Saturday, January 27, 2018

MOC® and the Gaslighting of America's Physicians

For the past several years as I (and others) have uncovered the corruption and the profit-driven nature of the American Board of Medical Specialties' (ABMS) Maintenance of Certification® (MOC®) program, I've had a growing sense of professional ennui and self-doubt concerning my effort and wonder if my efforts over all of these years will change anything and ever be worth the time and effort I've expended.

No matter how hard I've tried to expose the theft of millions of dollars of our testing fees to purchase an expensive $2.3 million condominium for the ABIM Foundation, the millions more for real estate purchases (see here and here), exorbitant salaries and use of our dollars to hire felons and legal teams as a "Test Security" division to strong-arm physicians, expose the undisclosed financial conflicts of interest ignored in our most esteemed medical journals, discussed with main stream media, appeared in person at AMA House of Delegates meetings and before state Heath Committees to testify on this corruption, nothing seems to change.

Instead, I have been called an 'unhinged' and 'virulent' critic by American Board of Internal Medicine lawyers or threatened with allegations of defamation by Wall Street attorneys as verifiable findings are tossed aside, ignored, or new Vision Commissions created to continue the manipulative (and financial) status quo. Despite everything exposed by myself and others regarding the harm imposed on physicians by this program, MOC® remains strongly supported, promoted, and (more importantly) mandated by our largest bureaucratic professional medical organizations and hospitals - all members of the Accreditation Council on Graduate Medical Education (ACGME) - as if the corruption regarding MOC® didn't happen, isn't true, and not that serious.

After a much needed vacation away from my clinical demands, I now understand why I feel the way I do.

Practicing physicians are being "gaslighted."

Gaslighting is a malicious and hidden form of mental and emotional abuse designed to plant seeds of self-doubt and alter physicians' perception of reality. It is my belief that by supporting MOC® in spite of the evidence against it, the ACGME and their member organizations (chief among them the American Board of Medical Specialties (ABMS), the American Medical Association (AMA), and the American Hospital Association (AHA)) use gaslighting to establish power and control over physicians on the front line of patient care and state legislators that are being encouraged to support it.

I encourage physicians to review this brief video on the origin of the term "gaslighting," and how it is used to manipulate the narrative on MOC®:

What to Do About the Gaslighting

A second interesting Ted Talk (video) by Ariel Leve gives tips on how to deal with the gaslighter. I encourage those interested to view it. In the video, Ms. Leve, a journalist who endured gaslighting by her mother for years, suggests four ways to deal with the gaslighter that have applicability to physicians and politicians at the forefront of the anti-MOC® movement today:
  1. Remain defiant.

  2. Recognize there will never be accountability.

  3. Let go of the wish for it to be different.

  4. Develop healthy detachment.

Given this reality, broad-based physician defiance and non-compliance with MOC® remains our most potent weapon against it. Understanding the psychological manipulation caused by gaslighting by the ACGME in promoting MOC® is the first and most important step in overcoming this damaging program (and others that will likely be developed in its place) in the future.


PS: A survey of Board-certified practicing physicians regarding MOC® is still being conducted. If you have not done so already, please complete the survey here.

Thursday, January 25, 2018

MOC Survey Update

The MOC survey, sponsored by Practicing Physicians of America, continues to be completed by a wider and wider physician group across the United States and US territories. Every single state and US territory have physicians who have contributed so far, but more are still needed to improve the credibility and statistical significance of the survey. Many physicians and state medical societies have worked diligently to assure frontline physicians voices are heard.

ALL physician voices are welcome. The average time to complete the survey has been about six minutes. Realize that all physicians will not see all questions on the survey due to logic contained in the survey. For instance, physicians who have not recieved their initial board certification will be have to complete questions on MOC (or Osteopathic Continuous Certification (OCC)).

I would encourage all doctors to share this survey with their colleagues and continue to circulate if as far as possible. I hope to be able to present these data at the AMA House of Delegates meeting in June 2018.

Thanks to everyone who has contributed so far. 


Friday, January 12, 2018

Collecting Practicing Physician Perceptions of Board Certification

An important new survey was launched today to gather information needed to provide strong, data-backed, counter arguments to the American Board of Medical Specialties and the American Osteopathic Association that continue to advertise their lucrative Maintenance of Certification® (MOC®) and Osteopathic Continuous Certification (OCC) products. Thanks to social media, this survey has the potential to be the largest and most authoritative of its kind, but not without your help.

As the MOC® controversy continues, I encourage all practicing all US ABMS and AOA Board-certified physicians to share the survey with your colleagues and include your names and email addresses (not required) to improve the survey's integrity.

Please take about 10 minutes of your time to complete this survey to provide us with the data necessary to defend practicing physicians at a national level against regulatory capture and third party intrusion into our profession.


