Wednesday, April 04, 2018

Feldman: MOC is Good For You

It was helpful for me to read this take on maintenance of certification from Wake Forest dermatologist Steve R Feldman, MD, PhD in There are so many straw dogs here it boggles the mind, but the piece exposes a level of naïveté by academic supporters that really don't seem to understand the myriad of problems with MOC. Take this quote, for instance:
The provision of medical care is highly regulated. Not all the regulations are to physicians’ liking. Along with our monopoly power, comes controls that are designed to assure the quality of the care we provide. Our education has been regulated, getting licensed has been regulated, and getting certified has been regulated. Now, maintaining that certification has been regulated, too.
Dr. Feldman justified MOC because, well, we need more regulation! He seems to imply we should just get over it folks: the unaccountable member boards of the ABMS can do as they please with your money. Buy a condo in the name of "Choosing Wisely?" Sure. Send some funds off-shore to the Cayman Islands for their retirement fund while you do the dirty work of seeing patients? Sure. Buy a nice pond or purchase a nice car collection with your colleagues testing fees? Heck yeah! And why not run a for-profit real estate management firm with certification funds, too? Why of course! Then you can perform research on your colleagues without informed consent! And best of all, you can make sure your pals on the Dermatology board force working physicians into becoming HIPAA Business Associates to CECity (A subsidiary of the $4 billion hospital Group Purchase Organization, Premier, Inc.) when they sign up for their recertification tests? Man, the digital data party never stops giving!

Poor guy. Maybe Dr. Feldman didn't know about all this. Or maybe he still needs to threaten working doctors to scratch his social justice itch. (Let's hope not.)

But if that was not enough, Dr. Feldman made this suggestion as an alternative to our current re-certification mess:
If the argument that MOC has not been shown to improve quality, claiming a CME requirement assures quality seems suspect at best. What would a serious solution look like? It would have quantitative, representative measures. Perhaps, it could include random independent evaluation of videotaped patient encounters, supplemented by review of treatment decisions made of lesions and rashes based on photographs or on “secret shoppers.” All the really serious means to document and assure quality would be far more heinous than anything being considered now.
Threats of physicians won't dispel the truth about MOC: it is corrupt to the core. It has harmed physicians. It threatens their right to work on the basis of metric that does nothing to improve the quality or safety of patient care.

Dr. Feldman asks for a viable alternative to MOC. Really, the answer is very simple.

End it.


... just as the AMA House of Delegates voted to do so almost three years ago.



Anonymous said...

There are a lot of ABMS elites who claim they are/or were participating in MOC, but when you look at their timelines and activities during the year they allegeldy took their tests, one discovers that they had no time for studying let alone going to a testing center. Christine Cassel got golden gloves care when she "worked" for the ABIM and ABIM Foundation.

A grandfathered physician in internal medicine, Cassel only "chose" to do the geriatrics certification when it was clear she was next in line for ABIM Foundation Chair and the heir apparent to the ABIM presidency. Testing, if it was done at all by Dr. Cassel, was done at the ABIM and with help. She knew little of medical practice. She was a politician and still is. The state of California would not give her a medical license for some reason when she became founding dean of the Kaiser Medical School. It was not just laziness, she would have a big problem getting a new license anywhere to practice medicine.

After leaving the ABIM Christine K. Cassel's true feelings for MOC emerged with relinqushing her geriatric medicine certificate by refusing to take a ten-year ABIM test. This in spite of the high positiion at the NQF and as founding dean of Kaiser's new medical school.
That sends a clear message to the fresh med school candidates that MOC is only for the huddled masses and not for the elites after all.

Dr. Baron has not come forward to show us his test center receipt or email response when he allegedly renewed his geriatric certification. He has been a director at ABIM since 2001. Another perk of the job? Free tests unlimited assistance? Whatever it takes to get us to do a test but not Baron. He had no time to take a test and there was not record at a test center. We are still waiting for him to display the proof of all his tests. 2018 he will have to go to a testing center in Philly for his 10 year test. We would like to see the proof of that reservation at this time. We are very doubtful there is any intention of doing what others are required to do at a center.

