Guest Post from Howard C. Mandel, MD
On February 10, 2012 Medical Economics published my letter: Why don’t lawyers have to be recertified?
As an obstetrician/gynecologist who finished my residency in 1985, I earned a 10-year certificate when taking my boards. If I had graduated in 1984, I would have been certified for life. The American Board of Obstetrics and Gynecology (ABOG) requires a two-part exam. The first part is written, and the second is a 3-hour oral examination, part of which is based on the entire list of all the physician’s hospitalized patients plus representative outpatient visits. I passed and was recertified 10 years later. In 2001, my specialty board modified the certificate to be valid for 6 years.
In 2008, it changed the rules again to require a yearly exam, plus a secure exam. In December 2013 in a letter to ABOG and then in March 2015 in Contemporary OB/GYN, I asked ABOG to reconsider. Now, seeing the bad press that the ABIM has had including several articles in Newsweek, with the ABIM retreating and Dr. Paul Teirstein creating the NBPAS, ABOG is backtracking a tiny little bit. But living in their Ivory Tower far from all us truly practicing physicians they have missed the point: Why do doctors have to be recertified and maintain certification, but lawyers and accountants do not?
Clearly, MOC has evolved into a costly burden to physicians, patients, and healthcare. The boards and their MOC program have become a profiteering juggernaut without any reasonable proof of benefit, efficacy, or patient protection, and compliance is slowly being tied to the privilege of practicing medicine. 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. Currently, more than 50% of the counties in America do not have one obstetrician who can deliver a baby. For several years, I have predicted that MOC and other external rules and regulations will worsen this public health travesty and unfortunately they have.
Perhaps the lawyers and accountants or the million dollar salaried executives of ABOG who only have to pass one exam in their lifetimes can fill the void. We are the only profession that has to do this. Architects don’t and our buildings aren’t falling down. Engineers don’t and our bridges aren’t falling down nor our airplanes falling out of the sky. Lawyers, well lawyers only pass the Bar once and our courthouses seem to function. CPAs once. Nurses once. Every doctor has to get relicensed and reprivileged every year or two. We are regularly peer reviewed and for the most part, the overwhelming majority of doctors perform very well. MOC does not improve quality.
Why should I read what ABOG tells me to? I should read, study and learn what will be in the best benefit of my patients. My obligation is to my patients not some “average or typical” person that ABOG believes is my patient. My patient population’s demographic is far different than the average American women—-medicine is not “one sized fits all”. It should never be. Learning should not be as well. Now with NBPAS every doctor can just say no to MOC.
Wake up ABOG, you are tearing the House of Medicine apart. Every OB/GYN in America should save money, save time and study for their CME what will truly improve their patient care and outcomes. Join me and abandon ABOG and join NBPAS.
HOWARD C. MANDEL, MD FACOG