Friday, April 12, 2019

Physicians Are Eagles Who Believe They Are Chickens

Chicken or Eagle?
Image by Wes Fisher MD
(Click to enlarge)
There are 800,000 physicians in America and more than 80% believe the Maintenance of Certification process, known as MOC, has no clinical value for patients. For the first time in the history of our profession, physicians have a fighting chance to topple a Goliath-esque organization, the American Board of Medical Specialties (ABMS).

In a 2018 survey conducted by Merritt-Hawkins, 78 percent of physicians said they experience some symptoms of professional burnout. Physician burnout is a public health crisis which threatens the health and well-being of all patients.

A burned-out physician reminds us of the fable about an eagle who believed he was a chicken.

When the eagle was small, he fell from his nest. A chicken farmer found the eagle, brought him to his farm, and raised him in the chicken coop with his chickens. The eagle grew up living like a chicken, doing what chickens do, and believing he was, indeed, a chicken.

One day, a visitor came to the farm and was surprised to see an eagle --considered the king of the sky-- strutting around the chicken coop, pecking at the ground, and acting like a chicken. The farmer explained that this bird was no longer an eagle, instead he was a chicken because he was trained to be a chicken. The man knew there was more to this great bird than “pretending” to be a chicken. He was born an eagle and had the heart of an eagle, and nothing could change that. The man lifted the eagle onto the fence surrounding the chicken coop and said, “Thou art an eagle. Stretch thy wings and fly.” The eagle looked at the man and glanced down at his home among the chickens in the chicken coop where he was comfortable. He jumped down off the fence and did what chickens do.

The farmer shrugged and said, “I told you he is a chicken.” The visitor returned the following day and tried again to convince the farmer and the eagle that he was not a chicken. He took the eagle to the top of the farmhouse and said: “Thou art an eagle. You belong to the sky and not to the earth. Stretch your wings and fly.” The large bird looked at the man and then glanced down at the chicken coop. He jumped onto the roof of the farmhouse and returned to the place where he felt safest.

The visitor asked the farmer to let him try one last time.

The next morning, the visitor returned and took the eagle and the farmer to the foot of a high mountain. They could not see the farm nor the chicken coop from this new place. The man held the eagle on his arm and pointed into the sky where the bright sun beckoned and said: “Thou art an eagle! You belong to the sky and not to the earth. Stretch your wings and fly.” This time the eagle stared skyward into the bright sun, straightened his body, and stretched his powerful wings. His wings moved, slowly at first, then surely and confidently. With the mighty screech of an eagle, he flew.

Because he was an eagle.

This past December 2018, four brave internal medicine physicians --recognizing they are eagles-- filed a lawsuit against the American Board of Internal Medicine, the largest ABMS member board, for harm they endured from the Maintenance of Certification process. Practicing Physicians of America has set up a fund to support our colleagues who are fighting this battle and need the support of fellow physicians.

Merely 1324 physicians, out of 800,000 in the US, have contributed to the legal fight against the onerous MOC process, despite the fact that it is reviled by the majority of doctors. Physicians members of the American Board of Radiology and the American Board of Physical Medicine and Rehabilitation have filed lawsuits of their own regarding violation of anti-trust laws.

Why are so few of our fellow physicians standing up when given the chance?

Unfortunately, physicians often choose consistency over happiness. If you’re used to being abused, ignored, or exploited, it’s strangely comforting to remain in the chicken coop and peck at the ground. These physicians are just like the eagle who believed he was a chicken.

Maybe physicians prefer the devil they know to the devil they don’t know. Maybe physicians are terribly uncomfortable at the prospect of failure. Maybe physicians believe it is better to control failure than be blindsided by it. Physicians are standing on the mountain and being asked to spread their wings and fly. What is stopping us?

The possibilities for the future of our profession are endless if we can win against the American Board of Internal Medicine. If there were ever a time to join the fight, it is now. Surely $100, $200 or even $500 is not too much to contribute to support our talented physician colleagues who have been harmed by MOC.

Now we are asking every physician in America, are you a chicken or are you an eagle?

- Niran Al-Agba, MD and Westby G. Fisher, MD

Drs Niran and Fisher and unpaid board members of Practicing Physicians of America.


Anonymous said...

Eagles are conditioned to think they are chickens. Ain't it the truth.

And the emperor is beating the hens/roosters with a stick without wearing as much as a stitch.

Arrogantly they prance about (naked) thinking they are royally clothed and have divine right.

