Monday, June 08, 2020

How MOC is Contributing to the Demise of Physicians

Dr. Torie S. Sepah, MD on the KevinMD blog:

Now, one could argue, what’s $500 a year to a physician? Well, it adds up to $5,000 in ten years, at which time I’ll shell out another several grand to take the recertification exam.  Contrary to popular belief, physicians aren’t exactly rolling in the dough. In fact, 8 out of 10 physicians under 40 carry over $150,000 in medical school debt.  It all adds up: the medical license fee, the DEA fee, the specialty association fee.  Is this extra $5,000 really necessary, and if so, what is it for?

Here’s what it is not being used for, to protect what our board certification stands for.

My board certification in psychiatry doesn’t mean much these days because NPs and PAs are also board certified in psychiatry without attending a medical school, completing an ACGME residency program, passing the three-part oral exam in order to become eligible for the written exam in psychiatry, and of course not participating in MOC or taking our rigorous written exam every ten years.

To make sure that the world knows they are board-certified, they often embroider it on their white coats. And now, in 24 states, they can practice medicine independently with board certification in a specialty like psychiatry.

More physicians are waking to multitude of harms caused by Maintenance of Certification (MOC).

This is why multiple antitrust lawsuits have been filed against the ABMS member boards. Right now, the American Board of Radiology has filed a Motion to Dismiss the first amended complaint filed in the lawsuit against them. They argue that MOC and initial certification are all one product (certification) and therefore the anti-trust claim filed has no merit. As physicians, we know better. The detailed 79-page amended complaint explains the differences of initial certification from all other "continuous professional development products" (like CME, MOC, "continuous certification" and NBPAS recertification) and explains why ABR's contention that MOC and initial certification are one product is wrong on many levels. We'll see if the judge in that case feels the physician plaintiff has sufficiently argued his case to move this case to discovery.

The American Board of Internal Medicine also had the original District Court lawsuit dismissed. But that first-pass lawsuit has now been appealed to the Third Appellate Court. That appeal adds lots of new evidence supporting the differences between initial certification and the "continuous professional development" program that is MOC and the ABIM's monopoly control, racketeering, and unjust enrichment that has followed as a result. The ABIM response to that filing is currently due July 6th.  

Our own medical boards have repeatedly poked a sleeping bear with MOC payment and testing requirements. Those requirements have harmed physicians and limited access of care to patients. While this is not an easy path to find justice, the best victories are those that are hard fought with lasting and meaningful results.



Unknown said...

I made it to 63.5 years of age and retiring from FP. The requirements are onerous and I’m tired of it.
CME was covered to a certain degree but I generally went over the allotment. I never travelled to
“exotic” places for a course as it would chew up too much of the allowance with travel costs.
Was in a classical practice of on call and office work. Do not have the stamina to do it anymore at my age as EHR has
produced a mountain of paperwork that the average Doctor has to urinate on. Nurses use to be able to check if the patient was
in between visits and handle the non-controlled drug refills like antihypertensives transparent to me. Kept me freed up to see patients.
Now production is down, job satisfaction is down and income is down. Time to leave. I look forward to being a civilian. Going into primary care is a recipe for dissatisfaction. Wasn’t always that way. At least 25 of my 32.5 years were good ones though and I’m definitely looking forward to leaving this July 1st. Hope there is success at ridding society of MOC.

Anonymous said...

The harms of MOC are blatant.

What is mind-boggling and disturbing to me:
The ABMS data supporting MOC are patently fraudulent and the ABMS abuses against physician and patient have been flagrant, yet still MOC continues.

What should be agitating to doctors and patients:
The ABMS and its 24 medical specialty boards do not protect the public or serve the profession. This is a false assertion of the ABMS. Their basis for tax-exempt status is bogus, hence false statements to the IRS and other government entities. These false statements to government bodies should put them under investigation.

From 1964 onward the ABMS (advisory) and sprouting medical specialty boards have been sock puppets for the industries and corrupt special interests they have served. This is clear from looking at their corporate and government histories.

From Big Tobacco, to Big Pharma, to Big Insurance, to the Military Industrial/Surveillance Complex, to Big Benefits Managers, to HMO's, to Big Data they have been all about protecting and enhancing the moneyed interests of "the industry", certainly not the public or the profession.

The lawsuits concerning MOC only scratch the surface of the conflicted and corrupt practices the ABMS and its partners have been engaged in.

MD to NP Bridge said...

NP and PA will take over all non procedural specialties by 2025 and procedural specializes by 2030. They will be leading pain medicine providers as they have full DEA licenses now in certain states. Further they can switch specialties (less lucrative to more lucrative) like changing pants.

Physicians will be turtles tangled in nets of board certifications, re-certifications, MOC, licenses; while those can be sharks with lots of speed and flexibility.

Now you choose what is your next move? I want a MD to NP bridge program...

Anonymous said...

Just to give some idea of what we are up against. I spent more than half of last year recertifying my two boards, reading 60 research articles, each with very detailed and often petty questions at the end. The articles were, I must admit, excellent but it was too much. I understand that I will be doing this every 3 years now...not every 10 as it was in the past. This activity did not count at all towards my CME for that year so I had to do my 60 hours on top of it(for 2 boards) and also two another Self-assessment tests. My third board sub certification got canceled so I have to take a new one this year, with a different board. I have been eying the book I am to read for some time now. Plus have to do my regular CME. Practically I will spend another year studying. I understand why people get resentful.

