ABMS and ABU Spin on DOJ Letter

Board certification of US physicians continued on its path of deceptive and misleading propaganda following the Department of Justice's (DOJ) letter issued on behalf of a request by the National Board of Physicians and Surgeons (NBPAS) in its effort to thwart the monopoly practices of the American Board of Medical Specialties (ABMS) and its 24 member boards. Despite that letter, the ongoing collusion between the member boards and the ABMS was particularly evident in the email circulated two days ago by the Executive Secretary of the American Board of Urology (ABU), Gerald H. Jordan, MD. The ABU's email attempts to spin the ABMS position as the same as what is stated in the DOJ letter by conflating initial lifetime ABMS Board Certification with the self-created separate time-limited Board certification market product (called Maintenance of Certification®):

The ABMS position that legislative interference which limits the use of physician certification is inappropriate is consistent with the position set forth in the DOJ letter. The ABMS and the ABU have always supported a fair and competitive marketplace for physician specialty certification and continue to do so, encouraging accurate comparison of our programs with other certification programs available.

ABMS agrees with the DOJ’s support of the right of patients and health systems to determine which certification programs best meet their expectations for providing information about high quality specialty care. The ABMS and ABU promote communications practices that allow the public to easily identify and compare the program standards used to certify that a physician has demonstrated, through training and assessment, that he or she in fact has demonstrated the knowledge, skill and judgment to practice in a medical specialty or subspecialty.

This continued deception of the ABMS and its member boards by conflating lifetime certification with time-limited "continuous" certification will not go unchallenged. I encourage all physicians adversely affect by their member boards complicit in this ruse to consider contributing to our ongoing legal challenge against the ABMS board certification monopoly.

-Wes

Resident Recall - "Cheating" or Part of Free Speech?

Read the opinion piece referenced below carefully. It discusses the widespread use of "resident recall" to study for the American Board of Radiology's board certification examinations by both residents AND faculty/senior physicians:

https://pubs.rsna.org/doi/full/10.1148/radiol.12120251

Then read the back story on how the American Board of Medicine threatened internists in 2010 on the basis of the threat to their training monopoly:

http://drwes.blogspot.com/2016/06/maintenance-of-certification-medicines.html

Then ask yourself: who has "cheated" whom?

It is clear that the American Board of Medical Specialties, who continues to promote its lavish ABMS Conferences with "stakeholders" in Las Vegas (full schedule here), has a serious problem on its hands. This problem is exacerbated when it claims to work collectively with "500 professionals from across the health care community who, working together, will accelerate the transformation of Board Certification and the delivery of quality patient care."

Where's the data a computer test and secret data collection scheme does anything except raise prices and stroke the egos/bank accounts of the boards' leadership?

What do these Las Vegas boondoggles do to reestablish trust in the ABMS board certification process?

The answer is quite simple:

Nothing.

-Wes

When the Walls Start Crumbling Down

From the Department of Justice via the NBPAS website:

'The DOJ explained that the ABMS Program on MOC may have the effect of “harming competition and increasing the cost of healthcare services to customers.” ABMS may do so “by imposing overly burdensome conditions on physicians who wish to maintain their certification.” The DOJ added, with respect to ABMS, “[the] vast majority of [its] board members are medical doctors”—i.e., “active market participants”—who may have incentives to limit competition through “industry self-regulation.” As a result, the DOJ warned, “there would be competition concerns, if dominant certifying bodies [like ABMS] set de facto participation requirements that did not sufficiently correspond to health, safety, or other procompetitive justifications.”'

While this letter is very helpful to the National Board of Physicians and Surgeons (NBPAS) and detrimental to the efforts of the American Board of Medical Specialties and their subsidiary boards to monopolize the physician continuous credentialing system in states' legislation accross the country, it might not be entirely advantageous to employed physicians because of this paragraph on page 14:

"At the same time, the Division discourages the legislature from interfering with unilateral business decisions—such as an individual hospital’s decision about what criteria to use for granting hospital privileges or an individual insurance carrier’s decision about what criteria to use for allowing participation in the insurer’s network, as restricted in the Workgroup’s Bill—unless a restriction is determined to be necessary and narrowly tailored to redress well- founded consumer harms or risks. ... The Division encourages the Maryland legislature to consider whether other tools, such as facilitating entry by competitive certifying bodies, can address concerns with certification without imposing restrictions on the unilateral business decisions of hospitals and carriers."

Still, this letter represents a significant blow to ABMS in their efforts to prevent NBPAS's entry into the physician maintenance of certification (or "continuous certification") market as 30 states have some form of anti-MOC legislation either pending or passed.

