Maintenance of Certification and Licensure: Regulatory Capture of Medicine

The official journal of the International Anesthesia Research Society, Anesthesia and Analgesia has published Dr. Paul Kempen’s (M.D., Ph.D.) comprehensive review of “Maintenance of Certification and Licensure: Regulatory Capture of Medicine” in Vol. 118. No. 6, June 2014 edition.

CLICK HERE to read full article

A related CME activity can be found at

Article Excerpt:

I grew up in a blue collar inner city “broken home,” and worked continuously from age 14 onward. I paid my way through catholic high school and public university, learning German as a premedical prerequisite. Financial aid allowed me to go to Germany as a “Junior Year Abroad” student. I was admitted after 1 semester into a premier medical program of the Albert Ludwig Universität Freiburg, founded in 1457, completing my American Bachelor of Science in Biology in Germany over the next 3 semesters. I then traveled to New Zealand for medical externship for 6 months.

As a medical student, I was qualified to work as a nurse after completing a 2-month rotation in clinical nursing as required by my program. During my semester breaks, I often worked 11-hour shifts as a night nurse on the surgical ward. My record was 30 consecutive 11-hour night shifts. This work, along with periodic red cell and plasma donations, allowed me to finance my medical study in Europe.

I am a foreign medical graduate. I completed the required Educational Commission for Foreign Medical Graduates, Federation Licensing Examination, and multiple English tests to secure U.S. licensure (despite being U.S. born and raised and graduating with a Bachelor of Science degree from the University of Michigan), as well as certifying in Anesthesiology (1989) and recertifying in 2005.

None of this makes me a better physician, I do that personally. As a better physician, I can  simply pass these tests without preparation. The waste of time and money to jump these hurdles seems unnecessary and possibly even offensive.

While currently in full compliance and participating in Maintenance of Certification (MOC), I decided to investigate this certification and recertification process.

I passionately, actively learn every day. Today, at age 59, 12-hour workdays, including night, weekend, and holiday calls, are not only common but are expected contract parameters of an employed physician. This is still amazingly better than the 24/7/365 demands on rural primary care physicians. Learning has been mostly limited personally over the years by access to journals and time to read. I have never learned specifically or systematically for or from the board certification process. Who has the time?

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