Tuesday, January 08, 2019

The ABMS Spider and the Fly

Mary Howitt

“Will you you walk into my parlour, said a Spider to a Fly;
'Tis the prettiest little parlour that ever you did spy.
The way into my parlour is up a winding stair,
And I have many pretty things to shew when you get there.
Oh, no, no! said the little Fly; to ask me is in vain:
For who goes up that winding stair shall ne'er come down again.

Said the cunning Spider to the Fly, Dear friend, what can I do
To prove the warm affection I have ever felt tor you?
I have within my parlour great store of all that's nice:
I'm sure you're very welcome; will you please to take a slice!
Oh, no, no! said the little Fly; kind sir, that cannot be;
For I know what's in your pantry, and I do not wish to see.

Sweet creature, said the Spider, you're witty and you're wise;
How handsome are your gaudy wings, how brilliant are your eyes!
I have a little looking-glass upon my parlour-shelf;
If you'll step in one moment, dear, you shall behold yourself.
Oh, thank you, gentle sir, she said, for what you're pleased to say;
And wishing you good morning now, I'll call another day.

The Spider turn'd him round again, and went into his den,
For well he knew that silly Fly would soon come back again.
And then he wore a tiny web, in a little corner sly,
And set his table ready for to dine upon the Fly;
And went out to his door again, and merrily did sing,
Come hither, pretty little Fly, with the gold and silver wing.

Alas, alas! how very soon this silly little Fly,
Hearing his wily flattering words, came slowly fluttering by.
With humming wings she hung aloft, then nearer and nearer drew.
Thinking only of her crested head and gold and purple hue:
Thinking only of her brilliant wings, poor silly thing! at last,
Up jump'd the cruel Spider, and firmly held her fast!

He dragg'd her up his winding stair, into his dismal den,
Within his little parlour; but she ne'er came down again.
And now, my pretty maidens, who may this story hear,
To silly, idle, flattering words, I pray you ne'er give ear;
Unto an evil counsellor close heart, and ear, and eye,
And learn a lesson from this tale of the Spider and the Fly.

~By Mary Howitt, 1829

* * *

If you do Maintenance of Certification, you are just a silly little Fly.

It is chillingly apposite: for the American Board of Medical Specialties (ABMS) and their 24 member boards' to live, autonomous independent-thinking physicians must die.

Spiders can never stop being Spiders.

"And now, my pretty MOC maidens, who may this story hear,
To silly, idle, flattering words, I pray you ne'er give ear;
Unto an evil ABMS counsellor close heart, and ear, and eye,
And learn a lesson from this tale of the Spider and the Fly..."

... then donate to Practicing Physicians of America's expanded legal fund drive.



Richard G. Battaglia ABIM CMO said...

How many X PwC PriceaterhouseCoopers, LLC advisors, managers, directors does the ABMS employ or utilize as consultants? What ever happened to the principle of advancing medical science?
Why don't we hear anything from the Chief Medical Officer at the ABIM. And why is he living in the Buffalo, New York area. He started in 2015 and it is already 2019. Still the ABIM has not dislclosed Battaglia's lengthy employment history as advisor, manager, director with PwC's Healthcare Division.

510 Walnut Street W. E. B. said...

ABIM in-house consultants and lobbyists - which offices do they hold on the 17th floor?

"The latest news and developments in the healthcare sector [2017]

Today’s health industry stakeholders face an array of emerging complex problems. PwC’s Health Services practice works with a range of healthcare provider and payer organizations - including large healthcare systems, hospitals, academic medical centers, for profit insurance companies and research institutes - to solve the issues they face. Our services focus on: enterprise strategy, deals, and transformation of operations, corporate functions, digital and technology, risk and regulation and marketing, sales and service."

Anonymous said...

Dr Wes:

Love you buddy!

You have done so much to advance our understanding of the true evil forces against the practicing physician. I thank you, from the bottom of my heart.

Just one favor....

After your name, remove the "board certified" bit...

In reality, YOU, and only YOU, is what makes a physician who they really are. Board Certification means nothing, is VOLUNTARY, and is something that you purchase.

A great physician, such as yourself, comes from a sense of compassion, caring and a life devoted to doing the "right" thing for your patients.

The ABIM did NOTHING to help you on that journey.

So please, just for those of us who have learned so much from you and your passion to do the right thing, drop the moniker after your name. Just keep it:

Westby G. Fisher, MD

That and that alone speaks volumes!

I am proud to count you as a colleague and a friend, and oh, by the way, as a patient of your too!

PwC presents Mr. COI said...