-Wes

Thank You, Colleagues

I would be remiss if I did not thank my friends and colleagues nationwide who contributed to our GoFundMe page to initiate our pre-litigation investigation of the American Board of Internal Medicine and the ABIM Foundation. While I was upgrading a DDDR pacemaker to a biventricular ICD today, I received a text from a colleague that we had reached our funding goal for this initial phase.

I cannot express my gratitude enough. Thank you all.

It is very reaffirming to know that others feel as I do about Maintenance of Certification and what it has done to physician autonomy, morale, and even our right to work. I know that the dollars contributed could have been used for so many other things. I hope you will soon see that it your money was well spent.

But as Winston Churchill famously said:

"Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning."

Thanks again -

-Wes

Video: 7007 US Physicians Weigh In on US Board Certification

From January through March 2018, a voluntary Internet-based survey of US physicians and surgeons was conducted by Practicing Physicians of America concerning ABMS Board Certification. 7007 completed surveys were available for analysis. Here is a brief video summary of many of the survey's findings as promised:



-Wes

Reference: pdf file of PPA Physician survey questions that formed the basis of this report.

Two Surveys: US Physician and Surgeon Perspectives on ABMS Board Certification

At the beginning of this year, Practicing Physicians of America (PPA), a 501c6 physician membership organization (with whom I serve as an unpaid board member),  collected results of a voluntary survey via social media channels on ABMS physician and surgeon Board certification. The method of data collection using social media. The data collection is  novel compared to previous surveys conducted on this topic and for a while represented the largest reported survey on Board certification ever performed. We submitted the results to JAMA (and later to the Annals of Internal Medicine) in hopes they would be published. They were not. As is true with most surveys, bias was a prevailing concern.

Shortly after our survey was being circulated, the American Board of Medical Specialties introduced their own survey on Board certification to pre-chosen "stakeholders" on Board certification. In July 2018 they announced the results of their survey. They had received responses from "36,392 people, including 34,616 physicians, 1,373 non-physician providers and stakeholders involved in the delivery of health care, and 403 members of the general public." To the best of my knowledge, the text of their survey was not made available to the public.

Since we were waiting the reviews of PPA's survey for months, we were prohibited from publishing our results. After considering the reviewers' comments (which were very thoughtful), I think the odds of ever publishing such a survey of this type in a peer-reviewed scientific journal are low. Hence, the board of PPA has allowed me to announce the results of our survey publicly via this blog and (hopefully) Doximity so these results may be interpreted alongside the survey results reported by the American Board of Medical Specialties' Vision Commission. Admittedly, our survey asked different questions than that conducted by the ABMS, but the results are not only notable for their differences, but also for some similarities.

By way of background, here are the 32 questions we asked in the PPA survey.

Here is the full paper (with some minor edits) we submitted for peer review that was NOT accepted for publication. This pdf includes the background for the survey, the methods used, the results obtained, and a discussion of those results, as well as references, figures and tables.

Similarities of PPA survey to the ABMS Survey on Board Certification:

• Both ABMS and PPA surveys used SurveyMonkey to collect responses


• A large number of physicians responded to both surveys. Still, the PPA survey represented only 0.92% and the ABMS survey represented only 4.5% of the total US physician population in 2016. Neither survey mitigates potential under-coverage bias and non-response bias.
• In the PPA survey, 93% of physician respondents were board certified vs 96% in the ABMS survey.
• In PPA survey, 80% (4973/6004) participated in MOC; in the ABMS survey, 69 percent of respondents were currently enrolled in a primary specialty MOC program, and 33 percent are currently enrolled in a subspecialty MOC program
• Costs, burden, and the lack of true reflection of their abilities as clinicians were of significant concern to physicians in both surveys

Differences of PPA survey from the ABMS Survey on Board Certification:

• PPA survey used logic to limit responses from clinically-active physicians only
• PPA survey attempted to geolocate physicians by IP address and excluded non-US physicians
• PPA survey included MDs and DOs; it is unclear how many ABMS physicians were MDs or DOs.
• PPA survey was simply distributed to physicians via social media, not targeted groups like the ABMS survey. Heavy contributors to the PPA survey included members of the Pennsylvania Medical Society and Doximity.
• Discontinuation of "continuous certification" was not offered as an option in ABMS survey. Ending MOC and reverting to lifetime certification with CME was offered as an alternative in the PPA survey.
• PPA survey assessed physician perceptions of the negative consequences, contract obligations, and potential conflicts of interest of MOC; ABMS survey did not address these issues.
• PPA survey specified physician-respondents' specialties and state of origin. ABMS survey did not.

Finally, here is a pdf of the Powerpoint presentation I presented in June 2018 at the AMA House of Delegates meeting in Chicago summarizing findings from the PPA survey.

