Weinberger (like Christine Cassel, MD, former President and CEO of the ABIM) decides to split and toss the MOC controversy hot potato to his successor, Dr. Darilyn Moyer:
"As many of you know, I am retiring from my position as ACP's Executive Vice President and CEO after Labor Day. At that time, I am delighted to turn over this responsibility to ACP's new EVP/CEO, Dr. Darilyn Moyer. As Dr. Moyer takes over her new position, I know she is as committed as I have been to seeing this process to a successful conclusion. Further updates will be coming from Dr. Moyer, but I will assist her as needed over the coming year as part of my interest and responsibility in assuring a smooth and seamless transition process."
Rest assured ACP members will remember Dr. Weinberger's "interest and responsibility" for supporting the MOC program. I encourage as many ACP physician members as possible to no longer renew your membership with the organization.

After all, it is now clear that the ACP is more about the ACP than its members' real concerns.

That's because their new "ACP Practice Advisor offers three new modules (author's note: for a price, of course) that (1) address key attributes and expectations of patient-centered medical homes, (2) are aligned with the Center for Medicare and Medicaid Innovation's Transforming Practice Initiative and the proposed MACRA rule, and (3) are eligible for CME credit and MOC points."

It's so sad to see that integrity, honesty, and financial transparency in our physician specialty societies are now officially being supplanted by little more than corporate greed as they abandon their responsibility to their members in favor of the virtually unlimited fees they can impose on their membership in the name of "health care reform."



Anonymous said...

ACP are spineless.

I wont be renewing my membership.

W.O.R.M. said...

The ACP leadership are akin to prepubescent street urchins role-playing as wannabe tough guys with wooden swords and all. Quite unlike the ABIM, whose political, legal, and organizational connections and tactics can be used to professionally hurt and extort you. Its pay to play with them. The ACP is more of a finishing school for future corpmed cronies transitioning in and out of a revolving door between governmental and private interests.

I fully support Wes's call to drop membership in the ACP. He has clearly demonstrated to whom their loyalties lie. Not with rank and file physicians currently under withering crossfire in this imploding ACA landscape. They do not support us, and we should reciprocate in kind.

Now here's the good news. Dissociating from the ACP is easy and painless. No twelve-step program is required. Simply do the following:
1. Stop paying membership dues,
2. Ignore anemic pleas to send in YOUR money.

I dropped my membership a number of years ago. There's nothing to miss. Outside literature and CME offerings abound. In return, you will gain the self respect of refusing to submit to a toothless organization that co-opts your financial resources and has aligned itself with powerful and corrupt entities that regard physicians as little more than cash cows. Let's send THEM a message for a change.

Anonymous said...

why does any practicing clinician choose to pay membership fees to the ACP! they have completely abrogated any sense of advocating for physicians. on their website they have link about 'patients before paperwork' but obviously it is just lip-service as there has been no real action by the ACP to do anything. don't want to anger anyone in the insurance industry.

Thomas Nielsen said...

This disgrace called MOC is just part of the larger sham called Obamacare. This entire system is more about politics than medicine, more about fat paychecks for those in charge than healing people. What we need is to empower doctors again and restore the doctor-patient relationship as an important part of our health system. Time to leave system-based, dehumanizing, patient-as-widget, "progressive" medicine behind.

It's all about the money and politics said...

"ACP moved into the lucrative New Jersey/New York/Pennsylvania ABIM certification market after muscling in on Dr. Arora's board prep territory and shutting him down.
(They set back and intimidated other prep courses and let them know big brother is watching, surveilling. Chilling effect on fair commerce.)

Here's the egregious result and the proof for any doubters about the willful intent of the ABIM/ABMS/ACP/AMA/ACGME to retrain trade and exercise their power over others. This is a very raw and obvious example of classic racketeering.

ACP's live certification prep courses offered for a pretty fee

ACP's streaming online/digital MOC courses marketed with an "offer you can't refuse" - if you fail the test"

Anonymous said...

