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.


Anonymous said...

Gaslighting is a symptom but not cause. Correct diagnosis is mandatory. Big picture is healthcare is being reworked to force acceptance of single payer. Many of us will walk away at that point. This is foreseen by the serried ranks of programmed NP's which stand ready to march into the breach.

First item on the agenda is the docs themselves must be divided, broken and cowed with showers of confetti like regulations and laborious busy work, like MOC.

AMA, ABMS, SMA's etc are all appointed commissars to oversee implementation and control of this agenda IMO. They are well paid, enjoy the control and do not share any of the concerns of working docs.

Mass MOC non-compliance is the only effective way forward.

an official of the Communist Party, especially in the former Soviet Union or present-day China, responsible for political education and organization.
a head of a government department in the former Soviet Union before 1946.
a strict or prescriptive figure of authority.
"our academic commissars"

Atlanta Dr said...

Dr Wes- PLEASE do not stop your HEROIC efforts on our behalf- Unfortunately change comes in baby steps- but together we can affect it...

Ed Rico said...

ABIM implements a Felon Goon Squad for the express purpose of violating Diplomates/Candidates' Fourth Amendment protections and they call *you* 'unhinged' , Dr. Wes ?

ABIM and their Cartel Cronies have honed their routine to Deliberately Obtuse mode and Ostrich Strategy, punctuated by furious tap dancing and blowing smoke, because that's all they have. Elites aren't used to having their usurped authority questioned and they're not very good at hiding it.

Unknown said...

Thank you for you. Your beacon of light and hope is a ripple that you don't always see. You offer hope and sanity as we trudge on in our own trenches.
Thank you for being you!

Christine White said...

You and other physicians who are putting their time and money and professional futures on the line in fighting the groups that wish to control physicians are doing a GREAT thing for docs and patients. It will take longer than we would like for big change to come, but with people like you spurring the rest of us on, it WILL come.

PLAY THE $$$$ GAME said...

Wes, there is too much money involved for these corrupt bureaucrats to disappear.

This is a multibillion dollar industry fueled by money from our pockets and the American Taxpayer. That's why no matter how they dither and hem and haw, the long game is the money game. Folks are refusing to pay the MOC Tax or delaying it substantially. It has utterly disrupted the ABIM cash flow. Older physicians on the cusp of retiring in the next 10-15 years are practically daring the ABIM to take them to court. The loss of that cohort alone will severely deplete the ABIM/F coffers.

Much progress has been made. The ABIM has shuttered multiple silos in their organization. They face more litigation which will drain their budgets. The literature is full of data completely destroying the ABIM narrative. The ABIM is a static, sclerotic, willfully ignorant organization facing skirmishes and attacks from dozens of fronts. There is a new venue for conflict resolution as more State anti-MOC statues are formalized. More opportunities to take the ABIM to court.

In as much it seems as if there is slow progress or no progress, I would submit we are at the cusp of a reformation at the ABIM.

Play the money game. Don't give these corrupt bureaucrats a single nickel.
Richard Baron will be fired soon. The ABMS "Commission" will conclude that new leadership will be needed.
Let's see how well Baron adjusts to taking weekend night call and seeing 40 patients in 15 minute slots.


Alexi Wright co-authored an editorial with her wife in the NEJM.

It would appear that even the academics in the most ivory of all towers are getting fed up with the bureaucratic nightmare.

It's part of a new narrative. Physicians are committing suicide in epidemic proportions. Healthcare is more about clicks, MOC ABMS B.S. and non sensical metrics than it is about taking care of sick patients. 14% of the GDP is dedicated to healthcare but it is diverted not to physicians and patients but to ABMS Physician Bureaucrats congratulating themselves at the Four Seasons as they skim money to pad the spreadsheet at a Cayman Islands pension fund.

The stench of rotting physician corpses in body bags and the even more pungent stench of Rich Baron and the ABIM stealing money so they can retire comfortably and then hop on the NQF/Lobbying circuit will overwhelm the senses of the Department of Justice and the IRS.

Tick Tock Dr. Baron et al.

drrjv said...

Keep up the good work, Dr Wes

You've had a big effect. Even our hospital (Bayhelath Medical Center in Delaware) just recently included NBPAS certification as an alternative pathway for privileges (it took a year for a forward-thinking group of physicians to get it passed :-)

Bungus said...

