Guest Post from Dr. Chip Smutny
Physician history has been to turn away from that which we don’t like and leave it alone. That brought us to where we are today.
That has to change now if we are to survive.
The way the government works in 2015 is by money first, period. We need to address that as a group. We might call this government now a Democratic Republic run by lobbyists, not voters.
Our organizations that continue to consume our money, do nothing for us on the matters we bring to the floor for them to consider and act upon while they hide their inaction, indecision and failures to respond to membership in rules of order, allowing themselves to avoid dealing with the difficult challenges or “failing” because they succumb to other outside money that we don’t get to see. (Transparency and responsibility to the membership)
AAPS could become a centralized source for our lobby efforts and for bringing dollars in to that effect but the next big issue is to actually discredit MOC etc in its ability to assure anything other than income to the purveyors of the misguided construct.
In this case, can we show that MOC does not secure telemedicine, does not maintain professional standards or interstate security of physician quality.
Bringing technology into practice is always going to be something that can help those who get access to it IF IT IS USED PROPERLY AND HANDLED BY THE PEOPLE WHO CAN BEST INTERPRET THE DATA EFFICIENTLY AND ACCURATELY. That would be us, not tehcnicians, not physician extenders except in emergency situations.
In as much, there will be a receiving physician somewhere that should be supervising the delivery of care AFTER re-evaluating the patient and BEFORE delivering a treatment so long as the treatment is not absolutely necessary in the field (i.e. emergency medicine). Most of the discussions and proposals I have seen do not discuss this at all.
We are the standard. The tests and study modules created so far are attempting to assess a very difficult measure, human functionality, which can currently, only be assessed by another human being through an interactive process that requires expertise to deliver and assess at the same level of the standard. Professionals must be actively involved in the evaluative/interactive process. We have seen and shown that this is well addressed in the old style CME process and that assessment within these forums can be used to determine concept transfer easily with post CME quizzes and the like. How that information gets used has to many variables to assess or evaluate other than successful outcomes of patient care. Even that assessment is fraught with places for accuracy and interpretation error, EHR, national data bases and patient satisfaction not withstanding.
We need to show MOC statistically as fallacious thinking and erroneous assumptions in black and white, we need to show that it is cost futile in comparison to its projected savings and safety. We then must lobby that into legislation against MOC etc as it is currently being considered voluntary or otherwise. We need to show that it is cost futile in comparison to its projected savings and safety. We need to show that CME serves all these purposes well already and cost effectively.
We need to demand that they do prospective studies that can be confirmed by third party evaluations without internal bias that the expenses they are expecting are providing what they claim, before they get a shot at changing the laws for their financial gain.
Sadly the only group that can make this happen is us and our history is against us. We have buried our heads in the sand for far to long (present company excluded of course) but need to motivate even the most remote of physician providers to take this up and work toward its resolution.
AAPS is an established organization that could do this. The new certifying board (Dr. Teirstein NBPAS.org) might also be a consideration even though it is brand new and does not yet extend certification to all physicians and surgeons in all specialties.
Perhaps the two organizations could work together to make this happen.
I would be willing to help make this happen and perhaps might be able to qualify as an “Academic Physician” since I have spent many years on staff at an Osteopathic School, served on many national organizational committees and research groups and also happen to have significant private practice experience in FP, Neurology, Cardiology and Neuro-musculoskeletal medicine (NMM). I also built and ran an NMM residency program for a few years and assisted in the development and delivery of an FP residency program which integrated NMM education to all its FP residents.
We have organizations that seem ready to help, we need investment of time and money on the part of independent physicians, we need a place to collect and manage that money and time wisely and we need to generate research data that definitively puts MOC in question or preferably in defeat.
There are member of this group that have seen this and discussed this already but now it is even clearer that many of us are the ones who need to initiate this. Can we get AAPS and/or NBPAS to take on this mantle and serve as a center for this construct? can we then get this group to begin to brainstorm the research initiative and begin to collect data for the purpose of publication against MOC etc. and finally can we get buy in from the remote sectors of our community to support our efforts?
It seems simple enough in construct but it is not actions that we have ever been able to support in the past.
The new physicians are being trained to be corporate medicine puppets on the way out the door of their programs. They don’t know what they are missing, we do.
It is up to us.
Is anyone listening, is anyone ready to take this on, do we have enough intestinal fortitude to carry this through?
I still believe in truth, justice and our old American Way that is being sold down the river. I am also willing to fight for that set of rights including our rights to practice with the full expertise that we have, to our patient benefit, without third party intervention in the physician patient relationship.
What say you?