Thursday, July 16, 2020

MOC and the Racist Origins of Grandfathering

From Paul G. Mathew, MD via Facebook: 

A hearing was held yesterday by the Rhode Island State Legislature's House Finance Committee regarding H7171 Article 20 on Healthcare Reform. One of the topics of discussion was the Interstate Compact, which will allow physicians to practice medicine across state lines. This will be especially helpful in providing tele-health services to areas of need. One major concern is that the compact is written in such a way that a physician is defined as someone who is compliant with the American Board of Medical Specialties Maintenance (ABMS) of Maintenance of Certification (MOC) Programs. The American Medical Association (AMA) has passed numerous resolutions that MOC compliance should not be a requirement to practice medicine ( This would be the first time that obtaining a medical license would require a physician to pay this non-profit private monopoly for a product that is expensive, time consuming, and has little evidence that it improves patient care.
MOC serves to increase the cost of healthcare, reduce patient access to healthcare, and contribute to physician burnout. As recently as May 28, 2020, the AMA has taken a public position that compulsory MOC participation contributes to physician burnout ( In addition, MOC compliance is discriminatory based on age, race, and gender, as time-unlimited certificate holders (grandfathered physicians) are excluded from participation, and are 80% white and 70% male (
The term “Grandfathering” has racist origins as the term was used in an effort to limit people of color from voting. As such, it should not be used by name or in discriminatory practice. ( Granting one group of physicians elite status of this nature is particularly concerning given our society's current focus on systemic racism and gender discrimination. The danger here is that if the Interstate Compact is successful, national rather than state medical licensure may be on the horizon, which should not be tied to MOC compliance.
As Director of Legislative Affairs of the National Board of Physicians and Surgeons (, I submitted testimony requesting that NBPAS also be recognized as a re-certifying entity. Physicians must have a choice in board re-certification providers between evidence based (CME) NBPAS re-certification or MOC based ABMS re-certification. I hope that my physician colleagues will join me in voicing our concerns to the leadership of our societies and policymakers that MOC compliance should not be required for practice, and in the case of the Interstate Compact, should not be a requirement for licensure.

View more about MOC, its harms, and inherent racial and gender discrimination here.



Anonymous said...

Just like some made apetiton to POTUS to sign an executive order for HC to be over the counter.
We should rask POTUS to sign an executive order to end MOC>

C K C said...

The ABMS/ABIM hypocrisy and discrimination is chronic. Very disappointing.

Former ABIM CEO, Cristine K. Cassel, et al are white racists according to court documents.
See employee and client discrimination cases against the ABIM. (Some settled out of court.)

Unknown said...

Good gosh! That would be great but I doubt if that would happen. :-). Nonetheless, I retired from an F.P. “classical” practice July 1st at 63.5 years of age. Classical practice is office, hospital practice and taking call. EHR has made it impossible to produce anymore and my income tanked beginning with its institution in 2008. I saved and decided to quit. Malpractice has run out and the tail has kicked in. Since I was with the provider for so long, the $30k tail is covered as long as I don’t go back and try to practice again. They don’t have to worry, I’m done with this permanently and don’t miss it one iota. Haven’t had a single nightmare since I quit and sleep like a baby. Up to a 5 mile hike every day with my autistic spectrum son and keeping a running total. Oh, took a week to get the paperwork done after I left July 1st. I be one happy camper now that I don’t have to be a nursemaid, guardian angel, secretary and health policeman. We’re not paid enough to do the first three and we are toothless concerning performing the health policeman’s task as once the patient leaves the office, they can continue their lousy health behaviors as they aren’t held accountable. Still, the powers that be want to hold Docs accountable for something we can’t control!!!
Primary care stinks and may God condemn to Hades anyone who tries to convince a student to go into it. MOC is another crime “against humanity” and may those who profit from it be cast into Gehenna as well.

Anonymous said...

It's déjà vu all over again.

Unknown said...

Except, I’m now outta here and happy to beJesus I don’t have to worry about it anymore!!!

Rick Bosshardt said...

