For the past seven years, I have devoted a significant amount of my time to investigating and telling the true story of US physician “board certification.” That story has been one of deceit, private back-room deals, profiteering, and (worst of all in my humble opinion), the exploitation of working physicians and the patients for whom they care.
This writing has not come without its personal and professional costs, but when the story is one that affects the corruption of the largest single contributor to the US economy, what else should I have expected?
As I reflect on what this side job has exposed, it would be naive and dishonest to suggest that physicians are exempt from bearing some responsibility for rising healthcare costs in America. But it may go much further than that: our medical profession and its hallowed physician education regulatory system comprised of the unchecked Accreditation Council for Graduate Medical Education (ACGME) might be the very reason things were allowed to become so out of control. Our non-profit tax laws with their opaque reporting requirements have allowed huge “non-profits” to go unchecked in America – and most of those “non-profits” are in healthcare. (Just take a stroll by the American Medical Association (AMA) building in downtown Chicago sometime to get a feel for the magnitude of the problem.)
Why should the physician education and credentialing systems in America be exempt from such corruption?
Well, they are not.
From the earliest reports of a multi-million dollar condominium purchase by the same non-profit organization that created the “Choosing Wisely®” campaign to promote health care cost savings, the hypocrisy of US board certification was laid bare.
As a physician educator practicing in the ICU/hospital environment for >15 years, I have noted a steady decline in the average resident’s knowledge base, clinical skill and efficiency, bedside manner and overall motivation. I am a harsh critic with extremely high standards, though I’ve supervised and been responsible for student/resident/fellow ICU rotations from an educational standpoint throughout. The vast majority of my colleagues throughout the nation have supported this observation. More telling, daily report from the ICU nurses has chronicled a perennial erosion of their confidence in housestaff!
If true, this poorly documented but worrisome phenomenon combined with the anecdotal, but near universal, acceptance of increasing complexity and acuity of hospitalized patients is a prescription for failure. Explanations are numerous and pervasive.
1) The public regard and economic rewards classically afforded physicians have dwindled dramatically. While this may select for a less gifted cohort entering our medical schools, I believe the effect on the finished “product” far exceeds any deterioration in raw materials. Our new medical students and young physicians are still gifted. Continue reading →
Just when did AOAs dues paying osteopathic physician membership and societies get to feedback alternative ideas and weigh in on OGME funding options as you stated in your Med Ec interview below? Not at all. The AOA trustees unilaterally make the decision some time ago. Many DOs and many component specialty societies like AOCD were dead set against the ACGME takeover, or, at least wanting defined terms and conditions set like ACOFP, otherwise bail out. Never did the AOA solicit member opinions or allow input, let alone dissent against the preset policy OGME sellout to ACGME takeover. AOA top-down propaganda are not grass-roots fact. Has the AOA administration learned nothing from the failed AMA takeover in California in 1960?
We’re being forceably strapped into AOA’s leftist liberal agenda “moving forward” off the government debt cliff, like the current US administration. No, thank you. As a private practice DO and AOA member for 20 years, I protest. And if you think I’m the only one… You will see.
After twenty years of increasing AOA corporatization and weak physician leadership, now is your chance at the helm. Steer our 140 year old brave physician profession into independence and freedom for the betterment of the patient-physicians relationship, away from government, hospital health system and special interest dependence. The choice is yours. We are all making ours.
Best wishes for good health,
Craig M. Wax, DO
Family physician, Editorial Board of Medical Economics
Host of Your Health Matters
Rowan Radio 89.7 WGLS FM http://wgls.rowan.edu/?feed=YOUR_HEALTH_MATTERS
Independent Physicians For Patient independence @IP4PI
Dr. Gina Reghetti responds to the events at last week’s AOA House of Delegates meeting in Chicago where the HOD approved the GME merger and brazenly blocked a resolution in opposition to OCC/MOL.
They are cowards. They all go with the flow in fear of consequences that would threaten their medical licenses. What good is it being a doctor when non-doctor providers practice medicine and are not bound by the same laws as doctors? We aren’t permitted to do anything anymore due to government and insurance regulations, and now the powers are fighting to take away self-pay for medical services.
One cry from several peers on the floor of the HOD at AOA this week was where was the support from within. People were afraid to stand up for their rights because they “get silenced while speaking, cut off by chairs that use Robert’s Rules to funnel dissent to the sidelines indefinitely or terminate discussions so that members are not permitted to explore the issues more fully”. Once their opposition has been registered ” They are often not invited back to sit as delegates.” In that environment compromise is not an option.
In order to have an organized mechanism we need to make a space available where people can speak freely and not have their opinions subject to scrutiny by their national organizations. “There are multiple examples of our professional organizations actually working toward academic censure over the past 20 years with individuals who speak out against current policy.”
The newest JAOA is below with two articles supporting the ACGME takeover of OGME. There seemed to be no article on or credence paid to the work of Dr. Norman Gevitz and his well researched, valid & logical argument that the ACGME takeover would sell out and dismantle the DO profession and its schools.
This summer new doctors will start their residency training in a host of hospitals across Arizona and across this great nation. These new doctors are entering medicine at a time when uncertainty about the future of medical practice is at an all-time high. Much of this is a result of the Affordable Care Act, yet other uncertainties remain; including ambiguities about the future of the very funding that supports residency training.
As Congress looks to curtail out of control government spending and rising deficits, one expenditure that has repeatedly drawn interest is funding for Graduate Medical Education (GME). The Super Committee, the Simpson-Bowles Commission, and the Medicare Payment Advisory Commission have all paid particular attention to this funding that supports the mandated training doctors must complete at regular intervals in the years after graduation from medical school. While budgets must be tightened, cuts to GME would endanger patients.
Dr. Gina Reghetti asks American Osteopathic Board of Family Physicians Executive Director Ms. Carol Thoma, MBA for a reply to her previous letter dated May 21.
June 29th, 2014
RE: Certified Article # 7012-3050-0000-2628-9885
Dear Ms. Thoma:
To date, I have not received a response back from the letter that I initially sent in May via email, and certified mail. It was signed for by S. Burnett on May 27th, 2014. We are nearing July. I would like answers to my many concerns. I would appreciate it very much if you would make this priority or forward it to someone that can answer my concerns.
Osteopathic physicians: it is critical for you to send a similar letter to your state society TODAY!
NYSOMS Board Members and House of Delegate Members,
I would share with you and especially the house of delegates members, the seriousness of the path that the AOA has taken in its several components of restructuring our profession and representing not only those who are members but all Osteopathic physicians, without seeking the opinions of the whole of the profession. As we have seen in the past several years they are moving closer to making massive changes in our way of education, training, post graduate educations and practice that may be irreversible without great expense and may spell disaster for our profession.
Thanks for the update. That was one thing that John Crosby did well. He initiated and sent out the daily AOA update email. This is something sadly missing now.
At any rate, the ACGME/OGME merger will produce many unintended consequences. I’m sure you’ve already read the position paper by Norman Gevitz PhD on how the unintended consequence of the merger will result in the destruction of the Osteopathic education system and it schools, and the profession with it. I am in agreement with Dr. Gevitz and I am very concerned for the survival of the osteopathic profession, schools and training programs. It seems to me this merger comes down from the top leadership not grassroots up from the bottom membership. At the AROC conference, the merger idea was presented as a done deal or fait accompli; not a flexible idea subject to change. There are other ideas to fund and maintain Osteopathic based OGME residency slots. Further, it seems like the plan would go in lockstep with the governments plan for OCC MOC leaving to MOL and the government controlled practice of medicine. You can bet your bottom dollar that this would not include Osteopathic anything.