Major Findings of the PPA Survey

7007 physicians responded (52% male, 48% female)

Demographics

• Every US state was represented, with the largest being PA (910), CA (506), TX (504), FL (406) being the largest physician participants
• Responses came from 24 different subspecialites, with the largest being family medicine and pediatrics
• 19% of physicians had at least one "grandfathered" certification.
• 65% of the respondents had 10 or more years of clinical experience
• Of the physicians with initial ABMS board certification, 80% participated in MOC.

Major Findings

• 90% of all respondents thought board certification should be a lifetime credential with CME used for ongoing education.
• 95% felt MOC increases burnout.
• 53% of respondents estimated costs (direct and indirect) were more than $4000.
• 94% were unaware their data were being sold.
• 80% felt IRB and informed consent should be required for research conducted by the boards.
• 86% perceived MOC could threaten their right to work.
• 8.4% failed a recertification examination.
• Of the 394 physician that failed recertification, harms experienced included psychologic harms (more than 56%), 10% lost of hospital privileges , 5% lost their job, 8% lost insurance panel participation, and 17% plan to retire rather than retaking the re-certification examination.

I hope these data are informative and provide a balanced perspective of a large cohort of US physicians' and surgeons' perspectives on ABMS Board initial and "continuous" certification.

Physicians and others are welcome to use these data under a Creative Commons license (see below), we just ask for appropriate attribution.

-Wes

P.S.: Physicians desiring state-specific data regarding the PPA survey results are welcome to contact me via Twitter or email.


Survey of US Physicians and Surgeons Perspectives on US Board Certification by Practicing Physicians of America is licensed under a Creative Commons Attribution 4.0 International License.
Based on a work at http://www.practicingphysician.org.

How Practicing Physicians Can Double Their Money

From now until we reach our contribution goal, an anonymous donor(s) has/have graciously stepped up to match, dollar-for-dollar, physicians' contributions to Practicing Physicians of America's GoFundMe page to fund the litigation factual and legal investigation and the drafting of proposed complaint against the American Board of Internal Medicine, the ABIM Foundation, their directors, executives, and perhaps others under federal antitrust laws and state consumer fraud and deceptive trade practices acts to bring an end to MOC™ nationwide.

After four years of bring this issue to my readers on this blog, the AMA, and state legislatures, too many questions and conflicts of interest remain about the financial and political shenanigans of these organizations. While the ABIM claims they have "listened," they still have failed to stop the ability of the proprietary ABMS MOC™program from potentially affecting a physicians ability to retain hospital credentials and insurance payments if they don't pay for the program; in other words, their right to work.

Hundred of physicians have been adversely affected by this program already. For every physician who drops out of medicine because of refusal to play along, approximately 2000 patients are affected in turn.

So please give generously. After all it's a "two-for-one" special going forward!

Thanks everyone (and thanks to our special donor(s))!

-Wes

P.S.: Again, here's that link to donate: https://www.gofundme.com/practicing-physicians-of-america

MOC's Greatest Lesson

Yesterday, I read with interest the American College of Obstetricians and Gynecologists widely circulated piece authored by Lucia DiVenere, MA entitled, "MOC: ACOG's role in developing a solution to the heated controversy" published in the August issue of OBG Management. By carefully listing the numerous physician concerns with MOC (costs, relevance to practice, lack of data to improve care, relationship to licensing, employment, privileging, and reimbursement), the article reinforced many of the issues on this blog while being simultaneously crafted to sound as if ACOG was really "listening" to physicians concerns about ABMS Maintenance of Certification (MOC).

It didn't take long for me to realize the article was really about the tired trope that the "ACOG asserts the importance of maintaining self-regulation." The leadership within the ACOG and Ms. DiVenere herself can hardly be described as "self" as far as working physicians are concerned. Ms. DiVenere is Officer, Government and Political Affairs, at the ACOG and OBG Management contributing editor. And while she "reports no financial relationships relevant to this article," her very job may have depended on writing it.

Which leads me to MOC's Greatest Lesson that it consistently teaches working physicians, both young and old: In medicine, it is okay to lie, cheat, and steal.

I do not say those words lightly. Everything MOC touches is corrupt. For a once simple medical accolade to be allowed to secretly morph into a one-billion-dollar-a-year enterprise and physician cudgel to fund the bloated bureaucratic and political aspirations of the Accreditation Council for Graduate Medical Education is beyond me. Yet this is precisely where working physicians find themselves. Are these the ethics to which we want our young doctors of tomorrow to aspire? Should they model turning a cheek the other way to ignore the implications of these actions on our patients just so specialty societies can maintain handsome salaries, political power, and "self-regulation?"

