Sunday, January 26, 2020

The Certified Deceit and Exploitation of US Physicians

For the past seven years, I have devoted a significant amount of my time to investigating and telling the true story of US physician "board certification." That story has been one of deceit, private back-room deals, profiteering, and (worst of all in my humble opinion), the exploitation of working physicians and the patients for whom they care.

This writing has not come without its personal and professional costs, but when the story is one that affects the corruption of the largest single contributor to the US economy, what else should I have expected?

As I reflect on what this side job has exposed, it would be naive and dishonest to suggest that physicians are exempt from bearing some responsibility for rising healthcare costs in America. But it may go much further than that: our medical profession and its hallowed physician education regulatory system comprised of the unchecked Accreditation Council for Graduate Medical Education (ACGME) might be the very reason things were allowed to become so out of control. Our non-profit tax laws with their opaque reporting requirements have allowed huge "non-profits" to go unchecked in America - and most of those "non-profits" are in healthcare. (Just take a stroll by the American Medical Association (AMA) building in downtown Chicago sometime to get a feel for the magnitude of the problem.)

Why should the physician education and credentialing systems in America be exempt from such corruption?

Well, they are not.

From the earliest reports of a multi-million dollar condominium purchase by the same non-profit organization that created the "Choosing Wisely®" campaign to promote health care cost savings, the hypocrisy of US board certification was laid bare. With not-so-difficult internet Google searches, it was just a matter of time before the multiple deep-pocketed corporate ties between US physician board certification and Big Tobacco, Big Insurance, Group Purchase Organizations, and the Health Care Quality and Safety Industry became evident. Even our most widely respected health care journals, many of which were owned by state medical societies or physician specialty societies, published innumerable articles with an editorial blind eye to these financial conflicts. Even the Chief Medical Officer of the American Board of Internal Medicine is just a hired corporate consultant. To that end, is it any wonder that the so-called "voluntary" ABMS board certification product is now anything but voluntary for physicians, as trillions of health care dollars exchange hands in hospitals and insurance companies whose corporations believed the published propaganda?

This is why the "Maintenance of Certification" (MOC) story must be told and understood. Continuing the cover-up only serves to fan the flames of physician burnout and risks loss of more frontline highly-trained physicians to other professions.

Thankfully, the true history of AMBS board certification was recently published online. But it was not published in a medical journal. It was published in the public Siva v. American Board of Radiology antitrust lawsuit case docket.

And what a complicated and tortuous story it tells.

It is a story of public deception.

It is a story of physician exploitation.

It is a story of greed.

It is a story of trying to use Maintenance of Certification to control state's sovereignty over medical licensure.

It is a story of money for bureaucrats, hospitals, and numerous corporate interests at the expense of the youngest and most vulnerable physicians.

It is a story of a sophisticated self-serving physician education and credentialing racket.

And now, you can read the 79-page story here.

Let's hope Judge Jorge Alonso (who initially dismissed the case against the American Board of Radiology) reads it, too.


P.S.: Please consider supporting the Plaintiffs in their ongoing David vs Goliath MOC legal battles.

Wednesday, January 15, 2020

Who Is the ABIM Chief Medical Officer?

Drs. Richard G. Battaglia and Richard Baron
(Image from the ABIM Blog)
Who is Richard G. Battaglia, MD?

In 2015, the American Board of Internal Medicine (ABIM) announced Richard G. Battalgia, MD as their new Chief Medical Officer (CMO). This was the same year the American Board of Medical Specialties (ABMS) paid $922,479 to PriceWaterhouseCooper LLP (PwC) for "Management Consulting:"
What the ABIM website fails to mention with their announcement, is that Mr. Battaglia worked for PwC for 14 years, 3 months before being "hired" by the ABIM.

Is Dr. Battaglia, the ABIM CMO, concerned about medical education of physicians or merely a consultant purchased by the American Board of Medical Specialties to "clean up" the ABIM Maintenance of Certification (MOC) mess?

