ABA should do the right thing: abandon time limited certifications completely #MOC

Paul Kempen, MD, PhD passes along correspondence with Lehigh Valley Health Network, Dept. of Anes. Chair Dr. McLoughlin with a short intro:

Just this week, Lance Talmage as Chairman of the FSMB board indicated that “300,000 physicians” are currently enrolled in MOC-as a very supportive statement. With over 850,000 docs in the USA this documents a small 37% acceptance! This needs to be advertised. It is time for the ABMS tyranny to be “irrelevant”!

Dear Dr McLoughlin:

Please consider the fact that Grandfather recertification is a non-starter, with well below 10% compliance to date. As the ABMS and the ABIM continue to push all 24 affiliates to subscribe to their demands, physicians are beginning to lose employment secondary to certification expirations. This is a real problem faced with the “physician shortage and baby boomer onslaught”. As “MOC compliance” becomes the “new standard” under ABMS tyranny, everyone becomes extorted into “compliance” or retirement. At the same time, non-physicians are being given the right to practice medicine and anesthesia, also outside the state board oversight. Some highly-trained nurses in Minnesota will no longer be required to have a physician supervise their work. Gov. Mark Dayton has signed a bill that gives advanced practice registered nurses the authority to practice independently.The licensing change, which takes effect Jan. 1, applies to nurse-midwives, nurse practitioners, clinical nurse specialists and registered nurse anesthetists. That makes Minnesota the ninth state to grant full practice and prescribing autonomy to all four categories of advanced practice nurses.

Please be aware, that many ABMS specialty boards resisted for years the move to 10 year certification (I have confirmed this fact through multiple ABA directors including David Brown), and if you examine the latest program of the ABIM-“Continuous certification” as subscription product,  it is the clear ultimate goal to be enforced onto all physicians AND all boards. Remember, the ABA in 2010 openly published this document (at http://www.theaba.org/pdf/MOC_PQRS.pdf) indicating a lack of value=Quality/cost of such PQRS-MOC and clearly implicated ABMS lobbyists to Congress in getting this extortion scheme passed. This  will be costing every Non-MOC compliant physician 1.5% then 2% Gross receipts from CMS beginning in 2015.  This will not go unnoticed or without backlash.

Physicians are being confronted with the extortion realities of the ABMS programs on all fronts and have begun to openly oppose. I had avoided publishing in anesthesia prior to 2013, because of the past impositions of David Brown-but now that I have been freed of  his oversight, you will find this comprehensive expose’ in a non-ASA oversight international journal (see attached).  I have personally pioneered in Ohio the opposition to the MOL  attack by the FSMB in 2010 (http://www.jpands.org/vol17no4/kempen.pdf), and recognizing the similarity of extortion in ABMS MOC, this resistance has mushroomed into ABMS opposition as evident on many fronts and even at the last AMA meetings in Summer 2013.

If the ABA wishes to do the right thing, they would abandon time limited certifications completely and provide and compete on the open, level market with all CME programs, abandoning the ABMS extortionist policies and  the new proprietary “MOC points”. It is time to recognize the VERY limited use or need for the ABMS/ABA as overlords.  Opposition in other board is leading to reevaluation (i.e. OBGYN). We have the state medical boards and do not need replication of that legal entity and the costs by either the ABMS or the FSMB, as dozens of other oversight governmental and private agencies already are in place. Incompetency is not a relevant reality requiring MOC with a very low incidence at 0.05% (see http://www.jpands.org/vol17no3/kempen.pdf).  ABMS oversight further has no force of law. The repeated publication of pro-MOC opinion articles WHILE excluding all opposition in both the ASA newsletter and the Journal Anesthesiology, is a frankly apparent and failed approach to control media, in this age of internet, grassroots and “Arab spring” realities. We see >15,000 physicians signing anti MOC petitions in 5 weeks http://www.petitionbuzz.com/petitions/recallmoc


Backlash grows against MOC process

By: ALICIA AULT, Internal Medicine News Digital Network
Resistance against the American Board of Internal Medicine’s maintenance of certification process is growing, with an online petition to overturn the board’s most recent changes having collected more than 13,000 signatures at press time.

Also: http://medicaleconomics.modernmedicine.com/medical-economics/news/moc-online-petition-swells-more-10000-signatures

While just this month Anesthesiology published again after the January “educational” issue, such one-sided and unfounded opinion ( written solely by simulations center leadership) = “advertisement” for Simulation,  indicating the success of the program while feeling the need to advertise “this is not a test!. My contra opinion piece was rejected by Drs Eisenach and Giesecke, quite in spite of emphasizing data from ABMS sources:” The reported overwhelming support for MOCA simulation reported  is based upon the 2,700 simulation participants to date (including simulation instructors). This is actually a rather small number, indicating poor physician acceptance and lack of support of simulation and MOC, in our specialty. Ten year expiration dates were mandatory since 2000. The totals for time-limited dipomates reached 13,760 anesthesiologists certified between 2002-11. With over 43,000 currently actively practicing diplomats in the USA, 2,700 diplomats is an underwhelming number through 2014, given significant recertification pressures. (http://bit.ly/1hq7nNl)  The stated goal of the paper “to allay concerns and anxiety about the experience” attests to this less than blinding acceptance,  becoming undeclared and unpaid advertisement.”

