Viewpoint of Abandoning MOC Deserves Discussion & Publication

Paul Kempen, MD, PhD writes Howard Bauchner, Editor-in-Chief JAMA

Dear Dr Bauchner,

While you have taken great care to include various viewpoints on ways to perform MOC, you have never allowed a viewpoint that argues for abandoning MOC entirely. Instead, you use Tierstein and Topol’s work as an “opposing view” on MOC when, in fact, it is another permutation of the same concept-only industrial competition has invited this view. Therefore, I respectfully ask you to consider publishing a perspective piece (“viewpoint”) that makes a case for abandoning the “MOC” program entirely in lieu of a more conventional CME model. I would also emphasize the difference Between MOC and CME is that CME is self-directed and MOC is centrally-directed — hence, a VERY different concept that has large patient care ramifications (and not to mention the recently documented by the very salesmen of this product (ABIM/ABMS, Etc) to have been a mistake).

Finally, your comment “In addition, JAMA is the only major journal to publish two papers indicating that MOC had no effect on clinically meaningful outcomes”, fails to recognize the fact that one of these articles was directly from ABIM employees (past and present) and concluded that financial benefits were noted by the same article: “but was associated with a cohort difference in the annual, per-beneficiary cost growth of −$167 (95%CI, −$270.5 to −$63.5; P = .002; 2.5% of overall mean cost).” I am sure this was the real goal of this paper, regarding submission and publication.

I would categorically state that virtually EVERY publication of the ABIM/ABMS and FSMB which documented retrospective, purposive and/or used multiple layers of statistical (proprensity testing) hyperbole to formulate “associations”, etc, WHEN given critical examination, also equally document that “MOC had no effect on clinically meaningful outcomes “ in spite of the continued projection that some spurious positive effect was explained as existing in the many “discussion and conclusions” from the ABMS.

Have you ever read the following ABMS attempt at meta analysis to prove certification matters? It failed miserably and only after decades of ABMS/ABIM trying to do so:

Sharp LK, Bashook PG, Lipsky MS, Horowitz SD, Miller SH. Specialty board certification and clinical outcomes: the missing link. Acad Med 2002; 77: 534–42.

I have submitted per your suggestion a letter regarding the regulatory capture of medicine by the 501 c organizations and would also categorically challenge you to provide me with a reference of ANY JAMA article to date specifically discussing Regulatory Capture in any way. I personally introduced this longstanding recognized political/economic concept into the medical jargon and look forward to seeing JAMA recognize this phenomenon by actually publishing the words in this journal.

Thanks again,

Paul Kempen, MD PhD

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