Unknown said...

I'm not sure what all the fuss is about. I am able to get as many CME credits as I need just by using up-to-date which is provided as part of my Mag Mutual Insurance. The only thing I have to do for MOC is to take a recertification exam every 10 years. Personally, I think this is a good thing to stay current especially in areas outside my focus of practice. I embrace any opportunity to stay sharp in my field. It's so easy to get complacent and fall behind on medical advances, especially if you practice internal medicine or emergency medicine.

Delfin said...

The answer should be simple. Physicians should abandon the medical associations that do not defend them from this abuse and stop taking the boards, or at least refuse to comply with the MOC. We are the most compliant group of people I've ever seen.

Bodywise007 said...

in reality, everything is contributing to the demise of physicians. The bureaucracy, standard of care, guidelines, algorithms, inefficient EMR's, HMOs, HIPAA. The list is endless.

There was a time long ago when the necessity for board certification for pediatricians was considered frivolous. We all knew children were just small adults.

Then I entered an emergency medicine for years without board certification. Board certification is a game. It does not guarantee competency. It does not guarantee expertise. It may in many instances. But is not a guarantee. That is why you need to take special board preparation courses to learn the rules of the game.

So the MOC, which I did not even understand at first, is all a scam. That is it. It is a scam. All these certification boards to extract more money from physicians. it is all a game. And it costs money. It does not guarantee better quality of care. It is self-defeating.

That is why you are seeing these suits. Enough is enough.

rfgh said...

As much as I hate everything about MOC, the thing that infuriated me the most was my last certificate doesn't even say I'm certified. It directs the viewer to the ABIM website to see if I'm up to date! Thankfully, I will never give another dime or minute of time to this ridiculous process.

Unknown said...

The hospital has courses you must take on opioids, compliance, safety, sex’l harassment, and more, then we have meetings, interviews, for residents and evals, plus cme’s, then clinic cases for free ...... and the residents leave with big debt , and more the MOC , ACLS online , what drs. make never includes all the extraneous incidentals that make you feel “ the blahs” . I love the practice, it’s the everything else .

Anonymous said...

After 42 years as a MD I was crushed to retire from Internal Medicine and Geriatrics but I had no choice. I was grandfathered in so I never was forced to do MOC but spent evening reading five journals Uptodate and taking Harvard CME course every other year. Hiwever as soon as I was upgraded to an EHR, I had to spend these hours from 6pm to 9pm every night as a data clerk. This finally did me in. None of the junk I was forced to input into the EHR helped patients , it was all required for billing and “meaningless abuse”.

A year later I am still unhappy because I desperately miss my patients, who still call me to twll me how much they wish I was doming back. I would love to go back but medicine as I was trained to practice does not exist anymore.

Anonymous said...

AIBiM is archaic, outdated, immoral, simple wrong
Studying for 10 year exam is very time and money consuming, it is not the test for your Speciality, PCP
Useless memorizing of the latest in disciplines that one will never use, Hematology, Oncology, Neurology, Cardiology, etc
They cancelled test this spring, refusing to acknowledge Covid pandemic for months, stating that Pearson centers crowded rooms are safe, that hand sanitizers, glows and masks are OK to be safe for 10 hour test. Ridiculous!
Test was cancelled when it was not possible to ignore it anymore.
I, like many of us “obliged” to take it due to employment contracts, studied for 4 months, 12 hours each Saturday and Sunday. 3 weeks time off was requested before the test.
Covid mobilized all of us in unprecedented way, endless hours, days, weeks, months of work on the edge of possible, burnout, physician suicide, patients deaths, financial uncertainty, lost revenues, jobs, patients mental health with great unemployment and insurance loss....
One can add much more
Not a single word, not a single guideline from ABIM. Until new announcement came that testing is resumed in October!!!!!
We are in the midst of the greatest public health crisis, doctors are working at the edge of human possibilities, and in the midst of it all we should study for the useless test? We are passing the test of Covid that they did not have in the books! Who can study now? Who can ignore the challenges of reopening, patients care and our own mental health? Who can take time off to study for this nonsense?
They should grant extension to everyone who was to take their artificial test this year at least!
We should not be silent! We should have a National referendum. Reform is long overdue!
ABIM claims “ gold standard “ How about “grandfathered “ MDs, how are APRN, NP, PA Gold Standard??

We need to raise our voices and made them heard on the National level! Maybe have Investigative reporter do expose it in a major National publication with all facts, financial disclosures, and implications!
We should not remain silent and feed the group of bureaucrats forever!

Unknown said...

Specialty boards, ever since the recertification scam was allowed to continue, have abused the principle of continuing education and turned it into a burdensome profit mill for their own gain. I'd suggest the National Board of Physicians and Surgeons. Their membership has grown steadily as have the number of hospitals and insurers that consider it a valid board certification. Check them out. Turn your back on the ABMS for all the right reasons.

Ted said...

Need to multiply this discussion times 100K.

Doctors Need Unions, Attorneys and Legislators said...

