Monday, March 01, 2021

The Courts Speak: Internists to Be Boarded to Death

It is with great sadness and a heavy heart that I must announce that on Thursday this past week, the United States 3rd Circuit Court of Appeals ruled in favor of the American Board of Internal Medicine (ABIM) and upheld the earlier District Court dismissal of the antitrust, racketeering and unjust enrichment lawsuit filed by four internists in December 2018. An attorney for the physician-Plaintiffs issued this statement following the ruling:
"The Plaintiffs are disappointed by the Court’s opinion but not discouraged. They remain committed to bringing an end to Maintenance of Certification (MOC). The ruling was based on a narrow and technical principle of antitrust law: whether ABIM Certification and MOC should be viewed together as a single product. The decision was specifically classified by the Judges as “Not Precedential” – meaning it should not be cited as precedent in other cases.

“It is important to understand that the ruling cannot be viewed as an endorsement of MOC or ABIM’s conduct. Contrary to ABIM’s litigation position, Certification and MOC are not voluntary. As admitted by its own leadership, they are an economic necessity for a successful medical practice.

“Significantly, the decision does not take issue with the many studies documenting the complete absence of any evidence of a causal connection between MOC and improved patient care. There simply is no reason for MOC to exist other than the hundreds of millions of dollars in fees it generates for the ABMS Boards and their management.

“Plaintiffs would also like to take the opportunity to thank the thousands of doctors across all specialties that have joined with them in this struggle. The emails and phone calls of support have been inspirational and demonstrate how deeply unpopular MOC and the ABMS Boards are with rank and file doctors, physicians who actually practice medicine and treat patients outside the corporate medical establishment.

“All remaining options are being considered, including the possibility of seeking a rehearing by the full Third Circuit Court of Appeals.”
The fight against MOC and in support of practicing physicians continues. The wellspring of our inspiration for supporting the Plaintiffs has been the Oath that we both earned and then gave when we became doctors. It might be stifled but it will never be extinguished.



Anonymous said...

Could the use of disruptive physical or disruptive administrator be used as s possible strategy to fight against the ABIM/ABMS and MOC. It seems that the forcing of MOC on physicians would fit that criteria.

"The American Medical Association (AMA) defines disruptive behavior as personal conduct, whether verbal or physical, that negatively affects or that potentially may negatively affect patient care. This includes but is not limited to conduct that interferes with one’s ability to work with other members of the healthcare team. However, criticism that is offered in good faith with the aim of improving patient care should not be construed as disruptive behavior."

As we know, MOC does not improve patient care.

Anonymous said...

Has the strategy of fraud be used to sue the ABIM? Since there are no definitive studies to prove that MOC improves patient care the ABIM certifications we put on our wall are lies. This means the physicians have been duped to take MOC and also the patients in believing in it.

Unknown said...

Doctors are blamed for everything, responsible for everything, have power over nothing, have no protection from multiple entities that pick our pickets and gives us nothing in return. I planned to practice for 14 more years. Now i want a way out. Parcin my french but F*** this profession. Let the midlevels have it. I am done.

Anonymous said...

I wasn't surprised it got tossed from the get go. I am surprised the appeal has failed. This is how corruption stays in power. Truth doesn't even get a day in court to prove the point. Makes you wonder how much money ABIM lobbed at them.

And now of course, I'm beyond depressed that tired old farts who haven't passed boards in years get to continue to practice medicine unmolested, but I have take boards probably at least one more time.

We need the medical equivalent of Atlas Shrugged right now. Let the NP's and PA's have the field. I'm tired of working long hours as a hospitalist, getting paid nothing yet doing more work than anyone and being treated like trash for the privilege.

Unknown said...

In the final analysis, each and every doctor has the personal responsibility to purge the filthy ABMS parasite from his or her system and flush it down the toilet where it belongs. If you can't change your hospitals credentialing bylaws to recognize NBPAS then move and practice at a hospital that does (the list is available on the NBPAS website). There are so many other options nowadays including joining a direct practice group or going solo without any "board certification" a most useless talisman of nothing. Don't wait for lawyers and the courts to remove your shackles when you can easily remove them yourself. I grandfathered myself in 2018, one of the best decisions I have ever made and now ABMS is a distant memory. Remember doctor, it is up to you and you alone to free yourself from this scourge!

Unknown said...

