Earlier this month (December 2014) ABIM President and CEO Richard Baron, MD took the stage to defend MOC before a group of PA physicians overwhelmingly opposed to MOC in a debate hosted by the Pennsylania Medical Society. (Note: PAMED has taken a strong stand against mandatory MOC.) PAMED has made a video of the debate available so you can see what you missed:
Dr. Paul Kempen writes in with an expose on the latest self-serving “research” from the ABIM:
In spite of three main authors writing this we also read this nonsense-this is a paid ad for the ABIM brand of attestation which incidentally was used as the “standard.” Time to write some letters!
Study concept and design: Gray, Gao,McCullough, Lipner.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Gray, Vandergrift, McCullough, Lipner.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Gray, Vandergrift, McCullough, Lipner.
Administrative, technical, or material support: Vandergrift, Gao, Lipner.
Study supervision: Gray, Lipner.
Conflict of Interest Disclosures: Drs Gray and Lipner and Mr Vandergrift are
paid employees at the American Board of Internal Medicine.
Funding/Support: The American Board of Internal Medicine provided financial
and material support for this study. This study was partially supported by
National Science Foundation Career Award 1254021 (Dr Gao).
Role of the Funder/Sponsor: The American Board of Internal Medicine had no
role in the design and conduct of the study; collection, management, analysis,
and interpretation of the data; preparation, review, or approval of the
manuscript; and decision to submit the manuscript for publication.
Dr. Chip writes:
SO, AOA shows us the government line and entirely leaves out the opposition. Situation normal.
Without taking a side please look at the details of the other view which is in fact looking at the risk versus benefit issues that physicians have to look into, discuss intelligently and then resolve with patient input as to what they, the patients, are planning, from which to risk in order to take benefit.
This is the physician in the trenches issue that government, MOC, MOL, OCC, FSMB, ABIM and IOM continues to ignore.
I know you received my prior and recent email and have not heard from you since. This was evident in your concerns that your “secret” communication was disseminated. Please realize the open nature of the internet and ability to find data there!
As an ABA diplomate, currently listed as “moc compliant”-what a joke, and member of the ASA and licensed physician anesthesiologist in PA, I find it UN-collegial of you to fail to respond to my previous email. Think it is time to really sit down and discuss the problems facing the ABA as a member of the ABMS. Your non-response clearly indicates your inability to discuss openly the real issues of extortion propagated by the ABMS. NO wonder, with the imposing leadership and financial obligations your new position imposes. YOu could make THE difference,but we both know you never would have gotten the job if you had a moral backbone. We both also recognize that the ABA NEVER wanted to go down the road of MOC or time limited certification, but I guess you and the leadership Have seen the Light and it = $$$$$$$$.
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.
Dear Dr. Baron,
On the one hand, little further clarification is needed, as the ABIM has seen fit to bombard me and all other diplomats with a tidal wave of informational emails (as well as similar info via the US mail). On the other hand, the current requirements of MOC are so convoluted that in all likelihood, no amount of informational messages could ever clarify what is inherently indecipherable.
writes Washington State physician Ken Lee, MD:
The latest campaign by the ABIM against Internists is using lay people to criticize and judge “board certified” MDs by adding lay people to the board member ship of the ABIM. So a high school dropout with dementia can be an ABIM board member and judge working MD’s honestly. It appears this Baron of ABIM has been reading Maoist history. During the dark ages of the cultural revolution in China from the mid 1960 to 1970, the Communist Party there decided to destroy intellects as society enemies; trained doctors were made to clean toilets while high school students learned how to be doctors by trial and error on people! The ABIM is trying to destroy us in a similar fashion which increases their power, just like Mao who destroyed the educated class to ensure his total power. Seem similar?