Doctors need to have unions like nurses in order to have better working conditions and pay. Or to fight scams like MOC and monoplist organizations such as the ABMS. There is a movement in this direction. It is necessary to build on it.

Legal representation is also, not just advisable, it is imperative! Nobody is going to rescue doctors except doctors themselves working together. It is important to show monetary support to the PPA legal fund. It sends a message.

NBPAS appears to have good resources. MOC and the ABMS has managed to keep its monopoly, though and this organization needs more support.

Physicians should all become vocal or the abuses and decline in US healthcare will continue. Physicians need medical societies to step up and work on legislative measures that protect physicians and the public from the menacing plague of corporate greed and takeovers.

Anonymous said...

Doctors in peril? I am at a lost to understand. Certainly not in peril are the physicians in leadership positions at ABIM, whose high six figure salaries and comfortable benefits are paid for by the MOC fees.

Unknown said...

As you get older you only can learn what is relevant to you so going ahead and taking tests that have no relevance to your clinical practice is just ridiculous. The good doctor like we do now is that we read up and learn stuff that happens to us every day and we become better practitioners for it. But apparently no one else understands that

Doctor Ross said...

MOC has always been about money. As an FP I refused to cooperate years ago when the FP boards first instituted it realizing it only was designed to enrich the board members and aggravate me. When I complained in writing to the FP Board they sent me a letter with a "study" involving 16 patients stating it was evidence MOC was valid? Excuse me? No! It is a well-known fact that the ABIM board members were paid enormous salaries for a few weekends a year as well as purchasing a property with the money. I was lucky in that I was grandfathered in at my hospital and now I am retired and only help out a local group from time to time and I still get over 100 hours of CME a year most online and free. As long as physicians continue to send in the money for MOC it will continue. I understand most won't bite the bullet and refuse but once the money disappears MOC will disappear.

Unknown said...

I find the MOC process demeaning. The articles are usually excellent but asking me to take a multiple choice test to prove I read them is insulting. I have more degrees than a thermometer, I did not get them by avoiding my work, and I do not appreciate having my honesty questioned as if I was a middle schooler. Tell me what you want me to know this year, I will read it, sign that I read it and we are done . I am a professional. EMR is another story and a good reason for 65 year old guys like me to be retired. I loved my OBG practice, but it was time to go. Good luck to all. GT Raleigh NC>

Anonymous said...

after 42 years in practice i fully retired over a year and a half ago as a hem/onc after going part time and then did some locums in rural areas in my state; i totally ignored the mocs; total garbage; at that point i could have cared less what they did; i feel for my younger co-professionals in all medical fields; it's a total rip off and has no remote relevance to capability

Unknown said...

It shouldn't be anti-trust complaint. It should be discrimination and double standards case

Anonymous said...

Instead of testing us up the wazoo, each specialty board should sponsor a FEW ESSENTIAL courses, with identical pre and post rests. These should cover what is essential new information to know. Scoring 25% better, or over 75%, should be sufficient to pass. We jumped the big hurdle of board certification. Academic volunteers can make up the course and testing, at little expense. This current expensive time consuming process is unnecessary.
At age 61, preparing for a 4th set of exams was preposterous. Enough already.

Starman said...

Took my ABIM boards 4 years ago for the 3rd time. They will expire in 2026. I am done. All my colleagues have already hit the golf course as they couldn't take it any longer.

I will start semi-retirement soon at age 66. Will work part time doing what I love since I don't really need the money. My health is not so good so I am staring the end in the face.

Most of my needs have been met as a physician but feel sad for the up and coming docs. Have advised my kids to avoid medicine as the writing has been on the wall for some time. I was able to provide good care-compassionate care- and I gave the world back a little bit. I am glad I chose medicine and I have no bitter taste as I get prepared to say goodbye.

Unknown said...

As a "grandfathered" internist, when I took the boards it was to establish that I had a knowledge and judgment base that was felt by the Board adequate for them to certify. My state required continuing medical education to maintain that my knowledge base remained adequate, and getting 75 to 100 hours annually of CME showed that I cared about my professional quality of care. MOC only is meaningful if CME is not useful, but the AMA or medical boards are what certifies that the CME is high quality and a practical way for a physician to keep up, and so the Boards are actually saying that their certification of CME is wrong if it doesn't permit maintenance of competence. Therefore if the Boards feel MOC is necessary they need to stop accrediting CME, which in the 1980s they suddenly decided wasn't enough.
We in practice understand that knowledge is part of the issue and judgment is at least as important. Have the Medical Boards any data that indicates that those who have judgment lose it as they practice? Because CME, and MOC, are both really about demonstrating keeping up with the constant evolution of medical knowledge.


During my Nephrology Fellowship I saw the trap of expensive wallpaper that many colleagues were being led into by the ABIM, spending thousands of dollars to sit exams that really didn't test useful information in practice --- information that I gained by budgeting an average of a half hour a night, reading the literature. I got initial Board certification in Internal Medicine and nephrology, attended the annual Scientific Meeting of the American Society of Nephrology, and did CME in excess of the 40-hour minimum that my California, Illinois and Tennessee licenses required. I subsequently served 30 years in the Air Force and another 15 in DoD-GS and the VHA, earning Fellowship in the ACP and the ASN, being on the voluntary teaching staff at UC Davis and East Tennessee State University, making multiple contributions to the literature, commanding two large squadrons and a military hospital, and finally retiring after 45 years and two careers to continue teaching as a Volunteer Faculty. NONE of that required the repeated exhausting and expensive trials that those who hitched their careers to the ABIM's recertification process required. And NOBODY ever asked me "have you recertified by the ABIM"? The needless and counterproductive conflation of initial certification and recertification that the ABIM has created is a redundant no-value-added drain on the Physician community. It needs to be ended. Initial certification, routine meaningful CME, and the continual close quality monitoring carried out by institutions are quite enough to maintain solid practice.

