Tuesday, January 15, 2019

Council of Medical Specialty Societies Weigh In on Their Vision for MOC

Just in the nick of time, the Council of Medical Specialty Societies (CMSS), another (smaller) member of the Accreditation Council on Graduate Medical Education (ACGME) that represents medical specialty societies, issued its public comment on the ABMS Vision Commission Draft Report on Maintenance (and Continuous) Certification on the last day the Commission is taking comments.

What is important is not only what the Specialty Societies said in the statement, but what they did not say.


  • That initial certification and continuing certification are two separate products offered by ABMS and their member boards and have "different purposes."
  • Specialty societies are in support of initial certification and the value of a secure examination for that purpose.
  • The recognition that boards have a responsibility to "inform organizations that continuous certification should not be the only criterion in these decisions" and further "encourage hospitals, health systems, payers, and other health care organizations to not deny credentialing or certification to a physician solely on the basis of certification status."
  • They had "serious concerns" with four issues:
    • Use of high-stakes, summative examinations as part of continuing certification
    • The practice improvement component
    • The role clarity between certifying boards and specialty societies
    • The timeline for implementation.
  • They likened the issue of trying to improve ongoing assessment of physician competence to "trying to change the tire on a moving car."
  • It was clear the specialty societies wanted to divorce themselves from the "assessment" side of continuous certification to the kinder and gentler "learning" side of "continuous certification."
  • And it looks like the specialty societies want to leverage the ABIM's earlier definition of "professionalism" created by the ABIM Foundation to leverage their own social justice imperative to participate in continuous certification, rather than just that needed by ABMS.
  • They acknowledge the high degree of physician burnout and the need to implement their recommendations in a timely manner.
  • They raised the "grandfather" and "grandmother" issue and voiced strong wording that the ABMS better not to mess with that exclusion, less the "grandfathers" at the specialty societies have to participate in continuous certification, too.
  • They thank the Commission and "require further collaboration and discussion prior to implementation."


  • They do not mention the finances of the ABMS member boards and the $5.7 billion dollars physician spend annually to participate in continuous certification.
  • They do not mention how the data collected from computerized testing of US physicians is used to ration their patients' care by insurance companies.
  • They do not mention how certification data are used to dovetail clinical registry data, physician data, and electronic medical record data, and the money earned by specialty societies for that collaboration.
  • They insist in continuous certification even though it has never been independently shown to improve patient care quality or safety over participation in independent physician-driven continuing medical education.
  • They do not address the excessive salaries and perks offered to the board members and officers of the ABMS Board system or the ACGME itself. (Should the head of the National Board of Medical Examiners really earn $1.2 million annually, for instance?).
  • No mention is made of the many conflicted parties that have benefited financially from the continuous certification process, including, but not limited to, PearsonVue, Premier, Inc., state medical societies (like Massachusetts Medical Society - owners of the New England Journal of Medicine), specialty societies (like ACC), medical publishers (like Wolters Kluwer and Elsevier), and the finances collected by AMBS Solutions, LLC.
  • Finally and most importantly in this CMSS comment letter, there was no mention (or acknowledgement) of the harms caused to physicians by "continuous certification" in terms of financial and psychological hardship, decreased patient access to physicians, strongman (coercive) tactics used to force participation, political motives that benefit these organizations, and the limitations that such a highly restrained and controlled educational product like "continuous certification" places on working physicians who must also deal with their overriding responsibility of caring for patients every single day.
In my opinion (as I've said all along), Maintenance of Certification was a clever shell game used to force physician purchase of a product created by American Board of Internal Medicine (ABIM). That product is far beyond any imposed by states to maintain licensure and requirements for Continuing Medical Education. MOC was rebranded and modified on multiple occasions by ABMS and its member boards to generate continuous cash flow to the ABMS member boards (and now specialty societies) without proof of its value to patients.

Without acknowledging and dealing with the corrupt realities of the MOC (and continuous certification), the recommendations issued by CMSS in their comment letter should be rendered moot.


Please give generously to our legal fund to end this corrupt educational product nationwide.


Anonymous said...

One would have hoped for more courageous leadership from the medical specialty societies.

Anonymous said...

I hope this blog post makes it to the vision for ABMS response for them to read. I saw Roxie Albrecht on the commission. I hope she remains the no non sense tough surgeon at Oklahoma when I trained there when it comes to this vision statement.

Anonymous said...

The Vision Commission is a diversion drawing attention away from the "ABMS MOC EXCHANGE".

Anonymous said...

Baby steps. It's a start at the very least. (Nice touch with the " grandmother's" inclusion).

UCSF State of the Union Address said...

$5 Billion Strategy& Equity Fund

UCSF Investment Company (Foundation)

Investment Company Board

Greening of Pearson UK with American MOC Dollars said...

The United States does not need MOC, but the ABIM/ABMS needs the money. Boycott MOC!

Pearson Plc has a history of lobbying in America pushing for lucrative high stakes testing. How much have they profited by pushing MOC in America when no other country on earth is buying it! MOC is an onerous royalty tax pocketed by rich elites. MOC is big green fodder for the likes of Pearson Plc/Pearson Vue and their ABMS puppets of thirty years.

Baron has been their lobbyist/stooge for at least two decades at the ABIM.

ABIM has their cork tightly invested in the MOC testing bottle.

Pearson and the ABIM are business partners. Tax forms from the "Platinum Star" NGO no longer inform the public how much the ABIM is paying Pearson Global every year. MOC is profitable and the ABMS and their extracurricular activities would fall apart without MOC and the MOC "MOB" to implement the mandates.

