1 thought on “The MOC:PQRS; Now More Than Ever, We Need Leaders

  1. Medical Practice Should be based on Evidence—MOC is not:
    It is interesting that Daniel B. Wolfson who regularly writes articles supporting MOC is the EVP as well as COO of ABIM Foundation. Never is a discussion of the obvious conflict of interest entertained…
    As physicians, we should demand evidence-based analysis of strategies proposed to improve our ability to practice, just as we do our research. We should not give in to potential threats of government mandates. For two centuries, the medical profession has evaluated the proper use of techniques, procedures, and therapies that have proved to be of important benefit.
    Most practicing physicians find MOC to be clinically irrelevant, and it has not been found to correlate with creating better physicians. Yet with an ever-increasing physician shortage, the boards are creating systems that potentially will decrease access to healthcare for many Americans.
    Perhaps the American Board of Medical Specialties or any of the individual subspecialties can spend their resources on studying why camaraderie, collegiality, and membership in local organized medicine has plummeted since the introduction of recertification. Perhaps, ABMS could study physician motivation to do unnecessary tests—defensive medical practice, cya hospital rules etc. Recently Dr. Wolfson quoted the NY Times article http://www.nytimes.com/2014/01/19/health/patients-costs-skyrocket-specialists-incomes-soar.html?_r=1 discussing physicians doing unnecessary procedures for profit as a reason for the ABIM “Choosing Wisely” Campaign. I am as Ms. Rosenthal calls a “modestly paid” OB/GYN who has seen his income drop 50% (70% if you control for inflation) since the late 80s. Although, I do agree with some major points made by Ms. Rosenthal, I don’t however agree with the true facts regarding Ms. Little—the main patient—and her story. This article unfortunately has an obvious sensationalistic bias. Is it coincidental that Ms. Little read up about the Mohs prior but then had it “forced” upon her? Did she really “protest” about a plastic surgeon, about the anesthesiologist and the Mohs? Was she really told that she had “no choice.” The standard of care dictates that physicians give patients choices as well as options prior to surgery and other procedures. This standard mandates the risks, benefits, pros and cons as well as a discussion of not doing the procedure. I would bet that Ms. Little signed consent forms that allowed all the procedures as well as a document stated that she was in fact informed about the risks and alternatives. It is also quite coincidental that she scheduled everything when she was “pressed for time” at semester’s end—this all could have waited. I bet she thought it was all covered by insurance, had met her annual deductible and only after she was hit with all the bills her insurance didn’t pay, did she conveniently have “no choice.” There is a big problem in America with cost shifting inflating real medical charges, but cases like this do not address the real problems; they only point out that Americans want cosmetic procedures done and paid for by someone else. More of the excessive health care in America is done because people want it and not because some capitalistic doctors are running mills. If physician leaders truly want people to “choose wisely”, we can not allow sensationalistic yellow journalistic scare articles to mobilize the population. We can not allow any waste of valuable resources. Unfortunately, “Choosing wisely” pushes MOC which does just that. Medical practice should be based on evidence. MOC is not.

    Howard C. Mandel, MD, FACOG

    Los Angeles, California

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