Anonymous said...

Yes. MOC kills, in so many ways. Why can't they just leave us alone?

H John Gerhard said...

MOC is simultaneously abusive and fraudulent - abusive to physicians (eg., forcing expenditure of large sums of money including the requirements to purchase CME from the governing agencies as well as the recurring exams) and fraudulent wrt the public (the exams CAN’T guarantee competence/skill though they are touted by the various boards to do just that) . As an aside, a 92-96% pass rate is evidence of the pro forma nature of the expensive exams; a higher failure rate would likely have resulted in earlier and more vocal protest from the disenfranchised/failing physicians . Though I have also decided to retire (while colleagues who are only a couple of years older but grandfathered continue to practice), I am rooting for the various law suits

Cyberderm said...

Take a look at The evolving maintenance of certification process: update on the financial status of the medical boards 2020
Author(s): Schwartz, ZivLieberman, Miriam RSiegel, Daniel M

Sutton’s Law!

Anonymous said...

For years I have tried to motivate the physicians in my community. The usual response "I don't have the time".

I would suggest that you support the National Board of Physicians and Surgeons. It is the only organization that I know is truly trying to help eliminate MOC and re-certification.

When will it get painful enough that we are willing to stop taking the re-certifation and MOC? Medicaid and medicare do not require physicians to be board certified.

I have stopped playing the ABMS game. I refuse to re-certify.

To all of you who continue to bend over, do not complain.

Anonymous said...

Patients want “NICE” providers. They don’t care that the “NICE” provider doesn’t know what they’re doing. They just want them to be “NICE”. That’s why we now have incentives on patient satisfaction. That being said, why do we need any education. A monkey can order every test and hope one of the tests will make the diagnosis. Patients call the NPs and PAs doctor and get defensive if I correct them that they are not doctors. Society wants cheap “providers” so all the hoops physicians have to go through are incentives to follow the other paths; PA school.

Anonymous said...

If every physician simply refused to recertify, then MOC would cease to exist very quickly.
Physicians, heal thyselves and "just say no" to their ridiculous scam to regain some of our power and agency in the best interest of our profession and patients.

Anonymous said...

I can only say that I have been too busy to fight what is a seemingly insurmountable conflict to defeat the ABFM at busy work to prove what? I love Family Medicine in spite of all the hurdles and lack of peer recognition. I am only part-time now and that lessens the pain. I fear for those who can't cut back in order to stay positive and truly help people.

Surf doc said...

I retired from clinical medicine at the beginning of 2015 after 35 years in the same busy ER. I need to keep my boards because of fire department administrative gigs I have. I’m due up in 2022, when the ABEM is switching to an open book format. I subscribe to Up to Date for CME. Still, I may need to take a review course and will be out $2K for the test itself. Currently undecided on my course of action.

sorry to quit but glad to be out said...

The only apparent purpose of recertification as it is currently set up is to subsidize academic physicians who give CME courses. To make it more bizarre the courses have a questionnaire at the end having nothing to do with practical learning.

Unknown said...

MOC 2 and CME should be one and the same. If I do a CME with Medscape, it counts for ABIM, but I am a member of ABP. Medscape has not paid the 'tout' to the ABP so the wonderful articles/CMEs on pediatric subjects cannot be used for MOC 2 for ABP. MOC 2 is redundant. MOC also restricts what type of education I take. I like choices - maybe just want to bone up on hematology this year, etc. - but I won't spend $ or time unless the CME also gives MOC 2 points. I can't pick my own areas of interest, etc.

MOC 4 and hospital/office Quality Improvement projects are identical. I've been involved with the latter for almost 25 years, but I now have to somehow link the projects to the ABP. We were told we need to learn how to improve. Waste of $ and time again.

There is talk of patient eval becoming part of MOC. This is also a function of hospitals/practices so again redundant.

I know several docs in their 70s who are still practicing, but those of us who are not grandfathered in waste so much time and $ on MOC that we burn out faster. Also it was insulting that the people who first created MOC were mostly grandfathered in themselves. I worked with California Assn of Neonatologists years ago to stop this, but ABP said they were bound by ABMS that controls all the boards.

This is similar to the licensure racket. Since COVID some states were accepting licenses from different states and privileges from different hospitals - how enlightened. There should be one credential, then maybe you pay a license fee to practice in the states or a privilege fee to work at a different hospital. When I moonlighted around the country, getting all the different licenses and DEA #s and, for that matter, hospital privileges was a waste of my time. I don't think a heart attack is that different in Iowa or Oregon... We're subject to all kinds of unnecessary BS. We should just use NPI or something, then that should be good everywhere at least in US.

Anonymous said...