MOC is just the tip of a toxic iceberg. It would be naive to have expected the American College of Physicians to censure the financial shenanigans of the ABIM. The relationship between the two organizations is incestuous with the officers of both the organizations frequently having served both organizations.
Why are they so powerful? because they carry the male of academia which is a cover for many nefarious activities.
Dr. Wes as an admirer of your determination all i can say is "Bravo". Unfortunately the political lethargy that infects our profession is I am afraid going to eventually lead to its destruction.
I am afraid however that like minded individuals and you are tilting at windmills .
It's too late the medical Judases have collected their thirty pieces of silver after seeing out a noble profesioni

The ACP needs a new leader. said...

Totally not surprised. Steve Weinberger was my attending on service when he was still a clinician in Boston. He left clinical and academic medicine in the mid 1990s to pursue this administrative position. Very cushy. Who can blame him from protecting his friends at the ABIM. He's making well over $800,000 a year telling everyone that ABIM MOC is cost effective and necessary. Steve is a great doctor but he is in a political conundrum. Does he support the clinicians who are out in the trenches taking care of sick patients or does he take care of the political elite in Philly?

So far it looks as if Dr. Weinberger has turned his back on the clinicians. He is opting for the ACP linking arms with the ABIM and stealing money for their salaries, perks and obscene benefits.

Steve- what has happened to you?

Anonymous said...

I quit ACP last year after a membership of almost 33 years for all the reasons stated above. I don't miss it in the least. Membership dues statements from ACP go in the same circular file as the ones from AMA.

Anonymous said...

ACP has MKSAP and their own board review course. Being a member of ACP gives you a discount on the books.

Many people buy the books multiple times during the course of their 10 year cycle.

Think about what would happen to their income!

All decisions are financially driven!

Anonymous said...

ACP, as the legal parent of the largest medical board (ABIM), is obviously pleading the fifth.
Every dollar the ACP makes from MOC is dirty money. Every dolllar the ACP and ABIM executives pay themeselves is money from racketeering. The AMA is the other leagl parent of the ABIM.
They all self-appoint and pay themselves with dirty hands. The first woman to head the ACP was Christine Cassel. Cassel has spread the dirt of corporate greed/government corruption from Walnut Street to Pennsylvania Avenue. The health care reforms that Cassel, Wachter, Baron and the rest of her cronies pushed through involved the illegal use of organizations and illicit collection and utilization of funds breaking US laws governing non-profit organizations. They all broke racketeering laws. (AMA and ACP as legal parent organization are legally responsible.) The executives of all three organization (AMA, ACP and ABIM) inclding their highly compensated employees/enablers are all corrupt to the core and belong in jail. There should be no money paid or received for engaging in fulfilling their sacred duty to humanity. The only honest thing for the outgoing head of the ACP is to take the money out of these corrupt organizations and return the money to physicians and pay the overude tax to the government and taxpayers. Then admit your wrong to the authorities and insist on the organizations being cleaned up. Anything less is a lie. No amount of money can hush up the truth that everyone of the medical boards and parent organiations have morally died and been transformed into Machiavellian organizations serving to ration healthcare and serve up political propaganda. Self-appointed and unvetted executives/crooks line their pockets and the bottom line of the Medical Industrial Complex corporations, executives and stakeholders.

Anonymous said...

I quit ACP many years ago

sub-optimal acceptance said...

In a decent society, most of these people would be in jail.

Let's call it for what it is. These organizations we speak about here have become "elite members only" clubs. Greedy medical membership societies and medical boards, etc., have become corrupted beyond recognition. Their self-appointed executives sold out American values and democracy. They sold out themselves.

For money and political power they sabotaged the US healthcare system in an attempt to gain complete corporate/political control. They have nearly completed their corporate/politico coup, but their is one big problem: They broke the US healthcare system and our democratically elected country--comprised of governmental checks and balances--virtually beyond repair in the process.

Physicians who mindlessly or reluctantly pay these corporate "quality assurance proxies" and their "crony political societies" aid and abet their elite masters who are proven to be involved in such domestic and global villainy as would most likely even shock any of the leaders of former notorious brutal fascist regimes.

Anonymous said...