The conversation regarding ending MOC has just taken an ugly turn. I have been a supporter of the move to end MOC since I first learned of this from your blog several years ago. I have contributed to the effort and planned to continue to do so, but now find myself with reservations. There are plenty of legitimate reasons for ending MOC, as you have articulated and documented so well in the past. There is no need to add racism to the list. This is a toxic subject and, to be candid, I find no justification for this. You see, I am one of those older, white males who earned my certificate before MOC and was “grandfathered” in. Now I discover, at 67, that the term has racist connotations!? I work every day with black, Hispanic, Asian, and oriental physicians. My wife’s gynecologist, who she loves and has been with for years, is black. If you proceed down this path of claiming that MOC is somehow racist, I foresee that you will lose me and others like me. Personally, I am tired of being assumed to be racist, if only by association, just because I am an white older male.
R. Bosshardt, MD, FACS

Physicians Disenfranchisement said...

If you google the term "grandfathered" for the original meaning, one gets this information, which is factual:

"What was the original meaning of the grandfather clause?
a clause in the constitutions of some Southern states after 1890 intended to permit whites to vote while disfranchising blacks: it exempted from new literacy and property qualifications for voting those men entitled to vote before 1867 and their lineal descendants."

I did not get offended by anything that Dr. Wes wrote (quoting mostly), but I am offended by the term "grandfathered". This term has nothing to do with physicians - a term that should not be associated with the medical profession. It is without doubt a term that does offend and a label that could appear offensive to millions of Americans. The ABMS should rethink its use of the term "grandfathered", especially after ABIM's recent communication showing support for racial justice.

I support the movement to end mandatory MOC, because of the harm it does to the profession of medicine and those they serve. I oppose MOC also because of the discriminatory nature of it. MOC disenfranchises hundreds of thousands of physicians who are vulnerable to loss of profession and livelihood if they do not pay and participate in MOC. This is not only unfair it if reprehensible. This "disenfranchisement" does grave harm and also divides the profession, which leads to even more harm. MOC is a patient disenfranchisement program, which is more important to point out.

I know of no physician today, "grandfathered" or not, who could be called racist. Doctors simply have no time with all the endless labor and sacrifice. In fact any physician who witnessed such an offensive attitude or behavior would condemn it. A doctor simply would not tolerate it in themselves or in another.

It is clear to me that the term "grandfathered" should be abandoned along with mandatory MOC.

I also find nothing wrong in speaking the truth about history or events of the past. Etymologies of words bring us closer to precise meanings and clearer communication. Bringing out facts for debate is important. Facts should not offend.

The truth will set us free, and only the truth. Propaganda divides. Lies divide and the passional nature of human beings. False science for the purpose of financial and political gain is always wrong. We see the ABMS full of this type of pseudo-scientific behavior to prop up their lifestles and political agenda.

I am standing behind Dr. Fisher, because he has devoted himself tirelessly to helping physicians and patients and a physician's "first commandment" for doing no harm. Wes has feathered out a fine point about the divisive nature of the word "grandfathered". The ABMS should clean up their language and call it "MOC-exempt" physicians. Or perhaps "MOC free" doctors.
Those terms would be less offensive, but it would not remove the real offense of discrimination in demand for payment and participation, or lose one employment/reimbursement. MOC does egregious harm to both physician and patient.

MOC is a program of disenfranchisement. Identity politics fan the flames of hatred and violence. I condemn both MOC and identity politics.

Words Matter: Why We Should Put an End to “Grandfathering” said...

Words matter. Inclusivity matters at organizations like the ABMS medical specialty boards.
Certifications are professional property. This property paid for by a certified physician is being taken away due to the age of a physician based on an arbitrary timeline. Physicians have rights. Property rights are being taken away. This should be concerning to every physician whether they are affected or not.

Physicians who are certified by the ABMS medical specialty boards have no right to vote and any policy, even though the ABMS professes that self-regulation is the policy. Who heard of self-regulation without a voice or vote? The right to vote has yet to be granted on any issue to physicians. The loss of property (certification) and the non-voting status of physicians should be cause for alarm to patients as well as it affects their physician-patient relationship. As such a patients rights are being taken away. Patients are also disenfranchised of a vote or referendum on MOC or any issue.

At the ABMS the word "grandfathered" means what it did initially in 1890. This is the unfortunate reality.

