Herb Kunkle, MD speaks out:
As a profession, physicians need to collectively look at all the policies, regulations, mandates, financial arrangements and such that impact the patient-physician relationship and our autonomy, the evidence that these have any clinical validity, and the (perverse) incentives of those who promote these. While I respect many of the various Boards members, and certainly mine, any thinking physician would have great trouble accepting Dr. Nora’s points for anything other than a fable, pushed by bureaucrats who wish to protect their financial arrangements and power.
There is little evidence that any of her points have validity; certainly no surgeon or internist would adopt a new treatment or procedure based on the flimsy evidence the ABMS uses to attempt to justify their cause. It is also telling that Recert, then MOC was constructed over the past 25-30 yrs, behind closed doors and c little input from the practicing physicians it affects, and c no evidence base. Sadly, our profession is beat up, c many physicians bright, but PC, risk adverse, test takers. And acolytes to those who choose to conscript them.
As we watch another poorly construed policy (PPACA), that also has the potential to hurt the patient-physician relationship, fail; one may wish to observe the talking points and narratives used to first promote it, then rationalize its reasons for failure. Very similar to what is used as ‘fact’ to support MOC and the ABMS agenda.
Our hope is that physicians will begin to wake up and push back to protect our profession and the patient-physician relationship that is being threatened at many levels, and by many powers and false prophets; the govt, insurers, trial bar, now MOC. As CS Lewis said- ‘Of all tyrannies, one exercised for the ‘good’ of its people is the most oppressive.’
Let’s hope that Drs Nora, Casel, Wachter, Holmboe, Choudry, et al will join us in devloping a true program of Lifelong Learning that we all support, rather than the sham of MOC and lifelong testing. This could begin by a series of open discussions and planning with practicing physicians.
I think we are all tiring of bureaucrats, theorists and social engineers telling us how medicine should be practiced, what quality entails, and what makes a ‘good’ physician. And the attendant ppwk and time spent on complying with these processes of little clinical value.
It is time for all to say – Enough is Enough