Part of the problem is the media is no longer responsible. The "press" is no longer free.
As an example the 2016 elections are controlled events and we don't get any truth from our media--only disinformation. Even the physicians involved in one of the presidential candidates healthcare may be misleading the public and harming the health of a very unhealthy battle-scarred woman who cannot/will not hold up to the pressures of the election or the office of the presidency. This is not just an example of the corruption of the system but is the very analogue of where we are headed with so-called healthcare reform, that is to say, something very unhealthy is being pushed on our nation that will cripple it to the core. And this unhealthy prescription keeps getting shoved down the throat of the American taxpayer by our elected officials who are lying to us as is most of the media. The ACA is just a corporate-backed political campaign using emotional and propagandist arguments to sway a nation. But the nation has had a stroke and is headed for a bigger one if we do not reverse the lying about medical reality and the artificial flow and unnatural pressure created on our health system. It is unhealthy and unsustainable. This reform and corruption has its roots in the previous Clinton administration of the 1990's and even earlier during the Nixon and Johnson administrations. These healthcare reform efforts/experiments failed to deliver and left us a mess, but the problems were more isolated to specific health care organizations early on, and was not the broad-sweeping unconstitutional violation as mandated by the illegal ACA legislation of today.

A review of how this legislation was passed and what non-governmental organizations were used and how taxpayer money was manipulated is unprecedented in the history of the United States and warrants a thorough independent investigation. The ACP, AMA, and ABMS should be at the forefront of representing physicians, but instead they manifest the expansion and control of our government by an unelected "deep state" that represents corrupt major corporate entities.

The US in danger of a fatal hemorrhage and the press is silent. Physicians are silent. It is not my story; it is not my patient they say. And fear of losing one's livelihood is the rule of the day. The press is controlled by corporations and the political elites who serve them. Meanwhile the voter is swayed by the political noise and not the truth. We need more than fragments of reality; we need the whole truth.

ACP Needs Political Courage like the PA Med Society said...

When Steve was in Boston, he was part of a hospital merger between the Deaconess and the Beth Israel Hospitals. The process of merging those two hospitals was difficult to say the least. Lots of egos. Lots of back stabbing. Steve was part of the leadership in the DOM that helped guide this process with the late Dr. Moellering. I can tell you that he was one of a dedicated corp of diplomatic leaders. Although he was hugely biased, overall he did a good job to try to build bridges.

His recent political decisions at the ACP as it pertains to the MOC is a big surprise. The ACP has not reached out to its constituents adequately. The ACP is not seeing this MOC issue from the clinicians point of view. MOC is massively overpriced and a utter waste of time. There are no data in the literature to indicate it helps to do anything for patient care. The ABIM and the ABIMF are two hopelessly corrupt organizations. The ABIM and the ABIMF have totally failed in their mission. Why? Greed. Greed for money. Greed for power.

Steve left Boston about 17 years ago. He is at the tail end of a long career.

If the ACP leadership cannot understand the burden the ABIM MOC process is placing on the shoulders of physicians, then Dr. Steve Weinberger needs to leave and the ACP needs new leadership.

Steve, you either support your constituents or you should step down.

What is the ACP? said...

ACP and Steven Weinberger: physician advocates or political propagandists?

Has the ACP become a political organization involved in spending membership fees on lobbying for partisan healthcare reform?

What is the AMA? said...

AMA and Steven J Stack: lobbying to usurp 2nd amendment rights?

Has the AMA become a political organization involved in using member fees on lobbying for partisan healthcare reform?

Anonymous said...


Maybe the fees paid to these corrupt greedy political organizations should be contingent upon them being used to support its members.

Better yet: turn the AMA and ACP into powerful physician unions headed by rank and file physicians and include concerned citizens devoted to physician-patient rights and interests.

At present these member organizations have nothing to do with its members and everything to do with corporate greed and power. They are non-governmental organization working to undermine democratic processes through the power of the purse and political professionals devoted to big paychecks (bi-monthly kickbacks and deferred bribes) and partisan political agendas.

deMOCracy said...

Powerful Political Cults

The psychological behavior and philosophical premises of the ACP and AMA are totally deranged. They are no longer free-thinking societies, but have become part of a 'political cult'.