Why is the PwC CMO working there (I mean in New York)?
New York has has a high income tax. PA has a low flat tax. Although Philly has a city tax for residents. Non-residents don't pay. Does the ABIM pay any city tax at all. Anybody know? They don't do anything for the poor to qualify for a charity really. They MOC[tax] us to death and give $$$ to themselves.

PwC's (Brand) Strategy& (lots of healthcare strategy&)

Big, Bigger and Biggest Data - When You Are the Market

Blue Angel said...

I think countless people share the same sentiment. Thank you, Wes!

Rick said...

I have followed Dr. Wes for years and contributed to the legal fund. I agree completely that the MOC program as it stands is broken and needs to be fixed. It sounds like a lot of house cleaning needs to be done in the ABIM as well. I do not know how things stand in my own ABPS ( American Board of Plastic Surgery). Since I am exempt from MOC, I do not truly have a dog in this fight but I stand with my fellow physicians, who are subject to MOC, and to future physicians who will inherit whatever broken system we bequeath to them. I am, however, concerned about a total dismantling of the process of board certification, which I hear expressed from some commentators. There has always been a process of training and certification of skilled professionals going back to the apprenticeships in guilds in the middle ages. The residency system as it stands has served us and our patients well in producing the best trained and skilled physicians ever. At the end of that residency road, there needs to be some form of certifying examination as a verification of a physician's credentials to practice their specialty. Medical learning is lifelong and we must insure that physicians keep up with advances in medicine as well. What needs to change is the for profit nature of our certifying boards and their members and the redundancy built in to CME and MOC. I have no problem with required CME but if I do this, I do not feel that periodic examinations are necessary for continued certification. I have never taken a MOC exam but I have taken my specialty's annual In-Service Exam every year since I went into practice. I have a lot of criticism of the nature of the exam and have voiced this every year- it is too full of esoteric questions of anatomy, physiology, pharmacology, and rare conditions and does not, I feel reflect common practice. That said, it provides a lot of CME, at reasonable cost, and without the need to travel or disrupt my practice. I hope that, in the rush to eliminate MOC, we do not also throw out board certification. This would allow pretty much a free for all in which any physician, and many non-physicians, can do whatever they wish, controlled only by their audacity and tolerance for risk. Our patients, those we serve, would have no clue as to the qualifications of the physician or "provider" they are seeing. We must not, as the saying goes, throw out the baby with the bathwater!

DrWes said...
This comment has been removed by the author.
DrWes said...

Thanks for your level-headed response. I think most of us agree that initial certification may be useful, but until we fully understand the depth and breadth of conflicts of interest with the ABMS Board system, I think we should reserve judgement on its value to our profession. Much has changed since ABMS Board certification's origination - the most significant being the development of the World Wide Web. Most of what happened with MOC's origins began before the internet browser was invented. It was a secret society back then, full of cronyism and guild behavior. The ABIM/ABMS has a long history of colluding with the Tobacco Industry in the 1960s to promoting smoking products (Thomas Brem, MD from Johns Hopkins was named in Tobacco settlement, for instance). Now we see a myriad of other conflicts taking place - many of which appear to have harmed physicians - for the pure benefit of corporate greed. We're just starting to understand what has transpired. A full investigation of the process is needed before making decisions as to Board certification's relevancy. That is why we're asking for a few more funds for our GoFundMe page now. I thorough re-evaluation of the entire system is needed. Thanks again.

ABIM Chair Thomas Brem and Big Tobacco said...

Thomas Brem of ABIM Chair and board member also served as head of the ABMS advisory board Dr. Brem did in fact work for the tobacco industry to advance their interests and accepted payment for it.
Brem obscured known relevant facts to perpetuate profits for "Big Tobacco", which is a global business with revenues reaching 500 billion a year. (2012 data)
How many people were harmed by his actions? It is unknown. One could only estimate.
Personal accounts indicate there was significant opposition to many of Brems views and actions during his lifetime. He was very political and lobbied by taking physicians/others on fishing excursions and close one on one encounters.
Does propagating partisan politics and pushing big tobacco cronyism fit in with the ethics/coi policies of university medicine and being a board member/chair of the ABIM or ABMS? Absolutely not. Brem went to medical school at John Hopkins and later worked for UCLA and USC.