I fully agree, after initially certifying in 1997 and recertifying in 2007 and 2017, I was done and happily joined NBPAS in 2016 prior to lapsing! I will not bend over for the money grubbing bastards at ABMS any longer!

Anonymous said...

I also dropped my ABMS board certification last year. As a psychiatrist in private practice, it's useless. No one (and I mean no one) has ever asked me about my board certification -- no patients, no other providers, no insurance panels, and my university doesn't even care about it for my volunteer clinical faculty position. It's a massive scam, and I don't miss it at all. I still do my CEs (most of which I get from teaching), and read a few choice journals.

kahn MD said...

I think there are 2 sides to this: 1. the costs of MOC, & the seemingly shady profits from it. & 2. the unquestionable value (really, can you question the value of reviewing & updating one's knowledge in a field?) of a process of studying. The first, one could do without quite well. The second, as others have accurately pointed out, can be done in other ways, & is mandated in several milieus.
I was always proud to recertify in GS & Vasc Surg, but I do not think it made me a better doctor. Working, arguing or discussing with colleagues, looking things up, reading journals at 1am, re-evaluating endlessly my clinical failures, or personal failures: these made me a bit better.

When I retired 5 years ago, I was thrilled to tell MOC folks to shove it, never bent over for the EHR, had felt the tyranny of hospital administrators with their increased power, & did not say goodbye to any of them. Locusts.

My son is a neurosurgeon. I hope he can cope with it all, & perhaps it will be easier if you are all heard. THANKS

kahn MD // NJ

Anonymous said...

Patients do not seem to know the difference in training between doctors, NP's and Pa's anyway. They don't even know or care whether a physician is board certified; leave alone re-certification. The combination of advent of NP's and PA's with less training and the endless burdens placed on doctors is leading to the demise of good doctors and to a different level of care patients will need to get used to. That is what the next decade is going to bring.

Anonymous said...

I recommend joining the “Association of American Physicians & Surgeons”. It truly represents physicians and the art & science of medicine. It has been around since 1943. Check it out.

Unknown said...

Let's face it; we've been snookered. All of us recognized and accepted that one of the tenets of Professionalism is a commitment to lifelong improvements in learning, knowledge and clinical practice. Maintenance of Certification,as conceived by the ABMS, seemed like a fair and worthy means of serving this goal, while at the same time ensuring public confidence in the profession. The ABMS developed an extensive network of semi-private agencies and managed to enlist powerful regulatory bureaucracies, including the federal government, to enforce mandatory adherence to the structural requirements-all under the guise of improving quality. The money came rolling in; and a huge cottage industry was created. Doctors who had found a far more lucrative way to make a living than seeing patients became fat and happy, and ever more greedy; they squeezed tighter with ever more requirements.

The costs in time and finances to run this pseudo-academic gauntlet are well-described in the comments above. I was certified in Internal Medicine and Endocrinology/Metabolism before 1984, but acquired added certification in Geriatric Medicine and re-certified-but never again. The costs in time and money are far too excessive for a busy internist. Now look closely: the "educators" who belong to the alphabet soups (ABIM, APDIM,the 24 ABMS subsidiary organizations, etc) that manage this enterprise, despite enjoying handsome incomes, often don't even bother to subject themselves to the same testing requirements.

What can be done?

[1] First, make recertification voluntary.

[2] Eliminate government mandates.

[3] Enable physicians to design and choose a program that best fits their own scope of practice.

[4] Publish the ridiculous incomes of the Czars of recertification and call attention to their pecuniary interest in this process, because they enrich themselves off the backs of hard-working physicians.

Physicians of the World, unite! You have nothing to lose but your chains!

Anonymous said...

For a profession that lives and dies on the hill of evidence-based practice, where is the evidence that MOC and high stakes exams has helped physicians and patients? I have no problem with the CME process and favor the type that requires literature review as a way to keep up with new developments. Beyond those simple and low cost strategies everything else is profiteering.

Mark said...

Odd you don’t state your specialty

Anonymous said...


Practice of Medicine, is totally taken over by Corporate greed. Introducing EMR made the NP and PA work most comfortably. MD's having to spend their time on EHR, rather than using their acquired medical knowledge on patients care but to satisfy the level required in writing for correct billing for each patient. NP's and PA's are gaining their qualifications on web. Their Board's on web.They are hired at lower salary by fellow MD's, just like opening a Gas stations in form of Practice 10 to even 20 medical practices. Earnings of MDs can be enhanced this way. These mid levels have acquired prescription rights, DEA numbers, almost at par with MD's when it comes to medical practice in this country.
Many patients and Corporate are calling them Doctors, that we busted our backs to reach that level.
Now most of the mid levels have taken over in VA hospitals to almost all Corporate run hospitals and Practices.
ABIM etcetera are just money suckered corporations, that has no relevance in practical fields.

MD's are defeated and are dying breed,NP's and PA are taking over completely very soon, if Corporate greed continues and stupidity of MOC Continues. What Board's all the mid-levels have Board certification and are fast replacing the MD's.
The shit hit the fan in 1970's in form of mid-levels and a strong force creeping allover.
We need to buy the lobbyist on Capitol Hill to regain some sanity. A meaningful trade not AMA, a toothless tiger,that old with no strength to defend.

Fleming said...