Bob Wachter is another former officer and director of the ABIM who will not post his MOC test center receipt and email/proof that he actually did the test at a public facility like all the rest of us are required to do.

So what is MOC for the elite ABMS executives and board of directors? A perk or bonus for doing the job as executive, with whatever personalized help they need?

It should be clear by now that many at the board execs and directors "cheated on the tests" or had a proxy take it for them at the medical board offices. Or just had a computer cook one up for them. That will be hard to do no as everything bears a time stamp and code that tells us many details.

Unless we have proof, not from the ABMS CERTIFACTS site but with a reciept and email from the testing center and proof of payment, we must assume that MOC is not really about any dire concern for patient safety on the part of the corporate enterprise known as the ABMS.

MOC Poster Child said...

I think the ABMS poster child Carmen Puliafito and his stained hands tell us a great deal about ABMS elites. Puliafito had strong ties with the AAMC, ACGME, ACCME, AMA, ABO, and so many other ABMS partners that it is surprising that his certification with the ABO is not suspended at least.

Maybe it is time to revisit this story and get an update on the ABMS/AAMC/USC Keck money boy with so much ability to squeeze money and energy out of everyone.

It does not look likely that Carmen Puliafito ever took his recertification test himself given that he rarely showed up for work and had his hands too full of illicit drugs and prostututes.

Under the circumstances it would be appropriate to suspence his certification to protect the public. Is that not the ABMS' role to protect the public? They certainly have no problem with revoking/suspending hundreds of innocent victims' certifications without due process in 2010 and later before any facts were known.

There are a great deal of details that would at least prompt the ABMS/ABO to send a letter of reprimand to the certified doctor who "volunteered" to participate in MOC for some reason and with so little time to spare for the task it seems.

Puliafito is just as much a nightmare for the ACGME, AHA and AAMC as well who he partnered with - all affilites of the ABMS.

Puliafito has surrendered his California license. Should he not also voluntarily surrender his certification. This failure to act on the part of the ABMS is a reflection of the financial and political courruption that is causing its collapse as we write this. No one trusts them anymore.

Barb said...

The AMA Delegates voted to end MOC immediately. And it has been nearly three years and nothing has been done by any of the leadership? How much lobbying do they do with our membership dues.
Obviously some people don't get the fact that those delegates were intended to speak for "we the people". The ones who paid for that advocacy and the rights of patients to have access to care.

What a party! said...

Wow! No idea how low the ABMS and the American Board of Opthalmology's measure for maintaining certification and professionalism has fallen. I can see MOC and the entire ABMS truly is all about the money!

Tina K said...

I have nothing but respect for Dr. Feldman, but academics just don't get it. It would be nice to have those of us in private practice weighing in on the value of MOC--or lack thereof, as the case actually is. Sad.

The art of self-dealing among the ABMS/AOA medical boards said...

MOC is not good for physicians or patients. It does harm by limiting access to care and diminshes the amount of time and potential quality of care. This is an unfortuneate consequence when millions of patient contact hours are wasted on a redundant and costly metric. Everyone knows its all about the money. If you speak for MOC its going to be about money or moving up the political/bureaucratic rank. This bureucracy is choking healthcare and sucking out the lifeblood in terms of time and cost.

Moreover what the ABIM and ABMS does with MOC revenues is not good for anyone. They stuff their greedy pockets to the max with the MOC booty. Then they engage in partisan politics, and even manipulate the world as if it were there business. These "indispensible and exceptional" hubrists whith their profits even break the prime directive of non-interference in other countries' political and social structures.

The adventurism they engage in domestically and internationally is outrageous and it comes at the expense of taxpayer and client. Look at the tax forms and court documents of those they have discriminated against and abused; public documents (if not supressed) spell out the profound indignities they inflict on unwitting US populations and we gete bits and pieces of the unsettling practices abroad.