DR MOC DOC said...

Is the ABMS involved in the theft of money and identity?

ABMS SWEATSHOPS® "The Only Cure For Healthcare?" said...

American Board of Medical Specialties - ABMS MOC® - ABMS CERTLINK®

Is the ABMS running high tech sweatshops in INDIA to support their monopolistic products and services?

Physicians in the US clinical sweatshops, should do their own MOC research as burnout increases and autonomy has become a long past "FIGMEND" of the imagination!

Keep your mouths shut! Slavery is alive and well in the US!

Anonymous said...

Eagle eyes see nothing if they are not open; the human brain becomes a dark follower.

MOC Block said...

Are physicians forced to do MOC by powerful revolving door politicos making markets for financial enterprises who lobby to the tune of millions of dollars every year?

Have so-called non-profit corporations of the ABMS franchise turned docs into a penal colonies - laborers working for the British/Dutch testing industry and the American medical industrial complex?

"Yes, Virginia", physicians have been transformed into fricken corporate chickens, with a lot of fear and not much spine. And even less time to do anything about it. Sold out by those who should know better.

MOC MATRIX said...

The tweaking of healthcare technology for money and power has already put virtually everyone's records on the cloud, which means health records are available for mass global hacking or data meltdown/catastrophe. Or they can be read by rogue intelligence organizations. (They may be all rogue today.) Isolated theft or loss is a thing of the past. Privacy/autonomy of the patient and physician has been compromised with the electronic health record. Data registries, we are all in them without consent!
The MOC mandate/program feeds the corporate Matrix - keeps the dollar theft/data theft alive.

Conspiracy theories? Not so fast, it is real even affecting the Dept of Homeland Security!
Even the government records of 4-20 million employees including intensive background checks/pertinent medical histories/fingerprints/security clearances stolen and the criminals are still at large today.

Rick said...

I have followed Dr. Wes's blog for several years, agree that MOC is seriously flawed and have contributed to support the lawsuit against the ABMS. I am, however, troubled. As a physician, I have taken an oath to put my patients first and foremost. If we demolish the edifice, board-certification, that has largely served us and our patients well, what will replace it? Board certification provides patients with the assurance that their physician has met the minimal (yet substantial) requirements to practice as a competent, qualified physician. It has assured physicians that their colleagues in other specialties have met the same requirements that they had to meet. I have seen first hand the havoc wrought when medical "professionals", including physicians, mid-level providers, and some with no medical training at all, can pass themselves off to the public as qualified physicians. This is rampant in my specialty of plastic surgery. Patients are clueless and their best defense has been to seek out physicians who are board certified. Once board certification is eliminated, as will happen if the ABMS is rendered totally impotent, what happens next? It is easy to take down a bad system relatively speaking, compared to finding a legitimate replacement for it. I hope we are not throwing out the baby with the bathwater.

DrWes said...


You said: "I have seen first hand the havoc wrought when medical "professionals", including physicians, mid-level providers, and some with no medical training at all, can pass themselves off to the public as qualified physicians."

Yesterday, a patient, seen by a nurse practitioner in an outside facilities' ER, was transferred to our ER for overnight observation because of a wide complex tachycardia noted on the monitor. The patient was asymptomatic. Closer inspection demonstrated the "ventricular tachycardia" was only artifact. Needless patient anxiety and expense were accrued. That nurse was "board certified."

Well-trained physicians are being replaced by lesser-trained physician "extenders" because they are cheaper and easier to crank out. Don't think for a minute board certification can replace thorough residency training. It is merely marketing accolade.

Unknown said...

The initial Board Certification makes sense but not the repeated certification required every 10 years. I specialized in breast cancer and knew I did a stellar job, however having to recertify in Pediatrics, ENT and other areas I did not practice in, caused anxiety and made absolutely no sense. Let’s support one another. The stars will shine through.

Steve Southerland said...

I am a medical director of a large private practice orthopedic group. I love my practice, my partners and my community. I consider myself a normal, well balanced individual with lots of side interests. I firmly consider myself an eagle in this scenario - I set my work schedule, have autonomy, and I love the work I do.

I have absolutely no issues with MOC, in fact I embrace the whole system. Maybe the American Board of Orthopedic Surgery is doing a better job than some other specialty groups, but the process seems fair and organized. A little spendy, but isn't everything?

I think the big issue is the overall lack of autonomy that doctors suffer from. If you lack the ability to run your own life and practice, then this is just another thing being shoved down your throat.