Repeatedly, polls yield significant opposition to the regulatory capture of MOC. See www.Changeboardrecert.com , data below from SERMO and my personal blog for more information-information that cannot be contained any longer. You should fear legal reprisal given the confrontation with Sherman act, FTC regulation and the current lawsuit directed in federal court against the ABMS as central tyrant in this process of regulatory capture (http://www.aapsonline.org/AAPSvABMScomplaint.pdf ). Examine the facts. There is NO ABMS influence in Canada, England or all of Europe-while excellence in care and cheaper care is the rule! The “revalidation and MOC” there emulates AMA-CME PRA methods-not ABMS! Read my attached PDF. I would welcome an opportunity to speak to you, the ABA board and/or any group of practicing physicians to debate the “value” of extortion. Nobody wants this except corporate interests. Lifelong learning is a contemporary reality very much without the ABMS impositions.   NONE of the ABMS family have been willing to provide open debate to date. The ABMS may just become irrelevant under due and legal pressures. The ABA does have a chance to move in the right direction-back to time unlimited certifications for all. The ASA may actually recognize and under pressure abandon MOC and return to simple CME after all is said and done. See you at the latest, in New Orleans!


Paul Kempen, MD, PhD

—–Original Message—–
From: Thomas Mcloughlin
To: atkinsj; richoflynn
Sent: Tue, May 27, 2014 8:43 am
Subject: MOCA and “Grandfathered” or NTL Anesthesiologists


As the current and past PSA presidents, I wanted to reach out to you for your opinions.  I am the most recently elected Director of the ABA, beginning my first four year term last fall, and now sit on the MOCA committee of the ABA.

The committee chair (Deb Culley from Brigham and Women’s) has asked me to prepare some material for our consideration related to MOCA participation by “grandfathered” anesthesiologists (or, as we call them, NTL’s – standing for non-time-limited).  Of course, over time, this issue settles itself as only those certified after 2000 come to dominate our workforce.  But, in the meantime, I think the ABA wants to be sensitive to issues that may develop for our NTL’s as time marches forward.  For instance, do you see, or fear developing, any age or job discrimination issues for those in our specialty who are NTL’s?  Do you see, or fear, developing any issues related to malpractice risk or coverage (for instance, this could go either way – I have heard in some instances that insurers will discount fees for voluntary participation in MOCA; alternatively I have heard rumors that some insurers advise against participation because of the possibility that “failure” would become a searchable record)?

We are also very interested in MOCA, and it’s associated activities, becoming value-added for our diplomates.  As I’m sure you know, issuing time-limited certificates and now progressing to “maintenance” of certification, are not processes that our specialty can elect out of – they are core to participation in specialty-certified American medicine as overseen by the ABMS.  Yet, in the ABA we hope to adapt our methods for assessment and options for demonstration of lifelong learning and performance improvement into paths that most reasonable colleagues will view as contributory to their careers and their individual excellence.  What, if anything, can we do to have our NTL’s view MOCA this way in the interim that they are not required to participate by virtue of their lifelong initial certification?  What are the biggest barriers?  Would they participate even with lowered barriers (such as reduced cost, waive requirements seen as burdensome, etc), or will they decline to participate in any event?  Should we be concerned for our NTL’s, to my questions in the first paragraph, or are these concerns inflated?

I look forward to your feedback based on your interactions, and to any counsel.  Thank you,


Thomas M. McLoughlin, Jr., M.D.
Chair, Department of Anesthesiology
Lehigh Valley Health Network


Sermo Poll May 19, 2014      (specific responses/total replies=2211)
It’s generally agreed that physicians need to keep current with new information and diagnostic and treatment guidelines, but the MOC process has been widely criticized. What, specifically, makes the MOC process so onerous?
  • 64%
Too expensive1412/2211
  • 56%
Medical boards should focus on content, not revenue1233/2211
  • 54%
Too time-consuming1186/2211
  • 50%
Shouldn’t be tied with maintaining board certification1096/2211
  • 48%
Process too complicated1063/2211
  • 43%
Not relevant to my daily practice949/2211
  • 35%
I do my own self-study771/2211
  • 3%
Nothing, the MOC process works well75/2211

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