It seems like post certification education documentation is all over the place. Is it CME's, formal testing, etc. I do feel there needs to be a major overhauling of the process especially considering there is no incentive for the ABIM to "pass" a physician. Also, the content of the testing reflects more often the "zebras" showing up in the waiting room than the "horses", as the old expression goes. The ABIM finally allowed the use of Up To Date, but why limit it to that? From the beginning when the ABIM tried unsuccessfully to negate past promised certification effectiveness periods, it demonstrated how poorly planned the process was and remains to be. I like many of my colleagues will prematurely exit the profession to avoid this as well as other aspects of medical bureaucracy that has nothing to do with promoting patient care, and don't even get me started on the litigation scene.

Anonymous said...

I'll certify through the ABPAS before I bail, and it's an option that looks better and better every time I look at the ABFM's q 3 yr trash heap. They will give you CME for giving the wrong answers, because the Board doesn't have to recertify. They're using fossilized questions and answers (I believe from the pre-Cambrian).
MOC costs in time and $, and afterwards you have to sort out the dangerously antique wrongness that the Board wanted you to learn to pass their test.
Lawsuits can bring down the ABMS monopoly and can restore meaning to the BC/BE credential. But the tide of the inadequately trained, arrogantly ignorant mid level is outside of our control.
I will watch carefully the ABIM lawsuit, and I wouldn't mind using that experience to aim the came cannons at ABFM.

Anonymous said...

I'm in Pain Management, so I deal with both my primary and subspecialty board MOCs. I disagree that in my case, there is any tangible educational benefit to my patients in recertification. I don't practice anesthesiology, so any time I spend studying for that is time I could have spent studying what I actually practice. But even the Pain Management MOCA does not augment my clinical knowledge base relevant to what I actually practice.

I don't treat post-op pain, headaches, pediatric patients, oncology patients, and numerous other sub-specialty areas of interest in pain medicine. But when studying for my MOCA exam, it is these areas that I have to study, because I don't otherwise don't get enough exposure to them to test adequately. The issue is-- I don't need to know these areas to the level of a "consultant." Every hour I spend studying these areas is one I could have used to learn more in the areas in which I actually practice. I intentionally avoid additional studying in the areas I practice because that isn't going to benefit me nearly as much on the MOCA examine as filling in knowledge gpas in the areas I don't practice.

As such, I would argue that the MOCA process actually impedes my education relative to my clinical practice, and is a detriment to my patients. How could it be argued otherwise?

Anonymous said...

Thank you for this article and for all the posts. It is good to not feel alone. I have taken and passed ABMS certification boards in internal medicine, haematology, oncology, and palliative care. I have re-certified in Medical oncology 2 times. I vowed in 2017 that I would not re certify again (as a matter of principle, in protest of the racketeering by ABMS and its abuse of doctors) and joined the NBPAS to support Dr Theirstein and an alternate to the ABMS. In the last 3 years (with the increased pressure from NBPAS), the ABMS has tried to appear benevolent to physicians, but has gone to almost every hospital and insurance provider in the country and made "ABMS certification" a requirement for credentialing. It looks like you have to "pay to play" when you are dealing with medical mafia. The only alternative is to stay in outpatient practice and go with a fee for service model which is very hard due to the price of medical oncology drugs. AAPS is also a helpful organization for people seeking advice on escaping from the medical mafia plantation. I am on the cusp of deciding to just write my memoirs and given the ABMS a middle finger salute, or hold my nose, get out my wallet and do 10 year exam in October. Hobson's choice.

Anonymous said...

I just retired from my Internal Medicine practice of 40 years...just before viral threats surfaced. CME/MOC guidelines are well intended, but do not necessarily make us better physicians. Those who are inspired, will continue to study and participate in the academic side of our professions. Those who are not, cannot be forced to be better physicians with MOC guidelines. I am through with the meaningless computer work which did not help patient care. I am through with the bureaucracy of billing, authorizations, and claim denials. Now we see mid-level providers taking responsibility, as if they were physicians. We are seeing Piper Cub pilots now controlling a 747.

Dr. Camara said...

I also am fed-up with MOC, but have to do it to be on staff at the hospitals. I asked the board of directors to consider my board certification with the National Board of Physicians and Surgeons NBPS. This is the alternative board to ABMS. It requires initial board certification from the ANMS, then 50 - 100 CME hours in 24 months depending on status of prior board certification. Check but out. I am hoping that medical staff at hospitals will accept this certification, and that insurers will follow suit.

Dr. Camara said...

I too am sick of doing the MOC of the ABMS and agree with most of the posts. I have board-certified through the National Board of Physician and Surgeons NBPAS. The require initial board certification through ABMS, then 50 - 100 hours of CME every 24 months depending on status of initial board certification. I have asked the medical staff board to accept this board certification in lieu of the ABMS board certification. I hope they do, as well as insurers. I hope more physicians will transfer their board certification to NBPAS.

Steven A. Reid, M.D. said...

As president of Doctor Lifeline, a 501(c)3 charity working to prevent physician suicides, I can confirm that the stresses of MOC contribute to doctor suicides. The suicide rate for US doctors is 34% higher than the rest of the world. Many other factors obviously also contribute, but undoubtably there have been doctor suicides wherein MOC was the "straw that broke the camel's back." See for more.