Despite all that has been uncovered by following the money, I still can't believe it's taken one simple GoFundMe page three months to raise $150,000 from working physicians to fight this corruption.

It seems MOC's Greatest Lesson has been taken to heart.

-Wes

On Trust

Elizabeth A. McGlynn, PhD, immediate past chair of the ABIM Foundation and Vice President for Kaiser Permanente Research and Executive Director of the Kaiser Permanente Center for Effectiveness and Safety Research (CESR) with Richard Baron, MD, President and CEO of the American Board of Internal Medicine,  at the 2018 ABIM Foundation Forum on "(Re-)Building Trust"

Recently, the ABIM Foundation hosted a webinar entitled "(Re-)Building Trust." Oh, the irony. The fact they need to have such a conference is telling of the dire straights the staid and outdated medical credentialing complex has become.

As physicians who funded the ABIM Foundation, why do we fund such nonsense?  The American Board of Internal Medicine has never sufficiently explained why this organization felt compelled to use over $78 million of physician testing fees to create the ABIM Foundation or how and why it uses that money. Is it really to fund such conferences?  Or might conferences like this really be a distraction for the real reason the ABIM Foundation was created: their retirement fund. By the way, whatever happened to those funds shipped off to the Cayman Islands? Why will we lose our privileges at hospitals or insurance payments if we don't pay into this scheme? And why is the ABIM Foundation colluding with Kaiser Permanente directors? What does Kaiser get for this relationship?

If physicians trusted the ABIM, we would not have to ask such questions and the ABIM Foundation would not have to hold conferences on "re-building" trust.

Three years ago, Richard Baron, MD issued the now infamous: "We got it wrong" mea culpa press release when the 2014 iterations of Maintenance of Certification (MOC) foisted on US physicians resulted in a powerful working physician backlash. Lots of soft-shoe, "listening," and MOC program changes have occurred since then. But in reality four years later, little has changed other than parsing our payments into annual aliquots rather than a single lump sum every-10-year payment. The growth of fees is back on schedule, climbing an incredible 276% in the past 18 years.  Even the ridiculous Part IV of MOC is back as before.

It is hard to trust any business, especially a nonprofit organization when they ignore the customer.

We should not lose sight that physicians are the customer of ABIM, not patients. We pay for their medical accolade and the paper certificate that ABIM issues when we successfully complete our initial Board certification and (now) subsequent MOC requirements.

There are many within the US medical board credentialing system who feel otherwise; for them, they are there to serve "the public." Yet this deflection is little more than a propaganda message created to justify their use of our money for their political and financial purposes.

When we see our funds continuing to be wasted at Las Vegas convention venues for American Board of Medical Specialties meetings with their "stakeholders" we realize that this old-school attitude of colleague disrespect and self-importance is endemic to the entire US medical board certification and medical credentialing industry. Hard to re-establish trust with overt demonstrations such as these.

-Wes

PS: Wonder what you can do to change things?  Donate here and get a free book at the same time! We're 78% of the way there!

Moving Mountains By Example: Doctor Inspires Others to Fund Anti-MOC Legal Effort

In a reaffirming gesture of solidarity, San Francisco cardiologist Michel Accad, MD has offered to supply an electronic copy of his book "Moving Mountains: A Socratic Challenge to the Theory and Practice of Population Medicine" (seen on Amazon) free of charge to anyone donating $50 or more in the next two weeks to our legal effort to end the onerous and unproven ABMS Maintenance of Certification (MOC™) program nationwide.

 Dr. Accad's affable and insightful personal blog (Alert and Oriented) and podcast (Accad and Koka Report) co-produced with Philadelphia cardiologist Anish Koka, MD, have garnered wide physician followings by respectfully and thoughtfully discussing timely issues that matter to doctors. (My recent 46-min podcast discussing this funding drive with them can be heard here).

While the sponsor of the legal effort, Practicing Physicians of America (on whose board I serve), has already reached over 75% of the $150,000 funding goal, I hope Michel's generosity will inspire many other physicians to join this funding drive in hopes working physicians of all ages can help end - once and for all - the expensive, onerous, and corrupt ABMS MOC™ program that has the potential to unjustly limit a physician's right to work.

-Wes

Federation of State Medical Boards Attempts to Legislate Away Liability

In a press release, the Federation of State Medical Boards (FSMB) announced their support of the “Occupational Licensing Board Antitrust Damages Relief and Reform Act of 2018 (H.R. 6515),” introduced by Rep. Mike Conaway (R-TX) and co-sponsored by Rep. Lamar Smith (R-TX). According to the press release:

H.R. 6515 eliminates fiscal antitrust damage liability for state licensing boards-including state medical boards- their members, and staff who are acting within their statutory mandate to protect the public. Currently, board members and staff are exposed to personal liability and treble damages for actions taken as part of their service on a board. The lack of protection has had a chilling effect on the willingness of some individuals to serve on boards, causing some board members to resign for fear of personal financial liability.