from Dr. Howard Mandel:
I find these comments on this thread quite interesting—-Marilyn as a regulator and as a lawyer, are you advising that all lawyers retake the Bar exam every year or two? If not are you advising that the federal government mandate that lawyers take a national certification or recertification exam? How about architects, engineers, nurses and other professionals? Every time testing goes on there is a pro and a con, a cost and a benefit——where does the money come from to pay for this? If there were proven benefit, we all could have a different discussion, but there is no scientifically proven benefit—-only cost. Lawyers are trained to argue based on law and interpretation of the law; doctors argue based on scientific fact. Doctors opine based on scientific fact, pros and cons, risks and benefits. MOC has never been proven to be beneficial but it does have real costs. Some of those costs are non economic and are harmful to the medical profession. There are decreased attendance to educational meetings that are more relevant to those individuals practice, there is decreased comradery and decreased time for physicians to read/study articles that apply to their specific patient populations. America has a very diverse population—-one size does not fit all. Do you think that all women should only buy a size “4″ pair of jeans? All men drive the same kind of car? Nobody should be uncivil. The tone that we all pick up from the thread is obviously one of anger and frustration. As a lawyer and defender of peoples rights, I can not figure out why you would defend MOC. It is a one size fits all program that has never been proven to improve the quality of care. It takes away individual freedom of physicians who have sought varied approved ways to keep current and it is weakening the profession of medicine by destroying other long proven quality CME programs and meetings.
(name of physician and ABIM administrator omitted)
Dear Dr. ?????,
Thank you for your inquiry about the governance of the American Board of Internal Medicine (ABIM). As you may know, ABIM is not a membership society, but a physician-led, non-profit, independent evaluation organization. ABIM diplomates do not pay “membership dues”; the fees paid to ABIM are for participation in our Certification and Maintenance of Certification programs.
However, like most standard-setting organizations, ABIM has its roots in membership organizations. ABIM was created in 1936 by a joint action of the American College of Physicians and the American Medical Association. The founders intentionally incorporated an independent organization to shield themselves from the pressure of dues-paying members and instead established a governance structure that relies on experts in the field to set standards for the profession in the best interest of the public. In fact “of the profession, for the public” continues to be the touchstone for ABIM governance decision-making. Sometimes tension develops between the standard setters and the members of their antecedent membership organizations. However, a well-functioning certifying board needs to be insulated without being insular, listening carefully to those who seek to meet our standard yet remaining independent and evidence-based in the standards and processes we set.
All of ABIM’s standards, policies, programs and products are developed by internists. ABIM’s governance is composed of distinguished physician experts with records of achievement in diverse health care settings, whom ABIM seeks out through open calls for nominations and outreach via a variety of channels, including professional societies.
The purpose of board certification is to offer a credential that distinguishes in a publicly recognizable way those physicians who have met a standard set by their peers from those who do not or choose not to. ABIM’s accountability is both to the public and to the profession of medicine. All diplomates are encouraged to provide us with feedback to help enhance our policies, products and programs. We regularly solicit diplomate feedback through surveys and focus groups, and many enhancements implemented or in development have been a direct result of diplomate feedback. To further enhance the relevance of our assessments, we have recently convened the Assessment 2020 Task Force, which includes a broad array of experts from both inside and outside the profession of medicine. This task force is directly seeking input from our diplomates and other members of the public about what skills a physician needs now and will need in the future. We encourage internist feedback via the Assessment 2020 website and the Assessment 2020 blog.
I hope this information helps. If you need further assistance, you may reply to this e-mail or call us at 1-(800)-441-ABIM (2246) Monday through Friday, 8:30 a.m. to 8:00 p.m., and Saturday, 9:00 a.m. to 12:00 p.m. EST.
Paul Kempen, MD, PhD comments on Medical Economics article, “MOC changes aim to lessen burden on physicians, but debate continues” :
I continue to be astounded that the ABIM refuses to openly debate the topic in an open forum. The Benjamin Rush Society invited the ABIM and ABMS to debate MOC in their home town of Philadelphia last April-they failed to come (http://www.youtube.com/watch?v=AetMD0OYVkY). The ABIM does NOT want to debate the issues openly in a neutral forum because the whole extortion process is unwanted by physicians in General, and it provides no index of quality. The ABIM and ABMS are trying to introduce these changes under the radar through the gradual program of lobby congress and hide from Open discussion. MOC is simply a money making extortion program self-serving to the certification industry. The ABIM itself concluded as early as 1986 and themselves published in 2000 the fact that voluntary MOC would not be possible (ANN INT MED 2000; 133:202-08 . THAT is why they imposed it with artificially restricting the certification to 10 then 8 and now to Continuous subscriptions to MOC to maintain a certificate that they themselves deem to be “VOLUNTARY”.