Anonymous said...

At nearly 70, I am retiring at the end of August. I love my patients and I loved the practice of internal medicine, but the combination of MOC and EHR data-clerk situation has finally driven me out. Struggling with the identity issue which I know will come, but I have had enough.
I agree with 99 percent of the comments above.

J J Perry MD said...

How many hospitals require board certification for credentialing? It's a lot.
The requirement for board cert is usually found in the medical staff bylaws. Bylaws that the medical staff approves.
Board cert is eyewash that the hospitals like. It confers an illusion of high quality.
Board cert is liked by quite a number of docs. It is a form of protectionism that many despise when the government does it, but embrace it when it benefits them.
There is no evidence base I've seen that supports its use.
We would do well to rewrite bylaws - or reject bylaws - that require Board cert.
If you want quality, then measure it and improve it. Board cert is useless for quality improvement.

Anonymous said...

This board certification issue is twilight zone stuff. We are supposed to improve/prove our competency as physicians through this testing. NPs and PAs essentially work as physicians, some practicing independently in some states. How in the wide world of sports can they claim to have the same ability as a physician that has worked through the rigors of medical school, internship and residency? The answer is simple. They don't. This fact alone explodes the fallacy that we must jump the certification hoop to prove our competency for excellent patient care. Certification is a scam. BTW, I am certified, but I will let this lapse. I refuse to play the game any longer.

John Brownlee said...

I reject the concept of MOC 4 and understand that all practicing physicians need MOC2 (i.e. CME). QI (MOC4) should be hospital/ peer based and therefore does not require a national merit badge. What is needed is someone to centralize all of our credentialing academic, and CME information nationally and allow any appropriate organization to verify all is true with a single query to the organization. There is an huge amount of redundant paperwork required every 6 to 12 months for all of us who admit to hospitals or apply for privileges/ licenses. My office has a full time staff member chasing this down to allow the doctors to keep working. If the ABMS wants to take on this needed job and have the hospitals pay for them to store and manage this information, then I would gladly welcome it (but please abandon the MOC 4 requirement)

Unknown said...

The national board of physicians and surgeons is a physician certifying board which each state could sanction. I have belonged for several years in Washington state. MOC and the money machine behind it need to be taken down. Our society will miss us qualified physicians who leave medicine.

Anonymous said...

Just create a new board! By Physicians for Physicians. the Board Must be renewed every 2 years. Board members may not have ties to INSURANCE COMPANIES (UNITED HEALTH), Hospitals or Pharma! the venture capitalist are pushing PRIVATE single payer they can only do it if they eliminate MD's. Protocol based medicine is here (KAISER). MOC is a way to weed out Docs. Demonization of physicians will continue. We have to change the Narrative or it will change us....

Unknown said...

You will see that the board you envisage actually does exist, I am a 59 year old neurosurgeon actively embracing "semi-retirement" largely due to the revolting corporatist cancer of US medicine well described above. I let my "time limited" ABMS certification expire on 12/31/18 and honestly would rather dig ditches than practice neurosurgery if ABMS MOC certification was its sine qua non, which luckily it is not. I enjoyed some of the excellent posts above and agree that US physicians of all specialties must now unite against the ABMS scourge. Quit the faux ABMS certification racket, join NBPAS, and vote with your feet by moving to a hospital that recognizes the latter. Alternatively, join your colleagues to object en masse to all ABMS credentialing requirements at your given hospitals to break their dirty profiteering monopoly once and for all. History tells us that the whiny acquiescence by most docs today does not ultimately freedom bring!

Anonymous said...

The American Academy of Pediatrics several years ago sent me a letter that they thought MOC was a good idea. A good idea as the insurance industry was constantly telling them that there needed to be better ways of proving our skills and knowledge. The pressure was continuous on them. What about the recertification they require and the CME the state requires and the trust and satisfaction patients require. That day I stopped belonging to the Academy. They do not advocate for me or my fellow pediatricians. The fee to belong is not small and I will support them as they let me down and support the insurance industries that as we know nickel and dime us constantly and continue to cause headaches whenever they can. We waste thousands of dollars on the ridiculous things they make us to provide patients the care they deserve and the rumeneration we struggle to get. And then the AAP took their side. If they had merely said MOC was a good idea and would take the place of recertification, it would have been more acceptable.
Everyone should leave their academy and stop paying dues to see what happens.

Anonymous said...

Yea sure, refuse to pay your dues or to maintain board certification. That sounds great until they decide to replace you with an NP or PA and their 2-year master's degree that they mainly got online... Thanks for all your hard work.

Anonymous said...

I plan on getting all the MOC I need but I will not be taking a test

Anonymous said...

So, wake up!!!
Initial certification AND MOC are not required and not needed. Residency and PASING your licensing exam is.
I graduated from UCLA Iin the 80’s and knew what the scam was!
Ever wonder why the exams in residency are by the same folks as board exam and MOC!
ATT was broken up by MCI!
Wake up doctors, initial and MOC is all about money!

Anonymous said...

Philadelphia, PA, June 5, 2020 – We, the leaders of the American Board of Internal Medicine (ABIM) and the ABIM Foundation, unite with our colleagues, practitioners, and partners within the medical community to decry the police brutality, racist violence and underlying structural, systemic and cultural racism that have had an impact on every aspect of life in our country.