Saturday, January 06, 2018

In JAMA: MOC® Denounced

This week in JAMA, the ABIM and the entire ABMS member board structure received scathing repudiations in letters from Carlos J Cardenas, MD, President of the Texas Medial Association, and Bradley D. Freeman, MD from the Department of Surgery at Washington University School of St. Louis in Medicine. Here's a snippet from Dr. Cardena's letter:
As Dr Johnson pointed out, self-regulation is a core attribute of the learned professions. It encompasses the responsibility and authority to establish and enforce standards of education, training, and practice. Physicians routinely defend that responsibility and authority in advocating against the intrusion of all third parties (such as government, private insurers, or hospital administrators) into the practice of medicine.

However, as evidenced by their comments at the Texas Medical Association and American Medical Association House of Delegates and at the committee hearings on SB 1148, many physicians today simply do not acknowledge the certifying boards as “self.” They are, instead, profit driven organizations beholden to their own financial interests. The MOC process is too expensive, requires physicians to take too much time away from their patients and families, and, most importantly, lacks sufficient research to document the benefits to patient care. Many physicians say the information studied and tested has little applicability to their day-to-day practice.

Thus, the certifying boards, for all their talk of ensuring physician competence in a world of rapidly expanding scientific and clinical knowledge, are not “self.” In fact, they are one of the outsiders intruding into the practice of medicine.

Until and unless the boards acknowledge their position as outsiders and completely overhaul their processes, finances, and lack of transparency, physicians in Texas and across the nation will have no choice but to continue to seek statutory defenses against these third-party intrusions into the medical profession.
In reply, Dr. David H. Johnson, former member of the ABIM Board of Directors from 2007 to 2015 (and its Chair from 2013-2015) and author of the original JAMA article entitled "Maintenance of Certification and Texas SB 1148: A Threat to Professional Regulation" attempted to defend ABIM's actions. He parroted these tired ABIM talking points while referencing the ABIM website or blog:
  • 800,000 physicians "choose" ABMS Board certification (as if they have a choice if they want to get a job)
  • The reorganized their personnel to assure "more than 70% of current ABIM governance members spend more than half their time in clinical care." (as if that addresses the ABIM's actions)
  • How they "rolled out" every 2-year "Knowledge Check-Ins" (so we could be distracted from patient care even more frequently)
  • And most of all, assured physicians of ABIM's transparency by referring the reader to their website and "Guidestar Platinum designation" (which they pay for and create themselves), calling this the "good faith effort certifying boards are taking to address the concerns of Cardenas and Freeman."
We should not be surprised that a massive $2 billion dollar a year industry would do MANY things to protect its income stream and avoid responsibility for its actions against practicing US physicians. Here's a short list of EVEN MORE things Dr. Johnson failed to mention the ABIM and the ABMS member boards have done since the MOC controversy arose over five years ago to cover their tracks:
  • Sold the ABIM Foundation's luxury $2.3 million dollar condominium at a loss
  • Offshored millions of our dollars to the Cayman Islands
  • Authorized Cristine Cassel, MD a $1.2 million golden parachute as she left for the National Quality Forum in 2013 under Dr. Johnson's leadership
  • Said goodbye the Eric Holmboe, MD, the unlicensed physician "Medical Director" of the ABIM now works at the ACGME.
  • Changed the ABIM Foundation webpage to erase the fact that they had claimed it was created in 1999 for the purpose of "defining medical professionalism" while giving our money to their favorite institutions and causes without generating revenue for itself (other than investments).
  • Claimed that the ABIM "only" took $55 million from ABIM diplomates to create their ABIM Foundation from 1990-2007, when, in fact, they took well over $78 million for their personal and political purposes.
  • Fired their long-time auditor because of the tax fraud that has taken place for years.
  • Ended their contract with their long-time lobbyist (reported as a "consultant") after this improper expenditure for a 501(c)(3) organization was exposed.
  • Said goodbye to their much-loved felonious "Director of Test Security" that helped organize a "sting" operation against vulnerable residents attempting to study for their board examination and closed his division in the organization
  • The ABMS member boards are making even more changes now, creating a whole new "Vision Commission" that plans to spend countless hours creating the next bureaucratic boondoggle for themselves at our expense.
  • Thanks to the entire ABIM Board of Directors' lack of leadership and oversight, the ABIM is likely insolvent (video).

Dr. Johnson should know all of these points, but chose to ignore these details in his reply letter in JAMA. He would likely claim he was constrained to add these points by a word count given to each respondent. Yet by failing to mention the past and current financial and political transgressions of the ABIM that he helped direct, Dr. Johnson, the ABIM, and all ABMS member boards represent the antithesis of what credible professional self-regulation should embody and should remain responsible for their actions going forward.