330 East Algonquin Rd. Ste. 6
Arlington Heights, IL 60005

142 East Ontario St.
Chicago, IL 6061
October 31, 2012

Dear Osteopathic colleagues,

As actively practicing Osteopathic Family Physicians, we all believe in lifelong learning from our patients, experience, readings and personalized elective coursework. Traditionally, our process has included 4 years of college, 4 years of osteopathic medical school, 1 year of internship (PGY I) and at least 2 years of additional residency(PGYII, PGYIII) or a minimum 3 years residency post graduate training. After completion of the academic and practical curriculum, a physician passes a board exam to gain lifelong board certification with no expiration. For every three year cycle after that, a physician had to complete CME credits to indicate hours of practice experience, teaching students and residents, home reading study and personal choice of formal CME programs. This curriculum allowed flexibility, personalization and relative economy for each practicing physician as they could choose the courses within the AOA categories.

Osteopathic family medicine residencies developed in the 1970s. In the 1980’s, physicians who didn’t complete a family medicine residency were allowed to be “grandfathered in,” and become board certified without having completed 3 years of residency training. They gained all the rights and privileges of board certification and continued with their 3 year CME cycle.

Starting for ABOFP/ACOFP family medicine completing residency in 1997, each physician now had to be recertified by taking another board exam every 8 years (time limited certification). This cost physician’s additional time and money. Physicians board certified previous to 1997, even those “grandfathered in,” were still lifetime certified and never had to spend their time and money pursuing board recertification. This is discrimination against those who rightfully completed family medicine residency by those in leadership positions who themselves were “grandfathered in,” and not actually residency trained. Their previous training, although at least 3 years less than those who were residency trained, apparently have omnipotent superior lifetime skills and don’t require additional testing to maintain their board certification.

Starting for this same group of ABOFP/ACOFP board certified family physicians who completed residency in 1997, there is an additional maintenance of certification/osteopathic continuous certification (MOC/OCC) procedure that becomes mandatory on January 1, 2013. MOC/OCC now demands that in addition to all the foregoing time, retesting procedures and expenses, residency trained physicians must additionally enter patient data on two time periods to somehow measure a physician’s skill and participate in an online procedure requiring many hours and cost an additional $3,000 at minimum. This is burdensome, expensive and not statistically proven to improve care. Further, it does stand to generate significant money profit for the ABOFP, ACOPF and AOA which makes it a conflict of interest. Furthermore, once again, those board certified previously to 1997 in osteopathic family medicine, remain lifelong board certified without additional testing or the requirements of MOC/OCC. This too is discrimination against those who have spent the time, effort and money pursuing residency training and initial testing for board certification.

All requirements for all practicing DOs should be consistent throughout and not required for some but not others. All MOC/OCC roads seem to lead to MOL – maintenance of licensure and the regulatory capture of osteopathic medicine. As a practicing osteopathic family physician, I refuse to participate in MOC/OCC and time delimited certification as they are:

1. MOC/OCC and time delimited certification are only required for those board certified finishing residency on or after 1997 and not required for those board certified finishing residency prior to 1997.

2. MOC/OCC and time delimited certification are not required for those who did not complete residency, but “grandfathered in,” to board certification.

3. MOC/OCC and time delimited certification are burdensome in practice by taking time away from disappearing patient care time.

4. MOC/OCC and time delimited certification takes time away from disappearing personal health and family time.

5. MOC/OCC and time delimited certification are not statistically proven to improve care.

6. MOC/OCC and time delimited certification are based on a discriminatory procedure that exempts residency trained physicians who completed training before 1997.

7. MOC/OCC and time delimited certification are based on a discriminatory procedure that exempts non-residency trained, “grandfathered in,” physicians who were in practice prior to 1997.

8. MOC/OCC and time delimited certification are financially burdensome to practicing osteopathic family physicians.

9. MOC/OCC and time delimited certification creates and maintains new procedures the ABOFP, ACOPF and AOA will gain significant sums of money from and is therefore a conflict of interest.

