Mainstream media highlights the MOC debate: What did they get wrong?

Recently, the American Board of Medical Specialties’ (ABMS) Maintenance of Certification (MOC) program debate reached a larger mainstream media audience when the Wall Street Journal published their article by Melissa Beck entitled “Skill Reviews Upset Doctors.”

While it is certainly nice to see an article reaching the main stream media concerning doctors’ concerns with the MOC program, the issue with the MOC debate is not that doctors are upset.  The real issue is that doctors have been enslaved by special interests and crony capitalism to complete a MOC process that robs patients of more time with their doctors so that regulators and payers can enrich themselves.

One only has to see how certain aspects of the Journal article were highlighted to see how Ms. Beck framed the debate toward business interests.  For instance, she quoted Ms. Lois Nora, president of American Board of Medial Specialties who said: “Many practicing physicians have not had formal courses in patient safety or quality improvment.”

I wonder if Ms. Beck or Ms. Nora have ever heard of the Hippocratic Oath? Doctors spend their entire careers (not to mention many sleepless nights) worrying about their patients’ safety and care. Their livelihoods depend on it!

Yet there is never a moment of serious reflection regarding the sweeping hubris of Ms. Nora’s statement. As spokesperson for the American Board of Medical Specialties, Ms. Nora suggests that without oversight, doctors are lax, uninterested in research or updating their techniques, inattendant to patient safety and unwilling to update their skills.  Instead, the ABMS welcomes the tripling of patient volumes, the cameo roles that doctors are increasingly asked to play in patient care, the refocusing of one third to one half of every patient visit staring into an electronic medical record so the ABMS can watch for flinches in quality of care.  The overseer who allowed this untenable health care scenario to transpire is effectively positioning themselves to patients that they are their last best hope.

Ms. Beck’s piece also ignored the existing CME requirements that physicians already must perform each year to remain licensed and the value of such truly voluntary learning.  Instead, Ms. Beck chose to highlight a quote from Richard Armstrong, MD — a board certified surgeon clearly without formal media training — who said:  “No one wants to come out and say we’re against quality, but most physicians find these modules to be cumbersome and, frankly, a joke.”

When doctors are quoted calling any quality process “a joke,” it really doesn’t matter what the doctor actually said, for few will take him seriously.  Let’s be clear: The MOC process is not a joke, it’s more like the twisted controlling strategy of the Hunger Games.

Ms. Beck also ignored that some MOC requirements now involve enrolling patients into study groups without their consent, doing the study and then reporting the data back to the boards. According to one doctor, “There are nearly 400 research projects being done on children through part 4 of the ABMS MOC program. Not only is performing research on children without consent immoral, it is costly in both time and money for the patient.”  Isn’t this consideration important for patients?

Finally, Ms. Beck’s article ends with the ABMS’s claim that “500,000 of the more than 800,000 board-certified physicians have enrolled in MOC programs to date” implying that the majority of doctors support the program.  Yet this statistic completely ignores the fact that doctors had no choice but to sign up for MOC despite their better judgement. As Ms. Beck hesitantly acknowledges in her article, this unproven physician metric is now increasingly tied to measures of physician “quality,” hospital privileges, legal standing in court, and insurance panels.  This unproven MOC program that was created by a self-appointed, private organization that is completely unaccountable to the public has also been indelibly etched into our new health care law.

No, it’s better not to mention these unethical and extortionary tactics by the ABMS that threaten patient care.

Instead, it’s far better to call doctors “upset.”

Wes Fisher is a cardiologist who blogs at Dr. Wes.

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  • Dr. Drake Ramoray

    I am on vacation and have limited internet acess (the best kind of vacation) but only an MOC article will bring me out of hiding. This article is very true and accurate. The big picture is that the ABIM has needed to come out with a public statement, and that public statement is necessar because on July 15, 2014 representatives of 25 internal medicine specialties and societies met with Dr. David Johnson (ABIM Chair) to discuss issues with the current MoC process.

    I received a letter from AACE with regards to this episode that I can’t find a way to link here (I am on vacation after all) that stated amongst other things. “The meeting was civil and all attending speakers expressed a commitment to lifelong learning. But the message from the societies was consistent and clear:”

    In summary:

    - ABIM needs to become more responsive to physicians

    - the “every ten year recertification exam was particularly singled out for criticism.”

    - “The economic and human cost of MoC and its potential effectons on the under already under-subsrbied endocrine work force was also stressed.”

    - “The lack of any proper scientific underpinnings of MOC recertification methodology was lamented by many speakers.”

    The ABIM is meeting this week to discuss the issues discussed at the above July meeting. If this article in the WSJ (I need a subscription to read the whole thing) is any indication it appears the ABIM will just dig in it’s heals for the money making shakedown that is board certification and MoC.

    To the other docs out there. Join the AAPS. Stop paying dues to the AMA and ACP. And work with your specialty group if they represent your actual interests
    .

    AACE has laid the preliminary ground work for their own certifcation process.

    https://www.aace.com/files/views/lifelong-learning-moc.pdf

    I have had communication from the higher ups that severing relations with the ABIM and starting our own certification process is on the table.

    The WSJ letter is the ivory tower acknowledgement that the natives are getting restless, nothing more nothing less. Expect to see more obfuscation and changing the subject, especially if the gravy train continues to be at risk.

    • LeoHolmMD

      Undermining their financing seems like the best method of raising their awareness.

    • Patient Kit

      Vacation?!? Did you not see the recent blog here about how docs work on vacation? I hope you’re successfully resisting conforming to that “work on vacation” thing and relaxing and enjoying a real getaway break. People who are committed to stressful, difficult work, like docs, need to pace themselves if they’re in it for the long haul. This “no real vacation” thing isn’t mentioned enough when talking about doctor burnout.

  • Eric Strong

    Thanks for the post. Completely agree!

  • LeoHolmMD

    I am in a board review course right now. The tone is definitely: cram for the exam. Probably not what the public expects of physicians. Certainly not in the interest of patients. We are spending time learning how board examiners may trick you with poorly presented questions, and you learn how to choose answers that are the least wrong. Physicians are tired of paying for this rip off. Patients need to understand the benefit to them is zero.

    • DeceasedMD

      Sounds like they have become the mafia of medicine.

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