The scope of the ACP and AMA has gotten totally misaligned and their political weaponry is aimed at physicians and patients to undermine both through propaganda, limited dysfunctional systems, and a divide and conquer approach.

All patient privacy is gone. The primacy of the physician-patient relationship has been violated. Gone! It has been replaced with an Orwellian invention, the likes of which, quite frankly, astonishes me how quickly physicians and patients have willy nilly accepted.

Who said if you repeat a lie to the masses fifty times it becomes the truth? Physicians and their patients have become like children taking candy from master propagandists in order to get them trained to lie down.

What comes next?

Stand up and do something before it is too late.

MOC is a Means Of Control said...

What is the relationship of Christine Cassel and George Soros?

What is the connection of George Soros with the ABIM Foundation?

What is the connection of George Soros to the Clinton Foundation?

What is Christine Cassel's connection to Bill and Hillary Clinton?

Are George Soros and the "Clinton crime family" personally profiting by foreign policy and the horrific conditions that they helped create?

Was the ABIM usurped by the Clinton crime family via proxies like Christine Cassel, et al?

Was the ABIM Foundation usurped by the "Clinton crime family" and cronies via Christine Cassel et al?

Was the NQF created by the "Clinton crime family" via their proxies in order to pursue their future corporate/globally funded political and financial interests?

Did the "Clinton crime family" compromise the security of the United States by aiding and abetting criminals involved in terrorism, illegal drug trafficking, money laundering, and more?

Has the "Clinton crime family" been directly involved in suppression of evidence about their own criminality, but also the criminal activities of others?

Maybe you should look into it?

It may be all related and you will understand why THE CLINTONS, Christine Cassel, Robert Wachter, Richard Baron and all the others can get away with various crimes that no ordinary citizen would get away with. It is not just about one set of rules for the elite and one set of rules for commoners, it is about something much more sinister. Much more heinous than the abuse of power and office and why we the people have no democracy.

Of interest is how the Clintons during their term in office turned a Turkish criminal (under investigation for international crimes including murder and assasination} into one of their assets. WikiLeaks will be releasing more supportive data on this.

FBI whistleblower Sibel Edmonds speaks on the "Clinton crime family" and the investigation she was part of while under FBI employ. The Clintons according to Edmonds pressured the FBI to reclassify incriminating evidence that would have brought a criminal and his network to justice, but instead the alleged criminal was given safe harbor in the United States to Pennsylvania. It is a shocking story.

Anonymous said...

Core thug values of the abim!

Anonymous said...

The ABIM, has taken a page from the same corrupt playbook and hired a goon squad to carry out its attacks on physicians to undermine and neuter them in the "healthcare system" and American society in general. The ABMS has been completely complicit in these various and continuous attacks, which not only utilized the improper use of the media to demonize and prosecute, but involved spying and collecting of files on physicians and non-ACP board prep courses and study materials through an illegal sting operation. They used a highly unusal ex-parte seizure of personal property and are guilty of many civil liberties violations. I consider what the ABMS did to be tantamount to a coup of American civil liberties, due process, right to privacy, etc...

We will not accept such illegal actions to be buried and forgotten. We won't let these crimes, which include racketeering and selective politically and financially motivated legal persecution and character assassination of physicians to go unpunished as carried out by ABIM executives, their hired felons and goon squads.

Lord John Russell said...

I was just looking up Mrs. Clinton's personal physician on the ABIM website. She is listed as "board certified" on the ABIM site. Her name is Dr. Lisa R. Bardack. Curiously, she is NOT listed as "Participating in MOC."

MOC Hall of Shame said...

The coming crash/major correction in the US quality assurance/medical bureaucracy

The taxpayer and the Fed want their money back.

The US taxpayer is paying higher taxes to pay for organizations like the ABIM, ABMS, AMA and ACP whose executives have their boards (on which those same executives are de facto principals) write huge paychecks, VIP health packages, tax-dodging deferred compensation, retirement accounts with matching contributions, travel perks, working 'luxury vacations', and guaranteed future advisory position/paycheck with the same or similar political/corporate crowd of state proxy actors when they 'retire'.