10. MOC/OCC may be used by insurance companies to discriminate against DOs on payments and network participation

11. MOC/OCC may be used by hospitals to discriminate against DOs for staff privileges.

12. MOC/OCC may lead to MOL and the regulatory control of osteopathic medicine.

13. MOC/OCC and time delimited certification are unreasonably burdensome in a physician’s time and money that is threatens their rightful practice of Osteopathic family medicine. This violates the Osteopathic oath of Andrew Taylor Still, DO that we all pledged to uphold, that even the AOA, “never by word or by act cast imputations upon them (DOs) or their rightful practices.”

Best wishes for good health,

Craig M. Wax, DO

Residency trained, Osteopathic Family Physician

Host of Your Health Matters on Rowan Radio 89.7 WGLS FM

Medical Economics Editorial Board Member

Sample MOC OCC board letter

Short board MOC OCC letter

Dear (insert specialty) certifying board

Please discontinue your maintenance of certification(MOC) program. I, and many other colleagues, will not participate. MOC is unnecessarily burdensome, costly in time and money to participate. Certification boards stand to make millions of dollars on MOC procedures, causing a conflict of interest with their membership. They spend hundreds of thousands on
lobbying efforts to help perpetuate their testing monopoly and also
what they pay their executives.

MOC is not statistically proven to improve patient care or outcomes. Actually, it takes countless hours away from patient care, our own health maintenance time and family time. MOC may be used by insurance industry to discriminate against participation or reimbursement. It may be used by hospitals and health systems to further discriminate against our staff privileges. MOC is leading to MOL – maintenance
of licensure trials in states. Physicians in Ohio refused MOL and the proposed trial was discontinued. I will not participate in the regulatory capture of the entire practice of medicine.

Do not mock(MOC) me or my hardworking fellow physicians.

Board certification was developed as a training outcome validation and nothing more. Certification should indicate the completion of residency and should be lifelong. No further testing should be required after residency, but only flexible CME as currently instituted in each state.


I. Do Care, DO, MD

Links to MOC and MOL explanatory lectures from

Links to MOC and MOL explanatory lectures on YouTube from

Change Board Recert website


Click to access kempen.pdf

Testing monopoly and what they pay their executives. See

What to do about MOC and MOL

MOC and MOL are moneymakers for certification boards

MOC OCC MOL board certification and medical license regulations

Dear physician colleague,

You’ve probably heard about the additional time and expense to pursue maintenance of certification (MOC) / osteopathic continuous certification (OCC) beginning January 1, 2013. If you were lifetime certified prior to 1997, read on because eventually it will effect you for certification and your state medical license. MOC/OCC will take countless hours from your patient care, personal health and family time, as well as, more than $3000 direct cost for each certification period plus extra thousands more in indirect costs. Physicians and patients already suffering at the hands of insurance industry and government regulations, but now our own AMA or AOA and specialty board are adding to our burdens in response to government and industry pressure and profit.

In Ohio during 2012, the state licensure board attempted to enforce a MOC/OCC program for medical licensure, MOL. The Ohio state medical board tried to implement this time and money intensive program just to maintain physician’s medical licenses to practice in the state. This is why ALL physicians must be active in rejecting MOC/OCC as it has led to MOL. It was the active practicing physicians in Ohio that rejected participation in the program and caused the state of Ohio to cease the MOL program.

The time is now to send a letter to the AMA or AOA, and Appropriate specialty board to refuse participation in the MOC/OCC program. This goes for ALL physicians no matter what your board certification circumstance.

Please DO it now.

Saving Private Osteopathic Medicine

Saving Private Osteopathic Medicine

Dr. Andrew Taylor Still intended for all DOs to think and treat Osteopathically. After a century of sucess, his fruit is withering on the vine due to the forced intervention of insurance and government which the AOA and its member physicians embraced, as did the AMA and our MD allopathic fellow physicians. Osteopathic manual medicine(OMM) has been marginalized from mainstream family medicine and primary care specialties to PMR/OMM/NMM specialists due to time and economic pressures. They, too, are now doing more reimbursable injection procedures and medications than actual contact OMM.

Osteopathic medicine is dying in DOs offices. In fact, the whole individual private practice of medicine by independent physicians is dying. It is not due to physicians lack of commitment or education but the changing conditions in which we practice, HMOs to ACOs. The AOA has failed to defend freemarket healthcare health freedom for patients and their physicians. Instead they have gone along lock, stock and barrel with the government and insurance matrix stakeholder model, ppaca/Obamacare, ACOs, AMA sponsored coding, insurance billing and denials, EHR tech, data entry and extraction for proposed payment.