One thing is for sure. We never get the whole picture of their greedy games as exeutives and their spouses fly first class conducting clandestine business deals, while they engage in political activism and secret lobbying. They cover it over on their tax returns by shifting money categories around and have amnesia about their non-profit charitable status.

MOC houses built on quicksand said...

Political and financial liquifaction

MOC equates to undeclared profits given to executives in the form of obscene payouts. But for what? What do the executives really do. What do they engage in. And why do they charge so much for tests? It is insane to keep insisting on a horribly corrupt and flawed maintenance of certification program? They keep going down in professional reputation after they re-built their 24 houses on what appears to be political and financial quicksand. The ABMS should be investigated by the DOJ, IRS and Dept. of State, because of their foreign transactions and connections.

MOCBETH said...

The billion dollar question: why do ABMS execs insist on mandating MOC and keep pretending it is voluntary?

They act like Macbeths washing their hands over and over trying to convince themselves they are not a party to the corruption and injurious collusion.

What is even more suprising they are mum about even trying to convince us otherwise.

These sleep walkers in crime will not even deny that they had anything to do with the creation of the biggest education Ponzi schemes in the history of the world.

"Damn spot, out I say."

What disparate selves guide this fragmented wreck of an institution?

Nonesuch Players said...

The ABMS is comprised of tragic figures indeed. But we do get some occasional comic relief when we see these naked emporers at a rare townhall meeting wearing nothing but an ass' head.

ABIM CLT said...

What is amazing about the dubious ABMS and its shadowy partners is how much like a cult it is.

One of the most defining and concerning things about a cult is that it's fairly easy to join, but very difficult to leave.

The other thing is that the cult members are invariably forced to pay for it all.

P Brayn said...

MOC is a distracting shell game in order to perpetrate fraud.
Round and round MOC goes, where it stops nobody knows.

Unknown said...

I read this piece as pure satire, it cannot be taken at face value. Just walk away folks, drop out of MOC and deal with it. Starve the beast. Until the MOC opt outs reach critical mass this dirty cartel remains. Docs are so obedient and respectful of the (corrupt) status quo it is sickening.

Dr Feldman totally invalidates his hypothesis with "even though additional testing has not been demonstrated to prove competence."

The ridiculous driver's/pilots analogy again? The skills needed to fly complex jets in instrument conditions are not the skills needed to practice medicine. Period. The latter are not tested by repetitive exams. Period.

Poor, silly doctors let's get off our knees and do the right thing for a change! The case for immediate elimination of MOC has been made in spades, what are you waiting for?

20/20 Views said...

The perpetrators of MOC and those who maintain and support the onerouos program typically speak from a place of money and political control. Political lust and financial avarice are their chief features and contribution to the world. Moreover what stands behind the ABMS' history of financial strongarming is the propagation of a heartless ideology under the guise of egalistariain healthcare models which profess the stewardship of finite resources. But what the ABMS does in reality starkly contradicts what they pretend to stand for. The cold truth that the ABMS flagship and satellite member boards have demonstrated a highly-honed and trademarked version of intellectual deception and patent hypocrisy as their core products is difficult for many people to fathom or accept.

Yet it is there, and we can hear their newspeak and doublespeak in that third core product of the ABMS which annoys to no end - their continuous evasive silence on the subject of ending MOC, which their parent organization's House of Delegates voted overwhelmingly in favor of.

The AMA House voted to end mandatory MOC.

that the ABMS executives and their partner organizaton political course in the world have little to do with caring for people and much to do with harming them.

War Machines and ABMS Certified Partners said...

What goes around comes around: Reed/Elsevier, Clarion, Blackstone, Middle East Arms Trade

The 1,2,3 and abc's of the arms trade and how it affects the health of the world

Wealth and Health said...