Transitional year paychecks for elite member societies that serve themselves

Look at this Weinberger guy with the ACP at how he will get paid to look for another elitist executive/advisory job and pass on the political/corporate agenda to the next corporate head. Lifers like Lynn Langdon at the ABIM exist in each of these organization. It is time for the money and the lifetime/generational corporate/political control and corruption to go.

Reporting on the medical bureaucracy/quality assurance scam

I'm not a physician but I can assure you once this scam gets out to the American public this political gravy train will be over and there will be DOJ prosecutions with IRS investigations.

In a real free and open society these heads should be rolling in vans with federal marshals off to maximum security prisons where they can get a taste for what the real world is like that they have helped create with their phony egalitarian political propaganda, grand theft of client money, price-rigging, racketeering, interstate trade restraint, awarding fat paychecks for non-pecuniary positions, and money sucking luxury condos called 'investments'.

Phony professionalism; taking back the achievement awards for (greedy) frauds involved in fakery and corporate/political scams

Just consider all the professional awards and sugar-coated press releases they give each other for practicing political cronyism and for slurping off the financial cream, sucking the healthcare delivery system dry with 33% of the financial cost burden, physician shortages, and bureaucratic waste created by these elite vampires.

Wages for taxpayer sin/fraud is a taxpayer-funded cell-block accommodation

The sweet chauffeur driven ride for these elite professional medial bureaucrats is over. I just hope they have enough cigarettes and other contraband to barter with in prison to find a stasis with the powers to be. And I sincerely hope they get courteous selfless cellmates like themselves that will not impose anything on them and allow them to get a good night's sleep. It would be terrible if these elite bureaucrats from the MOC Hall of Shame were assigned to a cell with some angry repeat offender upset about the lack of good jobs to support their family or a person disgruntled over their parent's diminishing health and healthcare coverage.

Anonymous said...

Dr. Fisher, there is a growing number of people who follow your blog, who like myself, are dumbfounded at what is going on behind our backs. We are angry as hell that strings are being pulled by elites from the cover of shadow organizations that strangely somehow have garnered decades of respect. ACP, AMA and ABMS and so on.

Who outside the profession of medicine ever heard of the ABIM?

Well, now we have, and we, as taxpayers and responsible citizens concerned for our family's health coverage and years of paying for bogus quality assurance are not going to bend over and take it anymore in the tax year.

We see why our taxes are going up and how we get less and less health care for our hard-earned dollars. We agree that the media have shilled for manipulative corrupt political practitioners at the ACP and ABIM who have nothing to do with serving the public and everything to do with serving themselves.

We also feel the physician's pain as they must suck up to these profligate political bureaucrats who have docs in a choke hold known as regulatory capture.

It is clear what is going on. Total greed, power and corruption.

Now it is time to shut these useless and wasteful organization down. They are broken beyond repair and enable so many other shadowy things that are undesirable in healthcare and our society.

It is obvious that physicians do suffer from Stockholm syndrome and are fear-mongered from medical school on, or this extraordinarily dire situation would have been corrected long ago. Or never been allowed. I would have taken to the streets. I hope the core of our moral culture has some sense of legislative activism and the guts and true grit left to bring about the needed changes.

A lot of us who once supported the propaganda of these organizations without understanding their source or the real nature of the charade might suggest that Dr. Fisher take this fight to some of the radio talk shows who don't yet see the connection of Hillary Clinton (and Billy Clinton) to the present healthcare crisis and how a Clinton presidency would just make these organizations more powerful, wealthier and corrupt.

Physicians usually do not have the quality of bold forthright language and sufficient reach into the populace to effectively bring about awareness enough to spur us toward the investigative and judicial action needed to correct this horrendous regulatory capture--which includes the onerous MOC mandate and the ACA burden. All that we see coming out of "Hillary care" and these organizations only harm the patient and physician. That comprises the whole of our nation.

Czarina of War and Queen of Death said...

