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 The decision was specifically classified by the Judges as “Not Precedential” – meaning it should not be cited as precedent in other cases.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...

Anonymous said...

ABIM is a self-serving "wealthcare management company"

The American Board of Internal Medicine is a shell company. It devolved over time. Now the "mock club", comprised of industry insiders and skilled propagandists, has nothing to do with benefitting frontline healthcare professionals or patients.
Just the opposite. They are there to control and diminish the profession and ration what a patient receives.

This downward spiral of the "medical boards" began when they created a fantasy mission regarding "quality" and "public safety". A lifetime certificate and pledge of lifelong learning became a self-dealing take-it-or-leave-it contract filled with ever-changing rules and ever rising costs and requirements.

In the court of public opinion everyone involved now knows that this testing company (ABIM) has become so longitudinally twisted to the point that the profession of medicine would be better served without them.

The ABMS is a crudely cobbled cabal of member organizations redesigned for efficient corporate tax evasion, while earmarking big "piggy barrel" payouts to its elite "political leadership". We understand by now that the boards and member organizations were invented by a clever class of bureaucrats working for "the industry", "fortune 5000" companies and select "government agencies". This was true from the beginning, but the seeds did not take root and become rotten until executive directorship with profit-driven motives took over gutting original bylaws and ignoring the non-pecuniary nature of the boards.

The purpose of the profit-driven boards and member organizations is clear. It is to control the profession of medicine and those they serve (patients) with the aim of cashing in for themselves and their partners. They implemented their agenda by slashing physician autonomy/reimbursement and reducing patient care and rights. What we are seeing is wage compression, the intentional overburdening of doctors with bureaucratic red tape and rationing of healthcare.

Civil lawyers and their corresponding court proceedings have no power and little appetite for what is obviously a case pertaining to criminal law with heinous violations of rights. It is not surprising that the courts covered their seats. Even if they sent the case back to the lower courts the bases were covered. No one would get to first base.

Discovery is not allowed with a stacked deck of cards. Seizure of electronic devices/securing of data storage sites and generous use of yellow tape would be more appropriate when you consider how many lives and livelihoods are at stake.

Unknown said...

I happily quit being a practicing physician rather than be part of this scam and have never been happier and thankful. The boards robbed me of precious thousands of hours of my life as well as dollars. May the people who enriched themselves from this scam and ruined the careers of doctors who still want to practice go to hell. On a side note it is us doctors who are to blame for allowing these sycophants into our sacred profession and then doing nothing about it.

Anonymous said...

"There are only two ways of telling the complete truth - anonymously and posthumously."

- Thomas Sowell

Very true about the ABMS MOC scam (so blatant) and "allowing these sycophants into our sacred profession and then doing nothing about it."

If the profession of medicine stood united against MOC the courts would be much less inclined to ignore their own sacred duty to provide relief to the 350 million maligned Americans (patients) they turned a blind eye to. But the lawsuits frame the harms too narrowly perhaps.

The courts would be unnecessary if all physicians "grew a spine" and fought MOC. Physicians ironically support their own demise because they control the purse. Patients and objective science are victims of passivity. Truth cannot be spoken. Only whispered in an era where we are seeing an extraordinary decline in our sacred rights.

Without thoughtful independent physicians holding the line, the sacred and truth will die in our country and the world. If MOC cannot be defeated it reveals how far humanity has fallen. These issues should be reinvigorated in our society. Otherwise God help the next generations.

Anonymous said...

Dear John:

I read with interest your recent article "Aiding and Abetting Burnout" in the May 2021 edition of the Psychiatric Times. So John, is this the best you can do to address physician burnout? Really? I had such high hopes when I read the title of your article and then...well, not much really. Oh, some insurance hassles to obtain medications for patients. That has been going on since the 1990's for sure, right? But what about all the other stuff going on? Like the ABPN taking away our board certification for no good reason and all the clicking and typing we have to do each day. You know John, I have to type about 9,000 keystrokes and click 1,000 times to get through my workday but no one seems to care. I have written Henry repeatedly and have asked him to address this in his column but he refuses. Why do you think this is John? Why do our leaders refuse to address these issues in their columns? Oh, the money. That's right. Lots of people making lots of money on maintenance of certification and EHR systems that would require major overhauls if...

So John, do you type and click during your workday? I have it from a good source that you don't. If you did, you would be writing every blessed column on how doctors need to type and click less. We need to type and click less John. And by the way, do you know Larry? I sincerely hope you do because he has taken my board certific...well, he will be taking my board certification real soon if I don't pay him. Is that fair John? Is it fair for Larry to take away my board certification just because I won't pay him? That might leave me jobless and then I really can't pay him. Do you know if there is a job locating service for psychiatrists (and neurologists of course) who are made jobless when Larry takes away their board certification? That would be real helpful John. Maybe you can write a column about that too. You have such a wide reach with your informative columns.

Anonymous said...

So that's it? I feel that this is somehow the end of the line here on this nonsense of MOC. Is there any update as to what the plantiffs are doing here? Is the suit being refiled? It's already been 2 years since I last had to participate in MOC and quite frankly I'm incensed that I'll have to do it again before this thing actually gets a hearing.

Any updates?

Anonymous said...