"On May 20th, 2017, U.S. President Donald Trump signed a US$350 billion arms deal with the Kingdom of Saudi Arabia.[1][2][3] The arms deal was the largest in American history.[4][1][5] The transaction included tanks, combat ships, missile defence systems, as well as radar, communications and cybersecurity technology. The transfer was widely seen as a counterbalance against the influence of Iran in the region[6][7] and a "significant" and "historic" expansion of United States relations with Saudi Arabia.[8][9][10][11][12]

On June 5th, it was reported that the arms deal consists of "a bunch of letters of interest or intent, but not contracts."[13]"

The signing occurred at the Riyadh Summit, and was part of Trump's 2017 series of visits to the Vatican, Saudi Arabia and Israel. It also was related to a $20 billion investment in mostly American infrastructure. [21]

Saudi Arabia signed billions of dollars of deals with U.S. arms producers and energy companies, including Lockheed Martin, Boeing, Raytheon, General Dynamics, Northrop Grumman, General Electric, Exxon Mobil, Halliburton, Honeywell, McDermott International, Jacobs Engineering Group, Rowan Companies, National Oilwell Varco, Nabors Industries, Weatherford International, Schlumberger and Dow Chemical.[22][23][24][25][26][27][28]"

"Saudi Arabia joined The Blackstone Group in May 2017 in a $40 billion fund to invest in stateside infrastructure projects.[29]"

Truth about Trump's 110 billion saudi arms deal

Trumps inks arms deal with Saudis 4/6/18

ABMS/ACGME/JC International said...

What is the aim? Money? Political intrussion? Corporate expansion? Why? How effective is this US based cartel? What is it really about and who are the players involved?

With a staff of 4 at ACGME International, what are they hoping to accomplish and how can quality be measured? Is it about the money in the end and some ambiguous effort to control?

ACGME International

"Relationship with ACGME
• Similar mission/ vision/ values
• System is designed to help country needs
• Inter-woven resources (data collection, field
• ACGME-I staff: 4
• Separate program requirements/ accreditation/

Our challenges
• Political differences
• Qatar, UAE, Oman, Saudi Arabia
• So far effect on GME is unclear
• Physician practice differences
• Family Medicine practice quite different, based on
population needs
• Pediatrics Adolescent Medicine in Middle East
• Pathology requirement for autopsies in Middle East
• Normal workload of physicians varies
• Differences in the quality of certification
• Strong desire for region-specific certification

Our approach
• Maintain quality but provide for flexibility
• Remove US-centric requirements
• Allow for variable program length
• Use region-specific milestones
• Provide a tiered approach to accreditation,
particularly for under-resourced countries
• Partner with stakeholders to address"

Why did ABMS Singapore get involved in Singapore's health system. The end result is not the same standard as we have in the US? How much money did they spend on this global adventurism? Do we get facts or glossies about their aims and relationships?

ABMS Singapore's ABMS/MOH experiment

ABMS International

ABMS Qatar
"Second Meeting in Doha Between ABMS International, LLC and Representatives of Healthcare Institutions from Across the Middle East >
Date: 6/24/2013
Continuing discussions on regional certification of physician specialists to promote high‐quality health care in the region, Weill Cornell Medical College in Qatar (WCMC‐Q), a member of the Qatar Foundation, and ABMS International, LLC (ABMS‐I), a subsidiary of the American Board of Medical Specialties (ABMS), met with representatives of elite healthcare institutions across the Middle East. The discussion focused on partnering to develop physician specialty assessments in internal medicine, pediatrics and emergency medicine for regional certification."

Is it about business, money and expansion of markets or quality?

The Joint Commission International

"International healthcare accreditation
JCI Gold Seal of Accreditation
Gold Seal of Accreditation
Joint Commission International, or JCI is one group that provides international health care accreditation services to hospitals around the world and brings income into the U.S.-based parent organization. This not-for-profit tax-exempt private corporation (a 501(c) organization) currently accredits hospitals in Asia, Europe, the Middle East, Africa, and South America and is seeking to expand its business further.[31]

The JCI has a small staff which includes principal consultants [32] and a number of other consultants from around the world.[33]

Cost of accreditation
JCI publishes an average fee of $46,000 for a full hospital survey.[34] Reimbursement for surveyors' travel, living expenses, and accommodations is required in addition to the survey fee.