It is interesting that this new bill attempts to circumvent the 2015 Supreme Court decision that held professional boards could not make decisions that potentially violated antitrust laws and quashed competition. The justices, in an opinion by Justice Anthony Kennedy, agreed with the government’s claim that although state entities are usually exempt from federal antitrust laws, the exemption did not apply because the board was not actively supervised by the state and because it was made up of self-interested private businesses.

The FSMB President and CEO, Humayun Chaudhry, DO, MACP has quite a history of working with similar self-interested private businesses.

In fact, Dr. Chaudry has long supported the notion of Maintenance of Licensure (MOL) that required Maintenance of (board) Certification (MOC®) and "lifelong learning." Chaudhry chaired a CEO Advisory Council (comprised of a slew of non-governmental U.S. medicine regulatory organizations) that advised the FSMB's Board of Directors and worked with an FSMB MOL Implementation Group (with Richard Hawkins, MD, the current President and CEO of the American Board of Medical Specialties (ABMS), in 2009). That group recommended that physicians actively engaged in the Maintenance of Certification (MOC) program of the American Board of Medical Specialties, or the Osteopathic Continuous Certification (OCC) program of the American Osteopathic Association, should be recognized as "substantially in compliance" with any MOL program that is adopted by a state. Because of this tie between MOL and MOC, the activities of the FSMB in the state of Ohio were met with formal opposition from the Ohio State Medical Association in 2012.

No wonder the board members from various state medical boards have resigned from their positions out of liability concerns. They understood there is credibility to the Federal Trade Commission's concerns that were upheld by the U.S. Supreme Court.

Legislators (especially Rep. Mike Conaway and Rep. Lamar Smith) would be wise to realize that the multi-million dollar FSMB has financial conflicts of interest that may cause more harm than good to our patients.

-Wes

P.S.: Like the FSMB, ABMS collusion with state medical societies regarding MOC® is also evident in this recent ABMS press release.

The ABIM Has Lost Their Marbles

From the institution that secretly funded itself with ABIM diplomate fees to the tune of over $78 million that culminated in the purchase of a $2.3 luxury condominium for itself complete with a Mercedes S class town car, and offshored funds to the Cayman Islands,  comes this news release:

The 2018 ABIM Foundation Forum will consider the importance of trust in health care – and how to build and maintain it – against a backdrop of political and social turmoil and all-time lows in Americans’ trust in institutions across society.

Make no mistake: this is our physician Board re-certification money they are playing with.

At the very least, the optics of such a conference are horrible given the ABIM Foundation's past.

I hope everyone will make good use of the hashtag #abimf2018 on Twitter and then contribute to our legal fund to permanently end this shameless gaslighting of US physicians and our patients.

-Wes

Board Certification: From Marketing Accolade to False Idol

I'm Board certified.

So is Carmen A. Puliafito, MD.

So is Farid Fata, MD.

So are plenty of other Medscape "Best and Worst" physicians from 2012-2016.

So what is "Board certification?"

Truth be known, it is little more than a marketing accolade.

And for a while, it worked.  Doctors took board certification examinations to market themselves as competent in their field. They would take a written or oral examination created by their peers to demonstrate to others they knew their stuff. And while it remained a lifetime designation, it had some legitimacy. In reality, however, it was up to the residency training programs to train the physicians and verify they knew their stuff.  Hospitals used to verify credentials by calling residency programs and verifying doctors participated. They had large credentialing departments that kept everything on file.

But competition between hospitals vying for patients soon grew fierce and hospital marketing departments jumped on the credentialing bandwagon. Soon billboards would appear: "Come to see our board-certified specialists!" and the race was on.

Lawyers joined the fray, too. "My expert witness is better than your expert witness - see how many board certificates he has?"

Truth is, we love this crap. Just look at how many nurse practitioners are "board certified" now!

In the 1960's to 1970's, the American Board of Internal Medicine recognized how lucrative this craze could be, but they had one big problem if they were going to make certifying doctors a full-time business: the number of doctors out there was finite. (It was about that time the board members started paying themselves). They also saw how much money the American Board of Family Medicine, founded in 1969, was generating using 7-year time-limited certifications.

But the ABIM knew internists would be on to them changing the rules for board certification from a lifetime to time-limited credential. So they first tried making a voluntary "super accolade" for internists, called the "Advanced Achievement in Internal Medicine." Needless to say, after four attempts that garnered progressively declining enrollment, the AAIM concept flopped. It was Lynn O. Langdon, MA (a non-physician and Chief Operating Officer of the ABIM) who declared the "End to Voluntary Recertification" and time-limited certification was born with the threat of "uncertain circumstances" if doctors did not participate.