The regularly capture of the entire practice of medicine is underway. Electronic health records (EHR) is the Trojan Horse to capture patient data. Insurance companies and government oversight will not pay claims unless they conform to their arbitrary standards, thereby capturing and changing the entire practice of medicine going forward. Physicians will be the slaves for the almighty government and their insurance industry taskmasters. Unfortunately, that leaves patients at highest risk in this terminal experiment.

Osteopathic smart phone apps and AOA approved EHRs and burdensome MOC/OCC maintenance of certification will not save osteopathic medicine from extinction. In fact, to the contrary, technology, insurance administration and government will occupy the entire patient-physician encounter. When will the AOA and its component societies awaken from its beltway narcosis and advocate for the only stakeholders that matter, patients and their physicians?

The only solution to the runaway US healthcare disaster is the restoration of freemarket healthcare healthfreedom for physicians and their patients. Physicians should be free to practice in any setting. Doctors must be able to enter and remain in independent direct patient pay private practice, unfettered by healthinsurance rules and government edicts. The AOA and all physicians must fight for their freedom to ensure their patients the best care choices. This would enable DOs to practice unlimited and further Osteopathic medicine at present and for the future. Patients would be free to choose holistic preventive hands-on DO care for their families as they have done for many decades. The AOA must achieve independence from government and insurance in order to survive and not be annexed, and if not, its principles and practice will be destroyed.

Government Medicare and Medicaid, as well as, private health insurance demands physician charity to the government and insurance industry by denied claims and hold harmless clauses in participation contracts. Medicare law makes it illegal to do pure charity for its members if the physician participates in Medicare. Physicians should be in charge of, and responsible for, the care they provide and the charity they freely elect to do. It cannot be forced by insurance participation, or worse, government law.

Health insurance in the last century was useful to reimburse patient directly for major out of pocket expenses, like the auto insurance model. People are free to maintain their cars as they see fit for their benefit and risk consequences based on their own individual value system. They may drive as much as they want and are free to purchase gas and make repairs and seek preventive maintenance anywhere they want. Auto insurance is reasonably priced through competition and only covers major repairs or damage, not routine maintenance or small repairs.

Now health insurance directs all aspects of care from offices checking patient eligibility to determining and collecting visit copays, prior authorization of tests, precertification of medications, coding, billing and denial appeals. Health insurance procedures and processing wastes a huge amount of patient, physician and staff time and money. The AOA and its physicians needs to redevelop inexpensive major medical indemnity patient reimbursement plans to free physicians and their patients to seek the best care together.

The healthcare equation for success:
Freemarket + competition + transparency + direct patient pay + indemnity insurance +/- voluntary charity = empowered healthy patients + efficient healthcare + reasonable cost

The AOA and its physicians must seek reimbursement from patients not insurance or government. Direct participation in insurance and government programs has led all down the garden path to the death of private independent practice and patient care rationing. Patients must choose, invest in and participate in their care at will. This is the only solution to improve care and outcomes.

Osteopathic uniqueness in thought and deed is too vital to humanity than to be allowed to be bludgeoned to death by insurance and government money stakeholders. The AOA advocating for freemarket healthcare individual health freedom for its physicians and their patients is our only hope for survival of Osteopathic medicine against computer algorithm based population medicine and the government-insurance stakeholder model.

DOs COMITT – DOs Committed to Osteopathic Medicine Integrity Today & Tomorrow

Craig M. Wax DO corresponding author
Carlisle Holland DO
Dane Shepherd DO
Richard Koss DO
David Zeiger DO
George Watson, DO
Steven Horvitz DO
David Dornfeld, DO
Charles J. Smutny III DO

North Carolina Medical Society Passes Resolutions Opposing MOC/MOL

The NCMS House of Delegates got right down to business at the 2012 Annual Meeting and accomplished review and adoption of numerous resolutions within the new, abbreviated timeframe of the meeting. Here is a brief summary of some of what was adopted.

Opposition To Linking Licensure To Participation In Specialty Maintenance Of Certification Processes Continue reading