In a curious way, these lawsuits amount to a dangerous distraction for the remaining vast throngs of huddled, ABMS shackled doctors. Complete psychological reliance upon the much hoped for "serving of justice one day" enables their ongoing and total abdication of personal responsibility to lift the merest finger to seize the freedom that they seek, themselves. These lawsuits encourage the entirely false belief that only the deus ex machina of the courts can grant them freedom when in fact their enslavement is purely illusory. As the comment above demonstrates, all any doctor needs to do is walk over and open his or her (unlocked!) cell door and walk away to obtain freedom from the hated ABMS. Many have done so but yet far more have chosen to remain in their pathetic state of enslaved and abject self pity. In so doing they only serve to nourish and enrich the parasite they so despise.

Christine Stone said...

I am a general internist in solo direct outpatient practice. My current IM board certification is good for a few more years. I am trying to figure out exactly HOW to NOT continue to participate in this process and still remain in practice. I think the cost of my professional liability insurance will rise(?) Is liability insurance even available to the non-board-certified? I don't think ditching the liability insurance is an option for me, because I think the granting of the state license is tied to it in this state(?) Ditching the ABIM certification of course closes down the possibility of returning easily to employment with most big-corporate healthcare entities. If anyone has some pointers on how to do this well, I would be VERY interested in hearing about it. In the meantime, I guess I ought to find out the answers for my own self to the questions I have asked above. Wes, do you know if there is a state-by-state listing of what else gets snarled for MDs who opt out of MOC? It seems to me that more folks might do it if they had exact information on how it is done.

Anonymous said...

I am a Pediatrician in Florida. I used toh ave my private practice for 11 years, currently working as an employee in non profit organization(3 years).
I never renew MOC(for the same reasons we all know), I am board by with NBPAS( long time ago), at least 6 years, I had never had any issue with insurances, reimbursement, I used to have privilges at a hospital(we changed the bylaws, to NBPAS). I will continue with NBPAS, until I retire.

Unknown said...

Hi Christine Stone above, board certification does not influence professional liability insurance. Is your current IM board certification dependent on your continuing to do MOC? It must be. I suggest you immediately join NBPAS and tell the ABIM to stick it where the colonoscope's light doth not shine. You have nothing to fear from a rise in medmal premium. Don't take my word for it, verify it with your insurance broker beforehand. Every day away from the moral injury caused by ABMS's rapacious enslavement and profiteering is a virtuous sunny day of freedom and self congratulation. Do it now and more importantly spread the word amongst your colleagues that you have done so!

Rick Bosshardt said...

I have followed this issue with interest since first becoming aware of the controversy generated by MOC several years ago. Until then, I had never questioned MOC, just sighed with relief that my board-certification dated 1991 predated the requirement for MOC in my specialty of plastic surgery. My younger partner, did not and has had to re-certify twice. I have seen the stress this creates and time/cost of the process. While I do not have to particpate in MOC, throughout my 31 years of practice I have maintained my CMEs diligently. When I was a member of the AMA (I quit in protest in the wake of the Obamacare debacle), I always qualified for the annual Physicians Recognition Award. I have taken the In-Service Exam in plastic surgery every year that it has been offered. I have travled on my own dime to observe surgeons on the cutting edge of my specialty. I am sympathetic to this cause and have donated to end MOC, but I remain a bit ambivalent about abolishing MOC outright without some alternative to ensure that our profession maintains that highest standards and our patients are protected from incompetent doctors. Perhaps rather than attacking the ABIM outright, a different tack might be to push harder to get the alternative to the ABMS board, i.e. the NABPs, accepted by as many hospitals as possible. It will be difficult to break the strangehold that the ABIM, and other ABMS boards, have on the recertification process, but I believe that with time and consistent effort, it can be done.
R. Bosshardt, MD

Unknown said...