In the 1960's big tobacco was under fire and from and Brem obfuscated facts that were know about tobacco. He was an ABIM/ABMS leader. In 1965 Brem changed the bylaws of the ABIM to allow for unlimited conflicts of interest with the creation of the executive positions. This made it possible for the insurance industry/large healthcare systems to walk right in and use its influence. MOC was born out of subsequent collusion and it is maintained and sustained by colluding partners with blatant conflicts of interest. ABIM Chairimen such as Christine Cassel who were full-time partisan lobbyists with egregious conflicts of interest advanced the interests of insurance companies, medical suppliers/data collection/analytics companies, and large medical systems like Kaiser and received significant compensation for it. Such CEO's get away with it because we allow such actions to go unpunished. Cassel for example never received so much as a reprimand from the ABMS or any of the member boards governance. The ABIM, not only is in the business of doing favors and lobbying for their political friends, but they get away with self-appointing only those who are of the same beliefs and political agendas. These facts are very relevant to the MOC debate. MOC is born out of conflicts of interest and an endless stream of corruption and collusion that not only needs to be investigated, it needs to be stopped immediately.

Tobacco revenues and death (Guardian 2012)

USC Keck newsletter alumni spotlight

Anonymous said...

Dr. Wes:

Two thumbs up, way up, for the incredible time and dedication spent in uncovering the mess surrounding certification. I have followed this blog for years and it reads like a novel. I commend you for this.

Now, regarding the concept of needing a "certifying" exam at the end of residency, as stated by an earlier post, I disagree.

The whole point of a residency is to have your attending physicians, faculty and staff review your learning year by year, as they are working side by side watching you and teaching you as you go. They, and they alone truly know who has mastered the clinical and knowledge for the speciality being pursued.

If they deem you have mastered the training and education then they sign a certificate indicating that you have achieved this and are now qualified to commence practice in that field. If however, they feel that you needed more time to master a particular subject, then they do so by keeping you for a few more months to a year.

Residency is where the qualification lies.

When I was in training, back in the days of very long hours, and lot's of coffee, I had great teachers who wanted us to learn, and they checked our learning by asking questions, tons of questions and by asking us to demonstrate those skills on a moments notice.

When, at the end of five years, they called us into a room and announced that we had finished all that was asked, then and then only did each faculty sign our certificates in front of us.

We were deemed by the very instructors who were with us each day, to have finished.

Two of my colleagues were asked to stay on for a few months, and to this day both of them did not regret it. They stayed on to master certain surgical skills, in one case, he had difficulty mastering a flexible scope, new in those days, but he got it! In the other instance, he needed more time reviewing clinical anatomy to master the surgical skills needed to perform a certain surgery.

My point is that the residency program is where the qualification lies.

I too have taken my speciality "in service exams" and I too have found those exams "full of esoteric questions of anatomy, physiology, pharmacology, and rare conditions and does not, I feel reflect common practice." to quote my colleague above.

Dr. Wes brings up a very good point: The internet.

Today, we all regularly look things up, heck, I can watch an entire procedure on the computer. But what is the value of a test when I have everything at my fingertips?

I'm just asking, where is the evidence that states board certification ads value to a physician?

Dr. Wes is right again: "A full investigation of the process is needed before making decisions as to Board certification's relevancy."


That's what all of this is really about.

If we want the best students of the future to look at medicine as a career choice, then we need to review the cumbersome and burdensome process that has put into place.

I urge everyone to read a fantastic article written by Eric N. Grosch, MD “Does Specialty Board Certification Influence Clinical Outcomes?” in the Journal of Evaluation in Clinical Practice written in 2004.

Here is the link:


Again, I am so appreciative to Dr. Wes.

D Funkt said...

MOC is Dead

I support specialty certification, but it needs to shift back to the academic millieu and be granted on completion of residency/fellowship. Forget the multiple choice ABMS and their MOC BS as the determining factor. Toss out the bogus psycho metric marks and scoring. that are so out of touch with the real world. Strict conflicts of interest policies and disclosures/absolute transparency is a must. The ABMS is a broken politicized and financially driven machine. A for-profit franchise that needs to go away. It's brandname/corrupt colluding business model/conflicted trademarks/for-profit and non-profit partner enterprises all should be shut down.

Long live an honest life-long certification/graduation with voluntary continuous education connected to academic/program settings.

ABMS in Venice.Back to the Future said...

The ABMS/AMA Man Who Would Be King - Round Up the Usual Suspects
(Always after "nationwide search" they appoint their own man/woman as CEO, this time consulting on "healthcare without borders" and representing "digital healthcare.")

What's wrong with this timeline for the ABMS CEO Richard Hawkins involving their 2016 Venice pleasure trip? It is two years too early for CEO Hawkins to be there. He was only made CEO in 2018. What does this tell us about the ABMS agenda? It's "back to the future" special interests driven (digital healthcare) and it is global in scope.