I wonder if one day a reporter will ever bring to light the real horrific significance of having one of Hillary Clinton's healthcare appointees added to Obama's white house as PCAST advisor. I am speaking about the dual role of Hillary Clinton as corporate healthcare reform queen through her proxy Christine Cassel (and her cronies) while Hillary Clinton as State Department Czar wreaked havoc and death on other nations leaving them in chaos.

Our healthcare system has likewise been ravaged and left in ruin by the same person in charge of both our nation's healthcare and foreign relations. Both positions have left our nation in debt and afraid of the terrorists that the Clintons helped create through arming of terrorists as proxy fighters to produce regime change or create complete chaos. The staggering civilian loss of life and exodus has been obvious. Now we are rationing out healthcare out as though we are a broken defeated nation, not a triumphant and healthy one.

What an honest reporter must ask themselves about our Democratic party is does the Democratic party even exist today? If it does exist why is the Clinton/Kerry foreign policy determined by closet neoconservatives advising and controlling Hillary Clinton, John Kerry, and Obama. Why are neoconservative policies ruling the day war mongers like Hillary Clinton and John McCain struggling in vain and with ill effect to dominate the world through our military or intelligence operatives. Our military is strained, maimed and has been psychologically framed into fighting decades of war after war. It is not uncommon today for our uniformed personnel to be a veteran of three wars. Yes, they are wars and war is hell.

So Hillary Clinton has borne two roles in government as of late. She has been Czar of deathly foreign policy and queen of a deathly healthcare cost-slashing policy that has us polarizing the world and secretly creating a system of rationing for healthcare to pay for more and more air power, terrorist foot soldiers, more US personnel involved. That means the US under Clinton will be taking part in armed conflicts involving US forces, and uncontrollable proxies creating a bleak future of more and more destabilizing destructive wars and global terrorism.

I come from a military family. I know what sacrifice for our country is and what it means to lose family and friends. If biased reporters still insist that we have peace and prosperity, then why have we steadily expanded NATO breaking agreements, encroaching on borders of nuclear powers with such aggressiveness that we bring back the cold war of the past? As I travel abroad this summer interested in facts and not fiction, I have heard many people accuse the United States of war crimes and torture. The slant on the news is very different when their country is in the US crosshairs and powerful media demonization.

Just as this medical healthcare crisis is not accurately explored and reported so it is with our foreign interventions. These armed conflicts with tremendous loss of life and destructive power are not defensive at all. They have been nation building interventions and regime change.

The bottom line bombs and lives are being wasted. Healthcare is being rationed and wasted eliminated to pay for the destructive power of offensive operations in other countries that have left power vacuums. Taxpayer dollars and lives are being wasted on these foreign interventions. We need to free rank and file physicians from the tyranny of a wasteful bureaucracy and let them practice and lead again, not the professional medical bureaucrats like Christine Cassel who are corrupt to the core as is Hillary Clinton. Both women and the corrupt organizations and entities they represent support war and death with their neoconservative politics and disgusting immoral behavior and total disregard for civil liberties, law and democratic principles.

ranjan paul said...

it is so pathetic how a number of people in our profession who are completely spineless devoid of any moral standings,have no interest of the constituents they profess to serve.the whole leadership of most of our physician organisations have shown none are really there for us.they all will do things so they can maintain a position and power .its shame.all i can say that more of us have to get involved to get rid of these kind of people from the positions of power and get people who are really looking after our interest,and keep things transparent and also scientific.WE NEED TO GET THE ABIM TO STOP THESE RIDICULOUS TIME CONSUMING WORTHLESS TESTS EVERY 10 YEARS IMMEDIATELY.No reason why they cant suspend this and let us participate in much less onerous and less expensive process.none of their arguments hold true that they are weeding out dangerous internist.we all are practicing for a long time providing good quality care with good outcomes for our doing a 10 year exam doesnt provide any improvement.what about the rest of the years,do any one of us remember all the things we read for 10 years for these exams .only some things remain and other are mostly forgotton with the information overload.we need to have a system by which new developments and updates are sent to al of us on a regular basis with little or no cost to us.they can ask for some questions to be answered on that so they they can see the stuff was read.