Saving Private Osteopathic Medicine

Saving Private Osteopathic Medicine

Osteopathic medicine is dying and it is clearly evident as our national organizations move away from maintaining the separate and distinct nature of our profession through unmistakable actions. The fact that all of medicine is being irrevocably substituted for by a corporate/actuarial-disease-oriented model only worsens the effect. Healthcare delivery in either osteopathic or allopathic medicine is systematically being eroded by an exchange for the control of the healthcare dollar at the expense of the health of the patient. This is not a new problem and was clearly delineated as far back as 1957. The technology is different, but the problem remains very nearly identical with technology currently being employed to benefit shareholders at the expense of patient care. The problem is most evident in the arena in which it started; in the denial of care for medically approved, medically necessary, standard of care procedures and the overall shrinkage of coverage. The tools the government and insurance industry has utilized to manifest the rapid decline in overall healthcare quality include, but are not limited to, health information technology; maintenance of certification; medical assessment technology; other forms of information technology and lobbying for pro-corporatization legislation. Through these actions, the distinguished care of the private physician has been eliminated from our national healthcare system. Continue reading

Maintenance of Certification: Good or Bad?

Dear Colleagues,

​A short history lesson: For years, physicians, upon completing a residency or fellowship, went through a challenging written, and for some, oral certification test, which, if they passed, rendered them certified for life. Like the Bar for lawyers, or a college or graduate school degree, no retesting was needed to maintain the certification. Physicians, by their very nature and the nature of their profession, remained up to date with medical knowledge by time honored methods, including obtaining a minimum number of CME credits each year (through journals, conferences, and the like), participating in Grand Rounds, M & M rounds, Peer Review conferences and similar peer gatherings, interaction with colleagues, and, of course, the most important opportunity for ongoing learning, daily contact with patients.

In the 1990s, it was decided that certification for physicians should no longer be lifelong and recertification, every 10 years, came into existence. Later to be known as Maintenance of Certification (MOC), this process was imposed on younger physicians by an older generation of grandfathered doctors who conveniently exempted themselves from the need to undergo MOC in order to maintain their certification.

​The ostensible logic for MOC was to ensure “quality of care” and maximize the public safety by holding physicians to a “higher standard”. The only problem is, to this day, there is not a single scientifically rigorous study that shows that doctors completing MOC provide any better care that those who have not done MOC. The few studies done fail to meet compelling scientist standards, and worse, are often co-authored by physicians who work for the very entities that create and administer MOC, an obvious conflict of interest that is never addressed.

​Every few years, MOC becomes more onerous, more complex and more costly. Currently, for internal medicine, the process includes, or will soon include the following:

1) Open book home tests modules, much of whose content is irrelevant to what we do on a daily basis
2) Practice Improvement Modules (PIM), a tedious, time consuming, busy-work process of no proven value
3) The requirement to submit patient answered surveys about you
4) The requirement to submit colleague answered surveys about you
5) A secure exam whose content is largely obscure and irrelevant to what we do on a daily basis, and whose secure nature is so insulting that we cannot even have a handkerchief in our back pockets or wear a watch during the exam.
Currently, we are told by our boards that MOC is “voluntary”, but this is just an illusion. As more and more hospitals are manipulated into believing that a MOC doctor is better than a non-MOC doctor, MOC is becoming a requirement for hospital privileges. Similarly, payers are being convinced of the same thing, and are requiring doctors on their panels to be current with MOC, thus linking MOC to reimbursement. So much for being voluntary. But now comes the final step, the effort to link MOC to Maintenance of Licensure (MOL). Pilot programs for such a linkage are already being proposed in 12 states. Such a linkage would utterly end any illusion of MOC being voluntary and would, in fact, force even the remaining grandfathered doctors to do MOC as well, if they still wanted a valid license. The other part of this, easy to overlook at first, is that MOL occurs every two years, and, if linked to MOC, then MOC, in some form, would need to be done every two years. In fact, the latest proposed acronym to come out of the ABIM, and similar boards, is CMOC, or Continuous MOC, with the implications that MOC would essentially be a never ending ongoing process for which, again, no data has ever shown it to be of value to patient care.

​So why are ever stronger efforts being made to force us to participate in a dubious process? For the always obvious reason, money. The test creating and administering industry (and make no mistake, it is an industry) and the test preparation industry have made, and continue to make tens of millions of dollars from MOC, and similar recertification processes. These are your hard earned dollars going to pay lavish salaries to board members who no longer even practice medicine but who feel utterly comfortable imposing on you these costly, onerous, time consuming and unvalidated recertification requirements.

​So what to do? Accept yet more abuse from the “system”? Passively bow to our fate? No! Enough is enough. It is an outrage and it is time for doctors to band together, take a stand and put a stop to MOC. Already, significant groups of physicians have in fact banded together and are employing a variety of strategies to achieve the goal of ensuring that MOC becomes truly voluntary, with no linkage to reimbursement, license or hospital privileges. If you want to know more about what is going on, who is involved in fighting this and what you can do to help, please look at the information found at these web links:

​Thank your for you consideration and support.

Jonathan Weiss, MD

Dr. Rand Paul takes a stand against American board of ophthalmology

Rand Paul, MD: I passed my ophthalmology certification, but took a stand against the way the board operates

“I took the American Board of Ophthalmology (the largest governing body in ophthalmology) boards in 1995, passed them on my first attempt (as well as three times during residency), and was therefore board-certified under this organization for a decade.

In 1997, I, along with 200 other young ophthalmologists formed the National Board of Ophthalmology to protest the American Board of Ophthalmology’s decision to grandfather in the older ophthalmologists and not require them to recertify.

I thought this was hypocritical and unjust for the older ophthalmologists to exempt themselves from the recertification exam.

In forming NBO, the younger ophthalmologists agreed to require recertification for all ophthalmologists.

In my protest to the American Board, I asked, “If the ABO thinks that qualify of care would be improved by board testing every decade, shouldn’t this apply to all doctors, not just those of a certain age? In fact, many of us argue that the older ophthalmologists need recertification even more since they are more distant from their training.

Is it fair that the ophthalmologist down the street can claim board certification, without renewing it, but that a younger ophthalmologist, who passed the same boards, is disallowed?

This is the kind of hypocritical power play that I despise and have always fought against. It reminds me of congress passing health care legislation but exempting themselves from their own laws. I protested to the ABO, as did many other younger doctors. This is when I came up with the idea of creating a competitor to the ABO, and formed a new organization, the National Board of Ophthalmology. Keep in mind that neither of these groups have anything to do with medical licensure, which is handled by the state boards.

ABO claims it is illegal to call for recertification of all ophthalmologists. This is untrue. ABO is a private group and create any rules they wish. (even discriminatory policies based on age) Having all its members recertify is not illegal just impractical because the older ophthalmologists will vote against it.

ABO argues that the older ophthalmologists were given “lifetime certification.” This is also untrue. The certificates of the older ophthalmologist do not refer or explicity grant “lifetime” certification.

ABO argues that they are the legitamate organization because they are recognized by the American Board of Medical Specialties (ABMS). They fail to explain that ABO helped found ABMS and gets to vote on who is approved by ABMS. One can imagine why ABMS and ABO would not want to approve a competitor.”

link to above story