"Research and Innovations for Healthcare Professions Conference
April 27-29, 2016 | Venice, Italy

The IGHPE 2016 Second Annual Conference focused on research and innovations that advance performance in the healthcare professions and was structured around three themes:
The Vision for Our Health Professions
Healthcare Without Borders
Preparing for Digital Healthcare

New paradigms, practices and digital solutions that altering or supplanting traditional pedagogical approaches were discussed. The program of the conference was designed to stimulate creative thinking and collaborations that address the demand for effective, integrated, 21st century health professions education.

The event was attended by leaders and stakeholders in health professions education, including educators, administrators, deans, and program directors from Europe and around the world who shared their vision and expertise in transforming the health professions learning experience.

Venice, one of Europe’s most important commercial, financial and artistic centers in the medieval and renaissance periods, provided an inspirational backdrop for the delegates as they met fellow professionals, explored novel ideas, and forged productive new partnerships to improve healthcare for patients.

Speakers at the IGHPE Annual Conference 2016 in Venice, Italy, included:

Peter Dieter, President, Association of Medical Schools in Europe (AMSE), Germany
Victor J. Dzau, President, National Academy of Medicine, USA
Barbara Brandt, Associate Vice President for Education, University of Minnesota , USA
**Richard Hawkins, President and Chief Executive Officer, American Board of Medical Specialties (ABMS), USA [2016 in Venice? Richard Hawkins became CEO only in 2018.] **
Mira Irons, Senior Vice President for Academic Affairs, American Board of Medical Specialties (ABMS), USA
IGHPE would like to thank the Association of Medical Schools in Europe (AMSE), Professor Peter Dieter, President of AMSE, and the AMSE membership for taking part in this program."

Richard Hawkins - the man with the global big data/IT corporate agenda

"CHICAGO – September 26, 2017 – The American Board of Medical Specialties (ABMS) has named Richard E. Hawkins, MD as its new President and Chief Executive Officer. Dr. Hawkins was selected by the ABMS Board of Directors following an extensive national search. He succeeds current President and Chief Executive Officer Lois Margaret Nora, MD, JD, MBA whose term will end in December of this year." [Start date Jan. 2018.]

Prior to joining the AMA in 2012, Dr. Hawkins was the Senior Vice President, Professional and Scientific Affairs at ABMS. In this role, he led education, assessment and international initiatives. Previously, Dr. Hawkins had been the Deputy Vice President and Vice President, Assessment Programs for the National Board of Medical Examiners, a role he assumed following his various academic appointments in the Naval Medical Corps, receiving numerous commendations for his service."


Nona Mas said...

ABIM's Globalist Agenda (ACP and partner PwC - more to follow)

Who is the American Board of Internal Medicine's Chief Medical Officer? Where did he come from?

If you hesitate answering this question, even for a moment, you are the Fly.

"Health Foundation for Central and Western New York
Richard G. Battaglia, M.D., M.P.H., was elected to the Foundation’s Board of Trustees in 2018."

"Immediately prior to joining ABIM, he was a consultant in PricewaterhouseCoopers’ health care practice. Working both nationally and internationally, Battaglia’s clients included academic medical centers, health systems, community hospitals, medical groups, payers and national physician certification organizations.
He received his bachelor’s degree in biochemistry from Canisius College. Battaglia obtained his Doctor of Medicine degree from the University of Rochester School of Medicine and Dentistry. He completed his specialty training through the University of Rochester’s Primary Care Program in Internal Medicine. Battalgia is a Fellow of the American College of Physicians."


Strategy& ACP& PwC said...

How many PwC Strategy& Partner Advisors does the ACP/ABMS/ABIM need

ABMS Globalist Agenda said...

ABMS CEO Lois Nora and ABMS-I Chief Richard Hawkins Globalist Corporate Torch - 2012 Flashback

"Overarching Goal of ABMS-INTERNATIONAL

To position the ABMS Board Enterprise as a global entity that can
provide support and add value to selected organizations around the
world wishing to set high standards for assessing and certifying
medical specialists"

How nice for the venture capital firms and investment-hungry consultants! Who does the accounting? I think everyone can do the math on this globalist agenda with $frenzied partners.

ABMS-I ACGME-I said...


A Bitch for Medical Special-Interests


A Corrupt Global Medical Enterprise for-Investors

Firebase link "broken" said...

Lots of beta including "experimentation", ML, data processing, including analytics and profiles.

Broken link on Twitter. (It is a broken link.)

Google is the parent company of Firebase.

Firebase has a crowd of app developers and a gang of investors. Terms of buyout by Google undisclosed.