Needless to say, with the help of conflicted members of the ACP who stood to make handsome returns from the Medical Knowledge Self-Assessment Program (MKSAP), they were off to the financial races. And what a race it has proven to be: a nearly $1 billion dollar-a-year enterprise for the entire ACGME.

Unfortunately, no one has ever stopped to study what happens to skilled, competent, board-certified doctors that fail their computerized "re-certification" examination or fail to garner enough "MOC points" to sit for their examination. No one asks about the damage this time-limited credential is having on our physician numbers and access to care. The money is too important to the system.

Not long ago, the chairman of our cardiology division had to relinquish his role as a teacher to medical students because he refused to re-certify in cardiology while also being "certified" in interventional cardiology. (He could keep performing catheterizations and stent placements and remain credentialed thanks to the change in double jeopardy rules that changed just in the nick of time). How many medical students lost out on his experience as a result? Are we happier that medical students are now being taught by younger (time-limited) Board-certified physician instructors rather than life-time certified physicians with decades of experience in the field?

Doctors and nurses know the truth. That's why when seeking out a "quality" physician for their own care, they NEVER ask if a colleague is board-certified since board certification is now a false idol - a hoop to complete whether they're competent, ethical, or not.

We know that it's now far better to ask a trusted colleague or health professional when seeking care because there's much more to being a "quality" physician than holding a computer-generated "certificate."

-Wes

Reference: Fisher WG, Schloss EJ. Medical specialty certification in the United States - a false idol? J Card Electrophys October 2016; 47(1): 37-43.

US Physician ABMS Board Certification: From Voluntary to Mandatory

The American Board of Medical Specialties (ABMS) is very careful to claim their version of "Board certification" is a "voluntary process," otherwise, this Chicago-based non-profit 501(c)(6) organization might be accused of anti-trust behavior.

"ABMS Maintenance of Certification" and "ABMS MOC" were registered by the ABMS in the US Patent and Trademark Office August 21, 2007 after filing the terms February 23, 2007.

MOC for ABMS has value.

We also know Ms. Margaret O'Kane, founder and President of the non-profit "National Committee on Quality Assurance" and that created and owns the Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS is a tool used by more than 90 percent of America's health plans to measure performance on "important dimensions of care and service." We also find that Ms. O'Kane was a "public member" of the Board of Directors of the ABMS and advertised the importance of the ABMS MOC program "to patients and the pubic" by video and implies the ABMS board's actions assures improved "outcomes" for patients.

So it should come as no surprise that some of those payers who stand to benefit by limiting patients' access to care (in this case, Blue Cross Blue Shield of Michigan) have made initial ABMS Board certification mandatory for physicians on their panels:



(Click to enlarge)

While claiming MOC as a requirement for physicians to receive payments because it assures their  "quality," BCBS of Michigan does not demand the same of mid-level providers like physician assistants and nurse practitioners without similar subspecialty training. Additionally, physicians who received their "Board certification" before 1990 and are farthest away from their training are not required to perform ABMS Maintenance of Certification to remain on those same insurance panels, introducing a hypocritical and discriminatory double-standard that financially benefits insurers and hospital systems (more insurance claim denials and cheaper staffing requirements).

ABMS is the puppet of the insurance companies, just as they were the puppets of Big Tobacco in the 60's.

The IRS, FTC, and SEC need to get serious about investigating this ruse.

Why?

It's compromising patient care and our patients' access to care.

-Wes

P.S.: If you haven't contributed already, please consider donating to the legal fund sponsored by Practicing Physicians of America that hopes to bring an end the ABMS Board certification/MOC monopoly nationwide.

A Critical Review of the ABIM Knowledge Check-In Program

This video is a first attempt at something new. I look forward to your thoughts. (Yes, as always, the comments are open).

As a professional physician who has devoted his whole life to helping others, the introduction of the American Board of Internal Medicine's (ABIM) latest iteration of Maintenance of Certification (MOC), called "Knowledge Check-in," is maddening. Knowledge Check-in continues the humiliating and embarrassing pre-test body search (now in the comfort of our own home or office), higher fees, and (as I review in the video above) places physicians at a very high risk of identity theft. Having doctors acquiesce to this nonsense every two years just so they can keep doing their job shows how low the independent non-profit ABIM (and all other American Board of Medical Specialty member boards that subscribe to this approach) will go to keep their cash flow going. They're not "listening" to physicians as they promised, they're using a classic strongman approach to market physicians as "cheaters" before caregivers, just as before.