Dr Bosshardt, your heart does seem to be in the right place but there are important contradictions in your following statement "..but I remain a bit ambivalent about abolishing MOC outright without some alternative to ensure that our profession maintains that highest standards and our patients are protected from incompetent doctors. Perhaps rather than attacking the ABIM outright, a different tack might be to push harder to get the alternative to the ABMS board, i.e. the NABPs, accepted by as many hospitals as possible." No one is seeking the abolition of MOC per se, only the fact that this proprietary CME is made mandatory by ABMS as a self serving profiteering restraint of free CME choice must be abolished. Furthermore MOC demonstrably has nothing to do with maintaining the "highest standards and our patients are protected from incompetent doctors" either. These are fallaciously hollow ABMS talking points. There are as many incompetent ABMS certified doctors as there are those who are not, you must surely know this. How can one not attack the fraudulent ABMS, knowing what we now know about their skullduggery and fraudulent profiteering? Spend more time on this blog to fully edify yourself in this regard please. Furthermore as a veteran NBPAS certified surgeon myself, I now know just how much a meaningless racket "board certification" really is. It connotes no quality whatsoever, see Grosch et al. Below for empirical evidence in that regard.

Anonymous said...

There's only one way to slay this dragon. All physicians MUST take an active role in shaping the bylaws of their hospitals to make MOC a strictly VOLUNTARY requirement for staff privileges, hospitalist work etc. Hospital admin can not be staffed or chaired by the pro-MOC, grandfathered caste of physicians who sit at a desk all day telling other doctors how to practice. And if MOC is to be required, ALL physicians no matter the grandfather status MUST participate in MOC.

Anonymous said...

Perhaps a better way to address this would be
1. Going after hospitals that enforce MOC and recertification as the only criteria for credentialing physicians who have expired certifications.
2. Working with congressmen and senators to remove MOC as a means of credentialing.
3. This might be a cheap shot, but under Biden admin's racial justice reform, it can be shown that colored/black minorities are being affected most by enforcing repeat certifications, since some of the congressmen want to remove all standardized exams. MOC elimination would be a place where they can start.
The above said I am sorry to note ABMS's financial might may be difficult to overcome while involving senators, congressmen and lobbyists

Unknown said...

The above two posts exhibit the sadly all too prevalent and passive wishful thinking of so many ABMS MOC shackled docs. "MUST" change bylaws, "go after" hospitals requiring MOC, "working" with politicians, cynically playing the race card etc. Wake up folks, knock off the displacement activity and act now! Go to the NBPAS website, pull up the state by state list of NBPAS accepting hospitals and move to one. If you cannot take responsibility for your own ABMS enslavement and taxation and don't wish to act to fix it then put up with it. Don't rely on others, the absent courts, or some other miraculous dream like deus ex machina to suddenly appear to absolve you of your own personal responsibility. It more than likely won't.

MOC Law said...

MOC Law and Suppression of Facts

This case needs to be reheard by the full court of appeals. Harm after harm has occurred and the injuries continue to be inflicted on physicians and patients. It appears justice has gone to sleep in this land.

Each justice on the panel needs to review the case against the ABIM and weigh in making their views known publicly.

The merits of the case need to be pleaded in front of a jury after a proper discovery. That is what is needed and what really needed to happen long ago. What went wrong?

Technicalities of law are not sufficient excuse for the higher court to dismiss the complaints and ignore the merits/facts. ABMS MOC harms. A district court judge erred badly using ABIM talking points. That is not law. It is MOC law.

The judicial process itself also needs to be put under the bright light of judicial review.

Why did the district judge who initially ruled on the case get it so wrong? What is wrong with letting the facts/truth come to light?

We need to be informed why judge Kelly was suddenly dismissed from all his several cases right after writing his opinion ruling in favor of the ABIM? In case one did not know, the case was handed to another district judge before completion. (Judge Beetlestone.) The PA courts are mute on this and any issues involved with the judge. Why?

In fact the senior judge (Robert F. Kelly) who dismissed the case is no longer even listed as a judge with the courts. I have not seen any public announcements about it either. The courts need to speak about this publicly and address why ABIM talking points formed the basis of Kelly's opinion.

Are the courts covering for bad legal judgement?

In my opinion it is scandalous to be silent about the mental status or health of a judge. It is disrespectful to any judge to not be forthright. And it is disingenuous to the public.

Truth is the foundation of our country. Without fighting for the truth we have no country left.

Censorship and suppression have taken root in the media and it appears in the courts as well. It is spring and there is a freezing chill in the air.

Anonymous said...

Has anyone considered addressing (with the courts) that the supposed “nonprofit” ABIM is—practical reality—an unregistered PAC for the Democratic party? Just about every executive currently listed on their website has easily verifiable ties to the democrats. That is not an accident and is not representative of our country as a whole! If you go back further (Cassel, Langdon, Kimball), the conflicts are even more egregious.

Anonymous said...