The disenfranchisement of doctors regarding the loss of property is discriminatory. Clearly. The right to vote is a disenfranchisement pertaining to all physicians. This is also discriminatory. Patently.

Patients are not allowed to vote on something as critical as the right to care. In a democratic society this is more than disconcerting.

Not being allowed to vote on a physician's right to practice medicine in a milieu of self-regulation and voluntary policy of participation or non-participation in ABMS certification and it's tied product MOC is not only egregious hypocrisy, it is heinously criminal.

Kurt said...

Ahhh, “Grandfathered” may sound discriminatory and derogatory to some sensitive folks out there but MOC in my estimation fits the description that Physicians Disenfranchisement describes above and warrants any designation that is applied to it! MOC is a human invention just as was slavery and the deprivation of voting rights to groups of people that followed thereafter. The utilization of the term “grandfathered” used in that age could be used to “denigrate” the above practices should not be taken as an insult to the past.
P.D. I can really appreciate your point of view and everything you say is true but I believe that MOC is on the level that is the same as the historical facts you quote! In that regard, to use any terms to describe it, historical or otherwise, should not be interpreted as minimizing the past but to reinforce the negativity of the “here and now”. Best regards, Kurt

Anonymous said...

"Here and now" (the present) is what we have to work with and that is our focus. Not the past.
We must see the present with clear eyes - beyond images, labels and ideologies. We must act in the present and be free of the past psychologically otherwise we keep repeating the same mistakes of the past.
MOC is the same/on the same level (or increased intensity) as the historical facts quoted above by PD. MOC is harming hundreds of thousands of physicians and countless millions of patients. A corrective action is needed.

The AMA House of Delegates "voted" to end mandatory MOC a few years ago. That is the corrective action that is needed - to end mandatory MOC. But unfortunately the "vote" and voice of state delegates to end mandatory MOC was negated/stonewalled by an inner core within the AMA and ACP. This core includes the ABMS, ACGME and many others. So, in essence there is no vote and no voice speaking for physicians and their right to property and employment/payment in any of these organizations. Physicians do not have the right to vote or retain property (certification). The AMA core (trustees/executive leadership and the financial/political interests they serve) took the rights of physicians away by stonewalling the vote to end MOC, even going so far as altering the resolution and then ignoring it completely.

In order to further understand the significance of mandatory MOC, the harms it creates, and why it must end, it would be helpful to understand the structure, history, and functions of all these organizations, especially the AMA which, not without significance, was founded in 1847 and Incorporated in 1897.

What history shows is that the present is the past. The divisions we face again and again, are mostly "man made" divisions. There is abundant evidence of this. Today and as it was in the past questions of race and inequality were and still are used to divide us and splinter us into factions to weaken us and erode/destroy our rights. False slogans and dubious movements acting in the name of human rights. Sadly, the race/equality problem is being aggravated/inflamed for political and financial reasons. The problems we see in America from the civil war to today are not really about individual rights, but more about empire and monopoly. Hundreds of thousands died and now into the millions for empire and monopoly not for freedom or human rights. Many historians with deep integrity and fidelity to the truth will attest to this.

The nation is suffering an epidemic, being divided/torn apart and ravaged before our eyes allegedly over human rights and protecting the vulnerable, but it is not truly about human/individual rights, but about the same things we saw in the past that plagued and plagues us today - empire and monopoly (power and money). But it is worse. Today, the media is in the hands of a few corporate conglomerates, so we hear little that is true. We are swayed into fiction by propagandists, not true journalists. Giant corporations dominate the finances and politics, including healthcare and the profession of medicine. Five large banks have most of the money and control of it. Government is at war and the "intelligence community" and media continues to undermine the executive branch of our government. Whatever party or neutral stance one takes this should scare the hell out of everyone.

Lark said...

Certainly eye opening. I never though to question the terminology of 'grandfathering'. Makes you wonder what else has been stained into our lexicon throughout the generations.

Unknown said...

Ummmmm, I was able to retire July 1st from this BS. May God dang to Haides anyone who tells young people to go into primary care medicine. The patients ignore what you have to say for good health and if one does an old time standard office, hospital practice and call, it is totally impossible to so anymore due to the EHR stuff Obama forced upon us. May he roast in Hades for for that!!! Kurt