DrWes said...


“I have absolutely no issues with MOC, in fact I embrace the whole system. Maybe the American Board of Orthopedic Surgery is doing a better job than some other specialty groups, but the process seems fair and organized. A little spendy, but isn't everything?”

MOC is much more than just “spendy.” MOC is coercive, fraudulently sold as an indicator of “quality,” tied to your initial certification and therefore, your hospital and insurance panel privileges, (and if you have one, your academic appointment). While it is true that 20% of physicians don’t mind MOC (like you), the vast majority do. The harms from MOC have never been studied. Perhaps it is time to learn what MOC has done (and is doing) to your less fortunate colleagues.

Particularly disenfranchised are your primary care physician colleagues (pediatrics, family medicine, and internists) who have seen their fees increase over 276% in the past 18 years without any proof MOC makes them a better physician to their patients. They have seen their fees used to create a political foundation to “define medical professionalism” for us while simultaneously covertly lobbying Congress, insurers, hospital group purchase organizations (like Premier, Inc) that MOC and its conflicted requirements like “patient voice” and “practice improvement projects” assured quality patient care. They even had a felonious “Director of Test Security” coordinate a secret sting operation on vulnerable residents studying for their boards at an ACGME-sanctioned board review course and then published that "nearly 140" of them cheated in the Wall Street Journal. (See )

All of this secret tape-recording/search and seizure occurred without legal due process. Meanwhile, their executives were laughing all the way to the stock exchange, the bank, the Caymans, and their $2.3 million condo equipped with a chauffeur-driven Mercedes S-Class town car.

But you are correct that the American Board of Orthopedic Surgery has been better than most: their CEO is only paid a little over $600k and they have fewer real estate investments than many other other subspecialties. But they are holding onto nearly $35 million in cash and investments for themselves, thanks to your testing fees. ( )

Why not get back to initial certification and CME like before? MOC was a money and political grab from the beginning. They have over-reached and what they are doing is likely illegal. That is why the lawsuit(s) were filed. This fundraising effort is to get to the truth and end this harmful practice to physicians. The conflicts of interest with MOC are just too far-reaching to ignore. It needs to end.

Jason Shatkin MD said...

Strongly agree with Dr. Wes sentiments. Having gone through the MOC process twice I absolutely sickened to have to go through it again.

The recent committee and recommendations are ridiculous causing unnecessary anxiety every 2 years instead of 10. As I’m boarded in 3 sub specialties I can’t think of a year without having an exam over my head.

The are beating us with a stick we supplied them and bend over so they can beat us with it.

Not only are we eagles, but the reality is the ABIM is attacking us in our nests. The only way to “break their stick” is to not take it. All physicians should be called on to boycott the MOC recertification process.

Pollo Loco said...

Good points. I may have missed having a family/children partly due to the stress of diligently "keeping up" with all the redundant MOC requirements coming around every turn. (Several staggered certifications.) With top percentile in scores, still the MOC requirements crept up like a nag biting me in the back -- and MOC was always there to worry about. Much heavier than a proverbial piece of straw, MOC is a useless time-consuming and costly pursuit. For me and others I know it has been an overwhelming mandate totally unjustified and unjust to impose. MOC is/was a sack of bricks always looming creating great tension and suffering for me. Broke my back (burned me out/caused anxiety) without making me a better physician in any way. Just a distraction from focused learning, a burden placed over-against patient care.
How do you get stolen years or opportunities for life back. Not to mention added stress and moments of panic at work, the time ripped away from patient care.
Don't make the same mistakes. Better get up and fight and take your life back.

Clifford Ehmke, MD said...

I would add that there is now a class-action lawsuit against the American Board of Psychiatry and Neurology (ABPN) alleging that its requirements for MOC are illegal and anticompetitive. The suit was filed on March 6 in the US District Court for the Northern District of Illinois. One of the suit's charges is that of unjust enrichment, citing tax records showing that between 2004 and 2017, after the advent of MOC, the ABPN's net assets skyrocketed 730%, from $16,508,407 to $120,727,606. As a psychiatrist who is currently going through the 10-year recertification process, I would like to know what ABPN is doing with 120 million dollars of assets?

Anonymous said...

MOC is a conspiracy. Add that to the list as we are manipulated by the AMA, AOA, CMS, just to name a few.

I would donate to support your cause if you provide an argument that you can win, and that I will eventually benefit as a family physician.