To prove the point. Look a the new Knowledge-Check-In and the arrangement for Proctored Online Testing with Pearson Vue (Division of Pearson, Plc). They signed a multi-year, multi-million dollar contract with the ABIM, which is outlined in the last financial statement from the London based Pearson.
ABIM MOC Policies/Fees [$500 International Surcharge 10 yr. Exam; $100 extra for 2-yr KCI]

Pearson Vue wins MCAT contract with AAMC [AAMC long term contract]

2018 Half Year Results Professional Certification - 2018 through June

"In Professional Certification, the launch of a contract to administer medical college admissions tests contributed to revenue growth, we renewed 42 existing contracts, signed 45 new agreements and five contracts were not renewed. Pearson’s Professional Certification business, VUE, partners with more than 500 credential owners across the globe."

MCAT Fees [$110 International Surcharge, regardless of fee assistance program eligibility]

The Demise of Patient/Physician Autonomy said...

The Suspension of the Patients' Bill of Rights

There are no rational justifications for onerous MOC® mandates and MOC® money demands.

MOC can be summed up as an unfair manipulation of the professional medical labor force (hard working physicians) coerced into paying for their own burnout and ultimate demise.

Billion dollar Ponzi scheme

$ Billions of dollars have been sucked out of the professional labor force/healthcare institutions flowing into the hands of a corrupt quality assurance cartel.

$Why have these NGO's of recent formation done this horrible thing to patients and physicians?

Answer that prime question and you'll be as clever as the special interest elites and 1% who have sucked $ trillions of dollars out of the healthcare system into their own foul pockets.

BS in Ethics (A tale of two morals.) said...

"If You Are Full of BS"

"The moral of the story is, if you are full of BS it can get you to the top, but it will never keep you there." (Stanford had protection and was well connected, but just no enough of it to keep him out of prison.)

- Allen Stanford (Ponzi Schemer sentenced to 110 years in a federal prison.)

Classic conflicts of interest (Christine Cassel, ABIM, ACP, NQF, Kaiser, Premier


Moral of that story (so far).

Sometimes in life if you're well connected and protected, the fox, instead of being indicted for foul crimes, gets put in charge of the other side of the henhouse where the chickens are even more plump and the potential for the abuse of power even more "absolute".

The Monoplists (Non-Profiteers) said...

What to do with a monopolistic corporation that thinks anti-trust laws just don't apply to them?

How about fair hiring practices? The ABIM (a de facto Political Action Committe/Lobbying Firm for the Democrat Party) has not hired any Republicans in the history of the organizations. And only one "non-partisan" double felon that never existed on their tax forms and whose dubious testimony is still under seal in court documents.

And what about those secret settlements and deals with employee discrimination lawsuits. Doesn't sound like an equitable fair place to work as far as I can see.

How about anti-poaching laws? It appears that rule does not apply to them either, since the ABIM/ABMS is/are the only medical specialty certification company in the country. And the ABIM ABMS, their associates, and colluding affiliates pass around their employees to each other "after nationwide searches", of course, to keep everything and everyone in one big incestuous and monopolistic corporate family.

And how about that price fixing. That does not apply to the ABIM/ABMS either, because they are "non-profit". It could not be all about the money for them. Right? Or could it!

How much does the CEO of the ABIM make again? Close to a million dollars? And travel and luxurious lodgings in DC?

"Doesn't sound like a non-profit [apolitical/non-partisan] organization to me."

Monopolist Non-Profiteers (raking in the money tax free) said...

Corporate Lobbying In Secret (with a partisan platform?)

If I were to name the lawsuits against the ABIM and ABMS, I'd call them many things, but this one fits tem for sure.

"Patients and Physicians Rights versus the 'Monopolist Non-Profiteers'."

Those tax-enhanced franchises under the ABMS umbrella, along with their cunning executives are a veritable money comb. And that Foundation (ABIMF) is one big money clip for the "RICH" courtesy of their offshore investment clubs.

We don't know a fraction of what they are doing. Only what their PR machines disseminate.

"Stakeholders" said...

Who's steering/running the ship?

NQF Stakeholders (ABIM Alumns Following Da Money?) said...

"Answering the call" for the patient or for special interests and select investment groups?

Christine Cassel
UCSF Presidential Chair for 2018-19

Public service

Humanist or globalist corporate agenda? Conflicts of interest may provide the answer.

Committee on Human Rights said...

The National Academy of Sciences Human Rights Committee has adapted the following:

Adopted by the United Nations General Assembly on December 16, 1966
entry into force 3 January 1976, in accordance with article 27"

Everyone should read this Covenant. It becomes clear after reading it that physicians and patients in the United States of America do not enjoy the minimum of rights guaranteed

"in accordance with the principles proclaimed in the Charter of the United Nations,

recognition of the inherent dignity and of the equal and inalienable rights of all members

of the human family is the foundation of freedom, justice and peace in the world,

Recognizing that these rights derive from the inherent dignity of the human person,"

Ending MOC will remove a critical capstone in the rigid yoke that Americans feel on their backs. Workers and patients push and pull daily struggling to survive trying to maintain well-being, health and happiness under the heavy weight of ABIM/ABMS' tyrannical demands.

Cyberderm said...

For those unfamiliar with the economics of the boards take a look at https://escholarship.org/uc/item/02p697p4
To get a sense of how wealthy the boards, individually and in aggregate, have become.