Just stop sending these jerks your hard-earned money. Just say "NO"!

Anonymous said...

Amen brother, join NBPAS, say NO to MOC and quietly walk away! Many of us have just done that. Starve the ABMS beast of your hard earned dough.

Anonymous said...

You have enemies? Good. That means you've stood up for something, sometime in your life.

Winston Churchill

James Noble, M.D, FACP said...

Two wonderful comments, and thanks for the link to the gaslightlng piece.

I have had one of those mental editorials floating round in my head for the past few years, addressed to the Quality - Value - Engagement -EHR Establishment.

The title is "What Have You Done?"

This has been a long struggle. When my Dad graduated medical school in 1947, he was advised not to do a residency but to go right into practice "Because Truman is going to take everything over in a few years". When I went to medical school in 1972, we were told in the first week that the Bright Shining Future was just around the corner.

Well, it's taken them a long time to break us. During my whole career, now past 40 years, my style for dealing with the Reformitariat has been to deploy the famous Han Solo line to Luke Skywalker - "But who's gonna fly it, kid? You?"

Beginning with the IOM report about hundreds of thousands of preventable deaths, onward to metrics for "quality", the reflexive and very clever strategies hospitals adopted to minimize service (length of care) and maximize revenue while cleverly assigning new diagnoses to the frequent readmissions, until the coup de grace - the EHR, which crushes the time for the patient encounter down to a few precious but totally inadequate minutes - it's time to admit that we are beaten.

They have created a simulacrum of a system to care for patients which can do everything but. They cannot measure anything important, so they declare what they measure to be important. Getting a predictable complication in an ICU, in a patient destined to die in 3 months anyway.? Bad. Very bad. Sending a sick, frightened, frail old person out of a warm bed with caring nurses into a snowstorm because the Geometric Mean has been hit? Good. No, very good.

They insist we use evidence, or even, boldly, the "best evidence", but THEY get to say what constitutes evidence.

Life is Short, but the Art, long
The Occasion Fleeting
Experiment Dangerous
And Decision Difficult

I am closer today to Hippocrates than I am to the Director of Quality Management. Or Care Management. Or the Revenue Cycle.

But Hippocrates is dead.

Anonymous said...

I would maintain that because of our personalities and our responsibilities, Gaslighting is particularly effective on physicians. It is not just the Boards that use it - it is also a favorite technique used by the management of physician employer groups, particularly management with an MD degree. It is a very easy way for them to reverse accountabilities and say "we are not the problem here - you are."

And not to be offensive, but I think physicians although high IQ are generally very low EQ. To combat Gaslighting we need to get our EQ up! We need to understand ourselves and how we are being manipulated. We need to assertive ourselves and be willing to be defiant!

Wes-keep up your brave work!

Anonymous said...

Where is the 2017 ABIM ABIMF tax forms? Why is it taking the ABIM to release their statute mandated Federal Tax forms?

DrWes said...


For the past several years, ABIM/ABIMF have requested “extensions” to their filing deadline. If granted, they will have until May 15, 2018 to file their 2017 returns.I suspect the delay is secondary to such a request.

Anonymous said...

I like the comment by another "Anonymous" a couple of comments back: "management with an MD degree." Because that's exactly what they are. The health systems, the medical group employers, etc. hire people with an MD degree to herd the cats, and you trust them, assuming they're on your side, the side of patient care. Sometimes they have additional training and have made a name for themselves in research.They get you to accept their "guidelines" for quality care, for example at the hospital OB committees, but when you really start to think about it, those "guidelines" don't really improve quality, they're designed to lower cost for the hospitals by decreasing nursing labor time. And by voting them in, you've just shackled yourself to do things in ways that are not in patients' best interest. Another venue that is available to us, at least in states with a corporate ban on the practice of medicine, like California, is to report these individuals to the Medical Board. They are assisting in the corporate practice of medicine, plain and simple, and they're a danger to patients. We have not been using the government agencies that are tasked with oversight because we have been conditioned to remain silent by the system, starting with Risk Management at the hospitals. Shaking off the chains that bind you is very liberating and it inoculates you against "physician burnout." The most important thing to remember is that physicians are professionals, and professionals don't outsource their thinking to anyone.

Unknown said...

It is beyond ludicrous that non physicians and non active practicing physicians should have any input into the 'credentialing' of physicians completing their training least of which on those that are actively involved in the daily care of patients.