Like tens of millions of Americans, we watched the killing of George Floyd in police custody. We also see the devastating and disproportionate toll that COVID-19 has taken on Black and Brown communities, which have seen far higher rates of infection, death and unemployment, facts that vividly demonstrate the structural inequity in our society and in our health care system.

Racial Justice Statement
As leaders within the medical community aware of implicit bias, we need to accept and understand our own roles in creating the current reality. A medical model that focuses only on the characteristics of a virus and ignores the constructed social world through which the virus spreads is insufficient and must be expanded.

It’s simply not enough to say passively we will “do no harm”; we pledge actively to do our part in opposing and dismantling systems and policies that cause harm to our patients and disproportionately affect those in Black and Brown communities.

As a physician certifying organization, ABIM commits to analyze our programs for potential disparate impact on racial or ethnic minority candidates, be transparent about the results and address any inequity to which we may be contributing.

The following statement is from the ABIM on Statement on racial justice to our community from our leaders:

"The ABIM Foundation has focused on the impact of trust on health care. We will devote our 2020 Virtual Forum to gaining a deeper understanding of how historically merited distrust in the health care system among Black and Brown communities has contributed to disparities, and what can be done to earn back that trust. We commit to identifying and spreading promising solutions.

Our oath is to preserve and protect lives regardless of race, creed, gender, or color. We must accept the sobering fact that the present reality speaks to a collective organizational failure.

We commit to do all we can to eliminate racism, its underlying roots of power and privilege, and its impact within our organizations, our communities, and our country."

This is from their website. I wonder if they realize that there are black and brown physicians who have to suffer because of MOC. This could be helpful to used as ammunition for litigation against ABIM/ABMS. The nature of MOC is discriminatory but I guess physicians don't matter unless they pay up.

Racism at ABIM? Yes, a clear history of it said...

The Court Record is Clear: ABIM Engages in Racial Discrimination

Racial discrimination case Wyatt vs. ABIM Case 2:10-cv-01366-PBT
Document 1 Filed 03/29/10

Settled quickly out of court by ABIM to avoid public attention to the racial implications.

The court record details racial discrimination against veteran black female employees. Read Wyat vs. ABIM. An account of the ABIM/ABIM Foundation systematic and calculating cure for employees of color. Not just one, that is what is so shocking. It was systematic.
(A word of caution, very graphic account of executive malice involving cruel and unusual methods of hiring a white female "contractor" to haze the employees. Not recommended for those with weak stomachs and hearts.)

The names of executives who participated are clearly outlined and detailed.

Anonymous said...

The disgusting hypocrisy and propaganda spewing from the ABIM and ABIM Foundation proves that the ABMS/ABIM is a political/financial sewer. Their lucrative self-dealing financial programs (MOC) and disinformation campaign on "TRUST" in healthcare are nauseating examples. The ABMS/ABIM/ABIM Foundation are full of self-serving lies and mandated policies. Monopolists and racketeers.

Vote with your voices and dollars! said...

US physicians are being discriminated against, scammed by the ABMS and 24 medical boards. Nowhere else in the world are physicians required to participate in a pay-to-play maintenance of certification Ponzi scheme called MOC. If you don't participate in MOC, you lose your certification, which has become ubiquitously tied to employment and reimbursement.

And the ABMS dares to call their MOC program "voluntary"!

Plus the ABMS imposes universal suffrage on physicians. Doctors have no right to vote in order to make their voices count at the ABMS or 24 medical specialty boards. None of the nearly one million ABMS board certified physicians have the right to vote on anything including the important restoration of an important property right. I mean the ABMS "lifetime" certification, which is being stripped daily from physicians who refuse to participate in MOC. Certification is a property right. Employment/insurance reimbursement are personal rights that have been taken away if physicians do not participate in MOC or pay up.

The right to care is a patient's rights according to the NQF, NCQA and other ABMS partner NGOs. Yet the redundant MOC requirement burdens physicians and takes away millions of hours of patient care. Unemployment and early retirement leads to potentially billions of hours of patient contact time over many years. MOC reduces the quality of care, obviously, yet the NQF and NCQA twiddle their thumbs and pretend that it enhances quality. Not a mole hill of evidence to back up MOC scientifically and a profound mountain of evidence proving that MOC does harm! This harm is inscribed into every physicians faces and hearts. Written into every frustrated patient's being when they cannot see their personal physician - from the MOC fallout or the EHR data duties, which the ABMS is reaping profit from along with their corporate cronies.

Physicians protest the cancellation of their rights. They protest being stripped of their freedom to choose their own CME. But the complaints fall on deaf ears at the ABMS. The "self-regulation" promised by the ABMS is a lie packaged and sold to physicians and the public. This false narrative must also be remedied. Rent-seeking executives have millions of reasons ($$$$$$$$$$$$) to stonewall and ignore physicians pleas for relief. Billions of reasons ($$$$$$$$$$$$$) to not give physicians the right to vote. Trillions of reasons ($$$$$$$$$$$$$$$$) to misinform the public about the real reasons a self-serving ABMS is harming the professions and the public.

Help fund the lawsuits to remedy the continuous degradation of professional and patient rights.