If you feel as upset as I do that this is no way to perform physician education, please join our effort to end this costly and unproven re-certification program nationwide for all subspecialties by contributing to our GoFundMe page.

-Wes

Rent-Seeking: ABIM Shows Us How It's Done

The new ABIM fee schedule was published online for 2018, and physicians should pay attention. Like the classic shell game played by a New York street hustler, there are lots of hand motions and movements in the new cartoon video produced by the ABIM that explains the new fees that cleverly hides the MOC fee increase. And here's how those "fees" are coached on their website:

But what physicians should understand now is the "MOC Fee" does not include the "Assessment Fee."  Here's what that additional "Assessment Fee" gets you that's NOT included with the "MOC Fee" above:

When one tallies all this together, here are the real 10-year costs for MOC in 2018, according to the ABIM website:

While the ABIM seems happy that "MOC fees have not increased since 2014," let's look at what they've done since 2000:

We should all have this kind of year-to-year return on our investments! Here we are, paying all of these fees, just so we can keep our jobs and insurance payments coming.

We now see how ABIM has been "listening" to practicing physicians: rather than addressing these exorbitant costs, the ABIM keeps adding to them by dividing them into pieces and making up new fees so the fleecing of US physicians can continue. 

It's time to end this charade. If you haven't already, please help.

This expensive rent-seeking behavior to fulfill political and personal agendas must end nationwide.

-Wes

More Changes Are Coming to MOC!

Today in Medscape, we learn that even more changes are coming to MOC.

The simple answer to the "will physicians get relief" is, of course, no.

Here's the comment I left, just in case it does not get published, that explains why they won't get relief from the changes proposed:

This entire charade - ALL of MOC - is NOT about physician's continuing education, but about using our Board certification and re-certification status/scores/demographics/SSN, etc - in other words, our DATA - as a pseudo-"quality" indicator for Big Business. Big Business includes Blue Cross/Blue Shield and Premier, Inc., the largest group purchase organization for the nation's hospitals. In not mentioning this, Medscape perpetuates the gaslighting of physicians that has occurred for years on a massive scale - (but then, they, too have their corporate conflicts). Physicians have tried to play nice and go with the flow at first, but now the situation is untenable, in large part because the member boards have wound their financial strings around the MOC bicycle spoke so far, they can't unravel it.

Nowhere is there mention of corruption and political activities that have occurred with the member boards, the $2.3 million condo purchased by the ABIM Foundation, the spousal travel, the $1.7 million Golden parachute Christine Cassel MD received from the ABIM when she left to join the National QUALITY Forum.

It's time to end the corruption. But myself and others can't do it alone. We need your help. Please visit our GoFundMe page and learn how you can contribute to pre-litigation investigation and the development of a legal complaint for fraud against the ABIM, the ABIM Foundation, and its leadership and others:

https://www.gofundme.com/practicing-physicians-of-america

Thanks-

Seriously, I can't do this alone.

-Wes

Churning Pseudoscience

Recently, two papers published by authors at the American Board of Internal Medicine (ABIM) appeared in the mainstream medical literature that purported to provide evidence to the value of their Maintenance of Certification program.

The first was "Associations Between American Board of Internal Medicine Maintenance of Certification Status on a Set of Healthcare Effectiveness Data and Information Set Process Measures" by Bradley Gray, PhD, Jonathan Vandergrift, MS, Bruce Landon, MD, MBA, James Reschovsky, PhD, and Rebecca Lipner, PhD in the Annals of Internal Medicine. The other was "The American Board of Internal Medicine Maintenance of Certification Examination and State Medical Board Disciplinary Actions: A Population Cohort Study" by Furman McDonald, MD, MPH, Lauren Duhiggt, MPH, Gerald Arnold PhD, MDH, Ruth Hafer, BA, and Rebecca Lipner, PhD published in the Journal of General Internal Medicine.

Both of these studies' senior author was Rebecca Lipner, PhD, a testing psychometrican who currently serves as the Senior Vice President for Assessment and Research at the ABIM earning $435,990 per year. Last year's tax records also disclose Dr. McDonald, ABIM's Senior Vice President "Academic and Medical" earns $419,497 annually for his services. The other author's salaries are not disclosed, but we can imagine their salaries are not zero.

The first study by Gray et al, is a cross-sectional design and used observational data. As such, its results only reflect associations and not definitive indicators of a causal relationship (acknowledged in the limitations section by the authors). The second study by McDonald, et al. is another observational study and cannot determine causality either.

