IN THE NEWS

BOARDED TO DEATH — WHY MAINTENANCE OF CERTIFICATION IS BAD FOR DOCTORS AND PATIENTS

http://www.nejm.org/doi/full/10.1056/NEJMp1407422

See the Wall Street coverage of MOC on 7/22/2014.

http://online.wsj.com/articles/doctors-upset-over-skill-reviews-1405985224

See the Washington Post coverage of recertification on 7/21/2014.

http://www.washingtonpost.com/national/health-science/docs-slam-recertification-rules-they-call-a-waste-of-time/2014/07/21/b566f186-10c5-11e4-ac56-773e54a65906_story.html

MOC: An examination of costs and impact to physicians

http://medicaleconomics.modernmedicine.com/medical-economics/news/moc-examination-costs-and-impact-physicians

2 comments

  1. NoMOC group: Note the fine, on target note from Callisto at Sermo this August 2014, excerpted below

    “The answer [to the practice of better medicine ?] … The answer is NOT in board certifications. This financial and time sucking scam must go. As must the ABMS as they have lost all credibility. The answer is to create condensed but more effective medical training, focusing on making sure ALL doctors know the basics for each specialty, then moving to more in depth clinical didactics. Always focusing on the human aspect of the interactions. A totally different way of learning medicine, which is much more correlated with what doctors actually do. There is a massive lack of core knowledge, while these boards teach ridiculous zebras and pharmaceutical pitches. And the patients, and public, know it.

    Medical education is SOOOO poor. And I think the untoward behavior conducted by MANY doctors resides in their deep seated insecurity. They THINK they know but are not sure. THAT is an aspect of our training, which is universal. ” — Callisto.

    I added that it is ironic that much of the trivia, new unproven drugs, products, and devices promoted by the high-revenue MOC testing industry on recertification tests would not be allowed and considered too expensive by our hospital C-suite executives and CEOs. The MOC test answers are and would not be allowed by ACO managers, insurers, and other health care institutions. Yet these very same hospital C-suite managers insist that all physician scholars and hospital staff physicians complete these costly MOC programs or face termination of hospital privileges! Practicing hospital doctors are pulled two opposite directions. An experienced, competent hospital staff doctor these days must give one set of medical responses to the financial interests of the American specialty boards including ABIM. Yet the same doctor needs to follow a separate, frequently very different standard for their hospitals and ACOs, or risk also losing hospital privileges due to economic constraints. Patients will receive targeted, cost effective care only when a complete moratorium or cessation of today’s MOC programs occurs AND health regulators restore and honor the physician-patient relationship. Just as Sir William Osler had warned: not to let outside entities interfere with any physician and his patient, lest your patient lose trust in you and medical science.

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  2. State Of Medicine in USA, ABIM and MOC:

    There has been extensive debate regarding new MOC requirements imposed by ABIM, which was supposed to be a voluntary organization created in 1936 by physicians to help them to promote/advertise but it has become lately an influential giant organization out of control. It is not an educational or licensing body but this organization is turning to be so powerful that it is trying to convert itself from a voluntary advertizing organization to a giant regulatory organization. ABIM was and is still being fed by physicians, who work hard, day and night to meet their ends meet. Physicians have been sweating their money and time to keep it alive. Instead of helping physicians ABIM is asking us to give her more money so that it can impose more requirements and thus get more money. We are threatened to have our names put on its web site as “not being certified or not maintaining the MOC requirements” if we do not do their modules and sit in their written exams. It is even pressuring congress and insurance companies to make it mandatory for all physicians. ABIM seems to be tightly knit with self credentialed patient safety/ medical quality industry developed here in United states. Authors of questionable studies which support MOC emerge either from this organization or are former ABIM affiliated members. Their data is not only flawed but is also published with no randomized trials conducted.
    Physicians can not just become competent by reading and giving exams (answering 50 or 100 questions). If this was the case then there would not have been residency training programs for 3, 4 and even five years, along with fellowship training for subspecialists.
    Physicians training never ends, it is an ongoing continuous evolving process. We interact with patients both in our private practice and in hospitals. In complex situations, we interact with our specialist colleagues to diagnose and solve patients problems, no matter how complex they may be.
    What authority does ABIM has to put our names as “not being certified or not meeting MOC requirement”. Why we should give more and more of our hard earned money to ABIM so that their secretaries and officers can enjoy high salaries, free trips and vacations..
    I just do not understand that how any board member or any other insurance company or hospital organization conclude that by seeing patients in a clinical practice or hospital is not a learning experience. In medical practice, each patient is different and complex and poses a variety of challenges which we have to understand and solve, either by ourselves or sometimes with the help of our other specialist colleague/colleagues. If this is not a learning and qualifying experience then nothing else will.
    Many of us have already gone through the process of certification and recertification. More exams does not and will not make us to be good clinicians but it is the continuation of medical education. CME will enhance our cutting edge knowledge and sharpen our clinical and practical acumen and skills.
    MOC focuses on established knowledge, while CME can include future and cutting edge innovations that keeps the physician on cutting edge. CME offerings are highly competitive and provide choice where as ABIM has monopoly on MOC (Paul Teirstein, MD. Debate in Feb 2015 on maintenance of MOC).
    I see no reason here for ABIM or other certifying body to impose more time and money consuming requirements, which have been proven to be of no beneficial value to physicians as for as their qualification/quality is concerned. It will certainly harm the care of patients as it will keep them away from their physicians for weeks or even months sometimes.
    Recent study done by Dr Sandhu and colleagues have shown that cumulatively 2015 MOC will cost $ 5.7 billion over 10 years, this includes $ 5.1 billion in time costs and $ 561 million in testing costs (Annals of Int Medicine, July 2015).
    Dr John Hayes and his colleagues did study in VA medical center, comparing care provided by Time limited board certified internists and Time unlimited board certified internists. Conclusion was that there is no difference in the 10 primary care performance cares (JAMA 2014).
    Medicine has changed quite a bit in recent years and will keep on changing in the coming years, it is an evolving process. Recertification and MOC requirements can certainly enhance the revenue of ABIM but it will not enhance the quality of patient care. On other hand, it will certainly decrease the revenue and put an undue burden on working physicians. It will keep physicians away from their patients and more so physicians may ultimately lose interest in this noble medical profession. No where in the world are physicians under pressure as we are here in USA. Overhead of physicians running medical practice has gone up and keep on increasing as there are more and more unnecessary requirements from various insurance companies including medicare and medicaid either in the name of quality or their shrinking budget. Easier way for them is to cut reimbursement to physicians.
    Recertification and MOCs is a product of USA and is money making machine for ABIM. No where in the world is recertification required. Just take an example of Europe, they have high quality of care and people have longer lifespan than people in USA. Their model for disease management is better than us. This is a true comparison data.
    Sermo survey shows 97% of physicians are against MOC. When ABIM and its affiliates were not successful in changing physicians minds they went to insurance and government agencies to make this mandatory. Government agencies were already looking to further reduce reimbursement to physicians. They tried SGR (Medicare Sustainable Growth Formula) for 17 years (1997-2015) and failed and now they are collaborating with agencies like ABIM, and making mandatory for physicians to do their monopolized version of MOCs. Failure to do MOCs will result in penalty, 2% reduction in the reimbursement to providers in the name of PQRS(physician quality reporting system).
    The main source of revenue of ABIM is from the fees they incur on physicians. Physicians are money generators but not stakeholders. Physicians and their patients do not get any benefit from it. ABIM staff and its board members salaries and compensation and operational expenses of ABIM organization depend on the revenue generated from physicians. More the revenue they generate, bigger the bonuses and raises they distribute. ABIM is a non profit organization so it has to spend all the money they collect from physicians or their other sister organizations.
    In a recent filing to IRS, ABIM spent $ 30 million compensation to 250 employees in 2013. They will spend more in 2015 and on. Why ABIM needs so many employees and why so much wastage of physicians money. Does ABIM realize that physicians not only pay for their salaries but they also have to bear the costs of travelling to exam centers, pay for hotels, pay for taking prep courses, and the time loss when they are not seeing patients during this time and more so inconvenience to patients as they do not see their physicians for days, weeks and sometimes months.

    ABIM should not be the regulatory authority, it should not be allowed to set the bar. In Fact, physicians should set the rules for ABIM as it thrives on their money. Physicians do not get benefit from ABIM, nor are they answerable to ABIM. The Physicians are answerable only to their patients and are also responsible for their quality care not the ABIM. Physicians are at the forefront not the ABIM. ABIM is just another advertising agency. It has colluded with the government agencies to cut the reimbursement and penalize the physicians in the name of quality and is forcing us to do their MOCs. This was put into the Law in 2015, which was just signed by President Obama.
    Let us (we physicians) raise our voice and be heard now, otherwise we along with our future generation physicians will be silent for ever or for a long time to come. We need to ignore ABIM and its sister organizations as they have done to us for many years now. We need to take our case straight to people and our patients and hospitals. We need to change our strategies. We are morally and ethically obliged to protect our profession and our patients.

    Dr G.M. Shaikh, M.D, MHS-CLP.

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