Sunday, August 25, 2019

Assuring Longitudinal Physician Exploitation and Burnout

ABIM Email Notification
His day started at 07:15 AM with two planned atrial fibrillation ablation procedures and an implantable cardiac defibrillator (ICD) implantation scheduled. As the day progressed, another unscheduled ICD was added, then three emergent pacemakers had to be implanted. Squeezed between the cases were rounds, inpatient consults, phone calls, post-op checks, emails, EMR tasks, and echos in his inbox. He finally headed home at 10:45 PM; another dinner missed with his family.

One of his emails included a notification that the American Board of Internal Medicine (ABIM) is developing a Longitudinal Assessment Option because they were "hearing those voices" from an overseas professor that implied "many of our colleagues have said they would like to see the process of maintaining certification offer more flexibility and choice." The ABIM now adapts behavioral and cognitive psychology to teach this busy electrophysiologist the "important competencies" of "professionalism, working in a team, and collaboration" promised by this new ABIM Longitudinal Assessment Option for MOC.

The ABIM stands on the head of a pin as it sends mixed messages about competency, professionalism, teamwork, and trust, all while maximizing the medical industrial complex's profit stream. It sends its email or tweets as they shape our next generation of physicians to continue to comply in being exploited and to make peace with the new medical group-think. A thinking person might see the contradictions inherent in these conflicting goals - but then this is the new MOC reality despite the lawsuits underway to end this program.

Pity the poor doc who now must decide at 10:45 PM whether he sits on his zafu, engages in relational maintenance with whoever is still up at home, or completes the graduated teaching assignment kindly forwarded by ABIM.

What we must never ask is whether there will ever be a MOC module or a pranayama sufficient to make this lifestyle sustainable.



Anonymous said...

The EHR crowd and the MOC crowd have found synergy in the security it gives the bottom half of the profession to replicate their student days - make your marks dark and black, check every box faster than any of the other kids, meet teacher's expectations and exceed them if possible.

We all know that's how you get IN to medical school. It's unfortunate that the stress of being a real doctor has driven so many back to the willing re-creation of the premed student experience.

Anonymous said...

Dr. Fisher-
Couldn’t agree with you more - well said. I’m a practicing cardiologist out of training six years and have tried to get NBPAS accepted by our hospital. Everyone was on board....but once we discovered payers won’t honored NBPAS, everything fell apart. The whole thing is a complete fraud, including this “longitudinal” step. Thank you for fighting on behalf of us but I feel as long as payers are in bed with ABMS, we will sadly lose. No private organization should be able to destroy a physician’s career...not after all we have done to get here. It is insanity. Truly.