I have to state that the legal system is corrupt itself. I am quoting it from Rudy Julliani who used to be one of the high level attornys in NY, he said it in a TV interview.
If you are skeptical still, watch the NetFlix documentary "filthy rich" about Mr. Epstein's case. It blew my mind away to see how corrupt the court system could be.
I am sure that ABIM has connections in the court system.

Flawed Pennsylvania Courts?/Censorship said...

The Case Against MOC

330 million Americans, and the million physicians who serve them, were censored by the Pennsylvania courts. By dismissing this case against the ABIM concerning MOC, the courts failed every citizen in the United States of America.

MOC does harm. It is a Ponzi scheme propagated by ABMS bullying, fear and propaganda. Victims need to come forward and demand their time in court to present the facts.

This story is not going away, and should not be allowed to be censored or dismissed. Everyone is a victim. We all need to come forward demanding a hearing and remedy.

Are the Pennsylvania courts skewed to favor the rich and powerful, naintain the status quo?

Anonymous said...

It is worth pointing out that our 'justice (sic) system' often aids and abets criminals, while falling like a hammer on the innocent.

Captured Justice/CapturedRegulatory Entities said...

The ABMS is a caputured NGO comprising 24 (or more) medical boards, an umbrella and many partner organizations. Its revolving door executives receive obscene payouts for their captured services. The money for its executive paychecks and perks ironically comes from its captured clients - physicians.
ABIM is the flagship in a captured armada of quality assessment organizations floating in a sea of systemic and institutionalized corruption.

Anonymous said...

Can any of the the research papers done by the ABIM be reported to the office of research integrity? This is not quality work and the outcomes are the harming of physicans and patients.

Anonymous said...

Start a new regulatory board. Allow independent physician discussion and feedback. Free sharing of research. I think assessments should be based on clinicians ability to critique research, discuss it and apply it safely and effectively. This should enter a public domain and be reviewed freely by other physicians. Participation should be professional and educational, not punitive. Physicians need to be heard and allowed to grow by their interests. Medicine is harmed by the militant manner in which it is largely administered by inappropriately financed agents. At some point, it also needs to protect the rights of physicians to practice as they see fit from coercion by insurers, the legal system, and encroaching public health agencies.

Anonymous said...

I'm sure everyone has seen the statement by the ABIM who has summarily decided to take a position that any physician "providing misinformation" about COVID 19 vaccine contradicts physicians' ethical and professional responsibilities and may be subject to suspension and revocation of their medical license?

Wes, can you chime in on this?

W.O.R.M. said...

Dr. Baron signed on to the Joint Statement on the Dissemination of Misinformation which states, in part, that any physician providing misinformation about COVID 19 vaccine contradicts physicians' ethical and professional responsibilities and may be subject to suspension and revocation of their medical license.

Fair enough. But Dr. Baron, how would you feel about supporting the following statement?

"Any ABIM employed physician providing misinformation about the usefulness of unending MOC examinations as a means of improving physician quality, which has undoubtedly led to premature physician retirement in the COVID 19 pandemic era, exacerbating the physician workforce shortage at a most critical time, contradicts physicians' ethical and professional responsibilities and may be subject to suspension and revocation of their medical license"

Just kidding. I already know the answer to that one, Dick.

Anonymous said...

ABIM Testing Continues Unabated said...

Go the ABIM website. This is what you see.

ABIM is actively monitoring news around COVID-19 and will post regular updates about any changes to scheduled assessments or other impacts to MOC related activities.
Scheduled for an assessment this year? ABIM is working with Pearson VUE to ensure your safety throughout your exam day. Learn more about what to expect at test centers.
Please follow the United States Centers for Disease Control and Prevention (CDC) for the most up-to-date information on the virus."

In the US there is a 28-day average of close to 33,300 deaths from Covid-19. That means nearly 1200 deaths a day.

How many of those deaths are among healthcare workers?
Lost on the Frontlines:

There are 240 questions on an ABIM internal medicine MOC exam and subspecialists typically will ahve the same format. How many questions covered SARS-2/Cov-19?

The answer is none. How relevant is the ABMS/ABIM and do they really care about doctors and patients or just the money and control?

During the full-day it takes to take an onerous ABIM test, one could have been getting training about how to understand the novel corona virus Covid-19 (that is stealing the lives of our loved ones and colleagues) and how to treat it as effectively as possible.

Add up the stressfull preparation time as well taking a MOC exam, whatever form it takes. How many hours and minutes passing where we lost someone to covid. Kept away from patient care by a particularly irrelavant test. How many passed while being treated in the hospital (from lack of professional care) or lying in bed at home not understanding that their lungs/vital systems were being ravaged to the point of no return?

Can someone tell me why we are losing so many lives in this country (more than the civil war and Vietnam combined) and why the ABIM/ABMS is not going to WASHINGTON DC and actively trying to lead us out of this nightmare, rather than distracting us with their shameful testing mandates.

Anonymous said...

Instead of fighting ABIM in court, which does not seem to understand beyond its legalise, can the arguments be taken to insurance companies and creating another physician led organization that can certify physician continuing education standards through education, not exams or penalty. Off course, it will need to have a mechanism to certify them first time as well. I think one such organization is NBPAS and we should support it strongly and stop paying ABIM for continuing education. No court can stop another competitive entity that does the same job.