For hospital to be successful in the accreditation process, there may be additional costs related to consultancy work prior to accreditation.

International accreditors incur different levels of costs with some costing less than JCI."

Anonymous said...

If the ABMS, ACGME and partners were properly investigated authotities would find a surfeit of public fraud at home and a wealth of it abroad. If ever there was a need for a special prosecutor this is one of those times, because what the ABMS and company are involved in touches the lives of everyone in the United States. The educational Ponzi scheme called MOC is only the tip of the iceberg regarding a mountain of far-reaching collusive corruption, financial deception and fraud.

Anonymous said...

Dr. Feldman is an apologist for MOC. His faux naïveté is a front for his sinister dealings. Look up, his creation to satisfy the heretofore eliminated MOC requirement of patientand peer surveys. He fails to disclose that he profits from MOC. He also fails to disclose that he was board certified in 1990 so he is grandfathered from MOC and has never participated in any of it. He’s trash and an example of the near sighted, self aggrandizing and megalomaniac characters we have in academic medicine.

Dirtlink®* *Annual MOC fees apply} said...

ABMS/ABD looking for test pilots in 2019 (Tell me it's not about the money!)

Meet DERMAMOC proving our committment to enhancing the value of ABD investment accounts:

Useless on-the-fly distracting testing brought to you by the greedy makers of ABMS MOC.

Actual press release below from the ABD website

"The American Board of Dermatology (ABD) is committed to enhancing the value of Maintenance of Certification (MOC) for our diplomates. To that end, we are pleased to announce the launch of a pilot program that offers an alternative to the traditional closed-book MOC exam.

Based on longitudinal assessment principles, the ABD CertLink™ Pilot program provides the utmost flexibility in maintaining your certification. The ABD plans to launch this pilot with a limited number of interested diplomates in 2019, gathering feedback on the process to inform future enhancements and the possibility of adopting CertLink™ as a new means of assessment.

The process of conducting assessment spaced over a period of time gives diplomates a smaller number of questions, at defined intervals, to accommodate preferences and practice-based needs. Throughout the year, a mix of core, article-based, and subspecialty questions will be presented online and via your mobile device, allowing you to access them when you want and from where you want—at home or the office. Because we know your schedule can be unpredictable, we are designing the program to allow you to choose when to answer the questions, within certain time frames.

The ABD pilot program is hosted on the CertLink™ assessment platform, which is powered by American Board of Medical Specialties (ABMS) and developed with input from ABD and several other ABMS Member Boards. CertLink™ questions are based on high-quality, practice-relevant content. Immediate feedback on question performance helps close the knowledge gaps created during the sometimes lengthy period of time between taking a traditional test and receiving your results. With CertLink™, when a question is incorrectly answered, the diplomate will later receive related content questions, providing an additional opportunity to learn. An interactive, private dashboard summarizes your question activity and is always available for reference and review.

No new fees will be charged for the CertLink™ program. All expenses are incorporated into the current annual MOC fee.

The ABD looks forward to launching this pilot in 2019. We will be in touch as more specifics of the pilot are determined.

ABD exploring an alternative to the traditional closed-book MOC exam."

MOC: a scam exposed said...

This cunning ABMS Ponzi scheme is not only injurious to the overburdened US taxpayer, it is a despciable assault on our healthcare system targeting decent hard-working physicians and the patients who need care.

When will the ending of MOC be fully supported by the AMA and the millions of $ we pay.
Or is the lack of coordinated effort on the part of the AMA to end MOC an clear indication of
how deep the conflicts go and how corrupt the powerful member societies have become.

NevusAlone said...

Dr. Feldman aka "the rules are for thee not for me"

and he gets to make money off our backs, a parasite on the carotid of his fellow doctors! what a tool! we must en masse stop complying with MOC!! it gets fed by our hard earned cash!! enough!!!