So why are ABIM diplomats funding so many "association" studies? Given the cost of producing these studies, might the ABIM be churning pseudoscience to forward their own agenda rather than forwarding helpful public policy or medical science? Not disclosed in their "Conflict of Interest statements is the fact that ABIM sells our board results and "status" via the American Board of Medical Specialties (ABMS) to others via ABMS Solutions, LLC. As such, these publications serve the organization's undisclosed covert agenda and should be called what it is: very expensive propaganda.

With our current era of the proliferation of predatory journals, it is clear we also have an era of proliferation of predatory publication that supports the needs of our ABMS member boards that is not in their diplomates' best interest as well.

-Wes

Recap: Dr. Wes Goes to 2018 AMA Annual Meeting

It was a rainy day in Chicago.  I elected to take the commuter train downtown to avoid the traffic well before my scheduled presentation for the PA Medical Society at 9AM. After leaving the Ogilvie Train Station, I walked to the cab station to hail a cab to the Hyatt Regency. It was then I saw this Facebook ad at the train station:

Such irony.  There I was, heading to the AMA House of Delegates to speak on this very issue and how it has adversely affected physicians.

"MOC is not about physician education, it's about our data."

-Wes

To view the entire presentation, you can view the live stream of the talk here. (Sorry about the quality, it was my cell phone that was only dropped once...)

Please consider giving generously to our GoFundMe page to begin the process of ending Maintenance of Certification™nationwide.

Everybody Knows a Frank

Frank is one of the smartest people in his cardiology division. He's bright, congenial, and capable of citing the latest clinical trial on the best imaging study to detect hibernating myocardium. He loves learning. Frank is the guy you used to confide in the doctors' lounge (that doesn't exist anymore). Others knew what a good guy Frank was too; Frank was nominated to write and edit questions for the nuclear medicine boards. Deep down inside Frank knows the boards are a problem. But he's afraid that if someone were to implicate his medical society as colluding with the boards, he'd see himself as being partially responsible for losing the one scientific meeting he attends each year where he can re-connect with colleagues and maybe learn something new.

At another center, Frank is the Chairman of the Department of Medicine responsible for the day to day workings of a large urban hospital system. He is a highly respected member of the Internal Medicine community, author of 14 books on the principles and practice of  Internal Medicine, and a beloved bedside instructor to generations of internal medicine residents. He also serves as a test-writer for the American Board of Internal Medicine and thinks overall they're a responsible group.  He knows how hard his fellow physicians work at constructing a meaningful continuing education process. As the  President of his local medical society, too, he knows money doesn't just grow on trees. And if people tried to disrupt the status quo, what's the endgame?

Frank on the other side of town serves as an editor to the preeminent hematology-oncology journals and has held multiple leadership positions in his subspecialty's medical society. He is widely respected by his peers, served as a director at the American Board of Internal Medicine (ABIM) and helps write test questions for the ABIM, too. He finds test-writing challenging and believes in the value of continuous testing to maintain a physicians fund of knowledge. He devotes countless hours to this endeavor to assure it is fair and impartial to those who must recertify. Sure there are some challenges, but given all the good people working on this, no one needs to question the integrity of the process.

* * *

The dilemma facing physicians today is that the majority of physicians who work with the ABMS member boards and our subspecialty societies are good, hard-working members of our profession. It is hard to fathom that a very tiny minority are corrupt and have been operating below the radar for years. I have no fantasy that your Frank or mine would approve of this corruption or even be able to believe it. And yet, here we are.

Our own inability to tolerate this complication threatens to paralyze us from cleaning up the corruption in our ranks.

There have always been good people in our professional societies and ABMS member boards. But these colleagues, who value contributing and community involvement, should be engaged in a far different framework. Doctors need community and support and collegial leadership. Returning medicine to a truly non-profit, voluntary, democratic representation of working physicians today rather than the self-selected, profit-churning, elitist employment service that it has become. Alternative structures are already emerging. It is time to be open to new possibilities or to take on the challenge of creating them.

What we face now is not new. There have always been top dogs who operate with impunity in contrast to all of the good causes that they publicly champion. In 2018, with the Harvey Weinstein, Matt Lauer, and Eric Schneiderman hypocrisies, surely we can understand this reality.

Today, physicians' ability to work, receive insurance payments, and willingness to stay in our profession, are threatened by the out-of-control, corrupt, ever-evolving Maintenance of Certification (MOC™) requirements supported by Organized Medicine. It's time to see it for what it is.

We all know a Frank, or several Franks and Francines. They cannot continue to be a shield for the exploitation of practicing physicians. Or a reason to look the other way. We all honor the hours of work it has taken our esteemed colleagues who have participated with the best of intentions over the years, but its time to clean up the corruption in the ABMS member boards and colluding medical subspecialty societies.

Cleaning up the corruption is the first step. Please contribute whatever you can to our effort to do so.

Thanks-

-Wes