Right now you're just another group of doctors trying to get my money. I'm full of those. Show me that your not just Peter trying to rob Paul and I'll send you money.

DrWes said...

Anony 02:08PM -

"I would donate to support your cause if you provide an argument that you can win, and that I will eventually benefit as a family physician."

There are very good lawyers working on these cases in both Philadelphia and Chicago. They took on these cases because they believe they can win. The charges are serious, far-reaching, and include anti-trust, fraud, racketeering, and unjust enrichment claims that appear sound. But I am not a lawyer. To the best of my knowledge and belief, such serious and far-reaching charges have never been levied against members of the ABIM, ABMS and ACGME. The RICO claims include ALL ABMS member boards, so if they win, EVERY subspecialty involved with MOC (or its latest tied re-certification program) would benefit.

Will they win? That is for the court to decide. Will it be a long battle? You bet. But at least it's a battle - one that working physicians never thought in a million years they'd be able to wager, and yet here we are.

Sorry but that's the best that I can offer to you. Decide for yourself if that's good enough for you. I refuse to arm-twist but hope everyone will VOLUNTARILY join this effort that at least stands a chance at making life better for working physicians (AND their families).

Anonymous said...

I am a Charter Member of the ABFM and graduate of one of the first certified FM residencies. I have been semi-retired for some time until, after 6 Board Certifications, Board Eligibility ONLY began also being turned down by companies offering locums. My days of enjoying being FM are over but my knowledge of experience is worth much more than a test that did not give me time to recheck my answers the last time, and only now is talking about how many times we must take the test, giving more time during testing,and giving 4 MORE YEARS in between testing.
I do believe in what you are doing and certainly would do volunteer work for your cause.

Portland Psych said...

To reply to Steve Southerland - MOC doesn't affect me personally either, as I'm sure it doesn't other cash only psychiatrists, as long as they've given up any desire to ever work in any hospital or clinic. It's not that easy to give this up entirely, because many cash only docs do end up doing some hospital work as a side job, here and there. And it might limit you if you want to move and if licensure is tied to this. And it might limit you in unanticipated ways. Nonetheless, the issue can, practically speaking, be ignored by some.

However, it does bother a whole lot of doctors greatly, and that's worth listening to, isn't it? Not only because they're our colleagues but because they're our doctors. What good does it do anyone to have doctors who feel like little hamsters on someone else's wheel?

I don't understand how anyone ever agreed to have "time limited cert" in the first place. Is your high school diploma time limited? Your college degree? What if other people had to keep jumping through hoops to stay where they are, or actually to prove they can pass lower degrees of education? It's insane. Do lawyers keep having to re-take the bar? Do soldiers keep having to re-pass basic training? Do PhDs have to keep re-defending their thesis every few years? It's madness.

As Dr. Fisher has detailed at length, this is all done in the name of HUGE profits to the few. There is no logic or rational reason behind MOC. It's purely money driven, and it causes distress to all of us, whether we're the affected doctor or their potential patient. Since group two encompasses 100% of us, I'd say we should all oppose this de-professionalization.

Anonymous said...

Anyone with personal encounters with ABMS executives discerns quickly they're dealing with professional liars.

Monopsony and Monopoly said...

Who are the buyers and who are the sellers in healthcare delivery/professional medical labor pools?

Bottom line there is no one looking out for the real interests of physicians and patients.

Physicians and patients have no monopsony power because they are not organized and they have no representation as a bargaining unit or units. The physician and patient working together is the key and not the physician alone fighting conflicted corporations and NGOs.

Destroy the physician/patient relationship and you destroy the unitive power to bargain effectively for high quality healthcare/delivery.

Physicians (and as a result patient care) are being slowly degraded in earning and learning power. Doctors are obviously being replaced (like all other labor markets) with various digital programs, mid-level/low-level providers, sundry forms of robotics, and eventual takeover by next generation waves/iterations of intelligent machines.
Vulnerable without any dedicated organization to represent doctors and patients, monopolies use their power to control and abuse physicians and patients.

"Examining monopsony by industry, he [Webber] finds that wages in manufacturing appear to be more competitive, while health care and administrative support are the least competitive, giving employers the most wage-setting power in these industries. His analysis also finds that low-wage firms and low-wage workers have higher labor supply elasticity."

Conflicted steering committees will not save physicians/patients

The AMA is not the cavalry that will come and save the patient/physician

Only a concerted effort by apolitical/non-conflicted people who actually care will make a difference.