Saturday, March 02, 2019

Why the ACC Threw Cardiologists and EPs Under The MOC® Bus and Why We Let Them

In its latest update with Maintenance of Certification (MOC®), the good ol' boy network of the American College of Cardiology (ACC), Society for Cardiovascular Angiography and Interventions (SCAI), Heart Rhythm Society (HRS), and Heart Failure Society of America (HFSA), announced their commitment to "continuous certification" and MOC® and all its lucrative trappings for US cardiologists and cardiac electrophysiologists.

It seems the authors of this announcement, all older white men without much to lose, just can't get enough of the money associated with locking their younger, more vulnerable colleagues into continuous participation in their expensive board review courses, scientific sessions, self-assessment programs, and pricey study materials. They convened a "Task Force" (or was it a "Committee?") some time ago to study the revenue lost without MOC® verses the money made with MOC®'s leverage on their programs, and it appears they have decided they just can't let go.

So they have a plan.
  1. First, make a lukewarm statement that is supposed to sound opposed to the ABMS Vision Commission, but really says nothing.

  2. Second, to co-brand their own version of "continuous certification" with the American Board of Internal Medicine (ABIM) and call it another name to assure annual payments continue.

They thought hard - really - and recruited lots of their well-respected academic partners and thought leaders in cardiology and EP - to create their own ABIM MOC® pathway called the "Collaborative Maintenance Pathway." (You can't make this stuff up.)

As if cardiologists are deaf, dumb, and blind.

But cardiologists and electrophysiologists have to be honest: we live with the reality that our skills and intellect are uniquely valuable to hospital and health care systems. Without us, they'd die. And now that 75% of cardiologists are employed by hospitals, hospitals need us just as we need them.

The ACC, tied irrevocably to the good fortunes of the Medical Industrial Complex and the realities of managed care data collection, knows this.

So they sugar-coat their decision to side with "continuous certification" as a "commitment to lifelong learning" instead of what it really is, an adhesion contract with the ABIM and the ACC, SCAI, HRS, and HFSA for their lifelong funding at our expense.

In effect, the ACC is saying "Cardiologists and EP's - get over it - you have no choice but to be the breadwinners for US hospitals and health care systems. We scratch their backs so they can scratch ours, so you have to pay up."

Ooops, I just said the unspeakable.

I can hear it now:

"But we are beneficent, selfless 'care providers' who do the work, take call, and save lives at 3 AM when we're dead tired, not just the funding vehicles for US hospitals! We are the good guys, need to keep up with the latest advances, and deserve what we get! How can you dare say such a thing?!?"

Because, deep down inside, it's the truth.

A growing tension is exacerbated by the ACC siding with the corrupt ABMS MOC® program: cardiologists serving hospitals' best interests verses cardiologists serving their patients' best interests. Certainly no one will argue with the benefit to a patient for stenting an occluded coronary at 3AM - it's the magic of what we do and why we do it. But there is also a growing conflict of interest that develops when we must live in fear of losing our credentials (and our jobs) because we don't participate in MOC® and MOC® is tied to our ability to make a living only at hospitals: that tie makes us beholden to our employer before our patient.

It has been revealing to be a student of MOC®'s evolution over the years. I believe there is are complicated psychological and economic principles at play with MOC® (or "continuous" certification).

First, MOC® forces the doctors to split. Psychologic splitting is commonly used to justify unreasonable behavior. Why else would highly intelligent people put up with the now highly public political, financial, and monopoly-making activities of the ABIM? Perhaps its because by participating in MOC®, we can remain the "good guy" in a guideline-directed decision making world of medicine while the ABIM can remain the "bad guy." No need to consider the realities involved with their conflicts of interests. By continuing to participate in MOC® (or it's latest "continuous" iteration, doctors don't have to worry themselves with the nasty details of the high cost of medicine, the waterfalls in the front lobby, and the big screen TV's in every patient's room. We are "just" the beneficent doctors working within the "guidelines." So we "keep up" with our education and those "guidelines" (thanks to the ACC and their "Collaborative Maintenance Pathway") to impress our patients (and truth-be-known somewhere deep inside, ourselves) by promoting this "board certified" marketing accolade and not dealing with its unpleasant realities.

Secondly, MOC® influences the "behavioral economics" of physicians in perverted ways. As an example, behavioral economics states that even if a doctor wants to lose weight and sets his mind on eating healthy food going forward, his end behavior will be subject to cognitive bias, emotions, and social influences. What is a bigger cognitive bias and social "influencer" than the fear of losing your credentials or ability to receive insurance payments because of lack of participation in MOC®?

So the next time you wonder why the GoFundMe page to fight Maintenance of Certification has been fairly slow to reach its ultimate goal, I believe this is why.

Many doctors are putting up with the MOC® charade because they are afraid of losing their job if they speak out and are not completely honest about the MOC®'s role in maintaining healthcare's costly financial status quo.

Perhaps it's time we be honest with ourselves. Who ultimately loses with MOC®'s perpetuation?

Not just younger, more economically vulnerable physicians, but our patients, too.



Anonymous said...


I have been saying for years on this site that the ACC is galvanized against the practicing cardiologist. The ACC is evolving into the AMA.

The ACC and their de facto control via the databases where we the lowly grunt in the trenches cardiologist are forced to become a data entry specialist to justify their business plan--all in the name of professionalism. That's right!! If your are a professional, you will submit to the will of the ACC.

I personally witnessed the most hostile medical meeting where every cardiologist (board of governors of the ACC) took shots at the AMA and their MOC garbage. The ACC (scum leadership) tacitly supports MOC despite the cardiologists, who they are supposed to represent, outspoken resentment of MOC.

The ACC is a money grubbing evil racket. Disgusting bunch!!

Every cardiologist should resign from the ACC like I did. The ACC (Washington DC bunch) only represents themselves and their ever growing quest to line their own pockets pushing a corrupt agenda all on the backs of hard working cardiologists seeing patients in clinic, answering phone calls on weekends, and STEMIs at 3am.

Members Only Clubs for Elites and Special Interests said...

"Go to the Back of the Bus"

Part of the ABMS cartel strategy is to take control of the "membership societies".

The corporate takeover of medicine has pushed patients to the rear of the bus - crowded out the back door. ABMS and their partners have achieved this in part by throwing physicians under the wheels one by one group by group.

Whether ACC or AACE (take your pick) executive CEO's are appointed to "restructure" the organizations gradually or immediately into "special interests" only membership societies. Loyal staff are fired and replaced. Governance subdued or manipulated in various ways that the victims may not even recognize.

The special targets those who vocally oppose MOC or the authority of the ABMS.

(ABMS has massive physician/society member group data files and corporate analysis.)

So much for independent views and 1st amendment rights!

Unknown said...

the ABIM needs to be sued, charged, made to pay, dissolved and no other form allowed, in its present form of profit making, they are thieves and racketeers.

Anonymous said...

Off topic:

Based upon the pecuniary nature of the ACC, I have a prediction that there will be a full throated endorsement of Apple and they Iwatch technology to detect afib. The real question is how large the 'grant' had to be for the ACC to endorse Apple's technology. I'm guessing in the $5-10M range but we will never know.