The ABIM website only says this about their CMO:
"Dr. Battaglia, a board certified internist, is Chief Medical Officer (CMO) of the American Board of Internal Medicine (ABIM). There, he leads ABIM's effort to incorporate feedback from practicing physicians and key stakeholders into clinical aspects of all of ABIM activities, including Certification and Maintenance of Certification (MOC).

Previously, Dr. Battaglia served as a primary care internist with Health Care Plan/Univera, a multi-specialty, staff model practice in Western New York before transitioning into leadership roles, including Medical Director of the Medical Centers Division and Senior Vice President, Medical Affairs/Corporate Medical Director. He also served as Medical Director/Chief Medical Officer of large multispecialty medical groups in Western New York. He has participated in national quality initiatives focused on physician group practice and health maintenance organizations. For more than 10 years, he devoted time to The National Committee for Quality Assurance, including a term as Chairman of the committee charged with accreditation decision-making. Most recently, he was a consultant (emphasis mine) for national and international organizations, including academic medical centers, health systems, community hospitals, medical groups, payers and national physician certification organizations.

Dr. Battaglia received a biochemistry degree from Canisius College, a Jesuit institution in Buffalo, NY. He obtained his medical degree from the University of Rochester School of Medicine and Dentistry. Dr. Battaglia completed his residency through the University of Rochester Primary Care Program in Internal Medicine and also served as Chief Resident."
Maybe PwC's "Unifying Thread" of using (physician) data is the real reason Dr. Battalia promotes "continuous certification" and MOC:
Data is the unifying thread across seven policy areas we highlight here. Privacy, antitrust, tax, regulation of artificial intelligence, and trade are converging around the collection, sharing and security of data.
Physicians subjected to lifelong payments to ABMS member boards for Maintenance of Certification (MOC) and Continuous Certification (CC) should know about Mr. Dr. Battaglia's PwC connection. Just like they should have known about Christine Cassel, MD's connections to Premier, Inc, Kaiser, and CECity, and Dr. Wachter's connections to the The Hospitalist Company and Teamhealth.

When considering patient safety and care quality, a corporate, non-clinical, damage-control medical consultant for a Fortune 500 accounting firm should not be Chief Medical Officer of the American Board of Internal Medicine.


Tuesday, January 14, 2020

Visible Cracks

it was a clinic day like all the rest
until it wasn't
she was there with her son and granddaughter
legs swollen "for a month"
afib, fast rate despite cardizem CD 300 mg daily, diabetic meds, norvasc.
BP 178/84, HR 124
meds to be started, but help?
EMR->no doctor
a nurse practitioner?
4:45 pm-> all gone
see you in two days
no appointments.

i wake too early
staring up
mind swirling
cases ahead
remembering her
and me


Monday, January 13, 2020

The Study We Weren't Supposed to See

Most US physicians are well-acquainted with the American Board if Internal Medicine's (ABIM) breathless claims of ABIM board certification and Maintenance of Certification's benefits. These have included:
  • The Public Expects It
  • Physicians Value It
  • Amount of clinical experience does not necessarily lead to better outcomes or improvement of skills
  • Certification is Associated with Better Care
But what about the harms of constant testing and its affects on physician burnout? Wouldn't it important for the ABIM to mention that their OWN study on 34 subjects, funded by US physician testing fees in the form of grants from the ABIM Foundation and authored (in part) by ABIM staff and consultants, has found that Certification and MOC:
  • "lead to higher measures of depersonalization and emotional exhaustion."
  • "may be an important source of medical errors related to clinical reasoning tasks in practice."
  • yet are considered the "Gold Standard of physician performance."

These are their words, not mine.

Where are these results published on the ABIM or ABIM Foundation website?

Shouldn't U.S. physicians who paid for such poorly conducted/self-promotional "research" be entitled to disclosure of (1) how much granbt money was paid to USUHS, (2) why the funding agency was allowed authorship of this "research," and (3) why the data contained in this work were not disclosed to ABIM diplomates on the ABIM website?


Please contribute to help support the legal effort to end Maintenance of Certification nationwide.