Tuesday, October 25, 2016

Are Hospitals Hurting Their Physicians?

It's becoming a near daily event for my email in-basket: receipt of another real-life story describing how the American Board of Medical Specialties (ABMS) and US hospitals are joining forces against capable doctors:
I am trying to find physicians in FL who have unfairly lost ABMS certification and as a result have been unable to find reasonable positions in Medicine.

I am a radiologist certified by ABR in 2002, the first year to require 10th year (re)certification. I lost my contract with a hospital in 2010 and took locums positions as I could find them after that. I have passed the recertification exam, for which I paid $2000, but because of short term locum positions, was not able to complete PQI requirements and consequently lost my certification. Now, unless I sign a promise to never sue the board (emphasis mine), I cannot even sign into my page on the ABR website to see my status. Since losing the certification the only work I have been able to find is a bottom-feeding imaging center where I earn less in a year than the MRI and CT technicians, while working 55-hour work week with no more than 3 unpaid weeks of vacation per year.

I am certified by the National Board of Physicians and Surgeons thru March of 2017 but this is not recognized by most locations. I was turned away at the door when I drove to NC after being invited to interview for a position. The reason -- the certification I had was not recognized except for by a handful of places.
What is going on?

It appears the ABMS Maintenance of Certification (MOC) recertification requirement is creating the situation where capable, experienced physicians are losing their job on the basis of this unproven "quality" metric.

I am sure similar stories are occurring elsewhere. There are only about 809,845 US physicians active in patient care nationwide. Many of these board-certified physicians, formerly a lifetime credential, are now receiving letters from their hospital credential committees insisting they recertify thanks to a unilateral rule change implemented in 1990 by the ABIM strictly for their financial benefit.

Why would hospitals (who need physicians to staff their hospitals) do this?

As usual, I believe it's about the money.

Many physicians are employed by hospitals that help train medical school graduates in their specialty. To do so, their post-graduate training program must be accredited and approved by the Accreditation Council on Graduate Medical Education (ACGME). Hospitals that are not ACGME "approved" cannot receive additional Medicare revenue for training these residents in medicine. The ACGME (and Joint Commission) accreditation process requires program directors to be ABMS board certified. And wouldn't you know: both the ABMS and JCAHO are member boards of the ACGME.

Appropriately experienced and trained physicians should have the right to work without having to pay into a corrupt system that funnels their money toward non-clinical executives' lavish salaries, luxury condos with chauffeurs, first class airfare, health club fees, and other delightful creature comforts, including world travel. I believe hospitals would be wise to side with their practicing physician staff on this issue. Don't hospitals need these experienced physicians to staff their clinics and to do the necessary work of training residents and caring for patients? Or do they just plan to hire less experienced (but cheaper) program directors instead? What would such a move mean to tomorrow's caliber of physicians?

How long before the growing frustration of residency training program directors swells to the point that they refuse to participate or just retire early?

I would hope that the leadership in the American Hospital Association (AHA - another member board of the ACGME) is considering these issues. Physicians unjustly targeted should come forward and join the AAPS anti-trust suit already filed against the ABMS. And currently employed physicians who have not yet had to endure this hassle should work with their Medical Executive Committees to incorporate alternatives to the ABMS MOC program in their hospital bylaws now.



Anonymous said...

The FTC sued the AMA in 1975 for setting "ethical" policies that restrain trade. The FTC was successful and after the expected squirrelishness the AMA eventually complied. From reading the particulars of this lawsuit it is quite clear that ABMS/ABIM are currently on a parallel path to that of the AMA in 1975. MOC and the 10 year re-test are NOT VOLUNTARY for anyone wishing to practice medicine. The ABMS/ABIM's use of an arbitrary unproven metric to restrain trade should absolutely be getting the attention of the FTC. Everyone, PICK UP YOUR PENS!

Donald Duck said...

From the ABMS into the lucrative world of "K" Street lobbying; or is it off to the ACGME or NQF top positions? The revolving door opportunities are endless and the money is mouthwatering.

Rather than announce that the ABMS President/CEO will end mandatory MOC, as the AMA House of Delegates so resolved, Lois Nora (CEO of the ABMS) decides to resign/run away to bury her head in the sand. Does she plan on having her head rolling in MOC revenue counting all the money for the next 14 months? She needs to keep her deferred account active after all.

But then is not every physician afraid of the liability involved in running one of the most corrupt political organizations and racketeering scams in Chicago. Nora is leaving at the end of her five year contract. Taking the golden parachute option is a no-brainer compared to staying and rolling up one's sleeves.

Typically a half-billion dollar corporation announces the CEO's retirement or informs of new employment in a proper press release. But his is typical.

The ABIM has undergone complete restructuring without letting anyone on the outside know when key officers leave or change positions like Lynn Langdon and Nick Hines. We still have had no press release on their "K" street all star line-up and professional fund-raisers for the DNC.

And we still don't know who stayed at the condo and what type of activities they engaged in. Lobbying with cocktails and nighttime view and discreet chauffeur unless you slip them a hundred bucks.



drfrappe said...

The AAPS does have a suit in progress against the ABMS. They would be good ones to comtact as you are a prime example of how this does in fact restrict trade. http://www.aapsonline.org/AAPSvABMScomplaint.pdf