In the fight against MOC, physicians are the underdogs

Wow. For those who think MOC isn’t a big deal, my open letter to the American Board of Pediatrics just hit 70,000 views.  That’s stunning.

For those commending my bravery,  realize efforts like this are not done in isolation. I am not alone. I have the most amazing partners. I can’t even express how blessed I am to work with the ten doctors in our private practice. Not only do we share a common faith, we share a fierce independence.  They know that in the end, I may lose my MOC battle even on the way to winning the war. Blue Cross Blue Shield of Michigan may force me to be certified through the ABP, and rather than lose access to care for my patients, I will pay $1,300 plus a $200 late fee to the ABP to regain my certification. But I certainly won’t lose quietly.

I also have the support of my state medical society.  Michigan State Medical Society has the strongest state policy on MOC in the country: MOC should not be tied to licensure, hospital privileges or insurance participation and it should not be the monopoly of one organization. It helps knowing there’s a 15,000 member society on my side. And they’re doing the impossible. But more on that in another post.

I have the support of thousands of Sermo doctors, over 5,000 signatures on our pediatric MOC petition and now 70,000 views on the letter without one single doctor opposing my stand.  I am not alone. Numbers are clearly on our side.

Since writing my original letter, my inbox has been flooded with hundreds of heartbreaking stories. Physicians with cancer, on chemotherapy and immunosuppressed, are denied waivers to delay testing in the public facilities, losing their certification and their jobs. Parents of children with cancer are denied waivers while their children are undergoing treatment, losing their certification and threatened with job loss. Physicians are retiring early to avoid another costly and demeaning cycle of MOC. Physicians are feeling isolated and embarrassed after failing their re-certification and are falling into depression and suicide.

My eyes are wide open now, and I realize this is more than mere annoyance or financial inconvenience.  MOC is a toxic stress that is literally killing doctors. The worst part is the boards have heard our voices, yet they keep pressing forward. Their unflagging defense of MOC in the face of what they know it’s doing to our colleagues is not a simple error of knowledge; this is a breach of morality. This is something we cannot participate in.

It appears we’ve come to the divide in the road.  If you’ve had enough and are ready for a revolution in MOC, there are some very simple things you can do. This applies to all ABMS specialties, but I speak directly to my pediatric colleagues here.

1. If you really don’t need MOC to practice medicine, please stop participating.  Continuing to financially support the ABP harms your colleagues, and it harms children as experienced doctors retire early.  Paying fees to the ABP harms more than just pediatricians,  as the ABP turns around and gives $837,000/yr to the American Board of Medical Specialties Foundation, which develops MOC programs to inflict upon your colleagues in other specialties. When you give up your certification, send a letter to the ABP explaining exactly why.

The ABP has threatened to sue any doctor who calls themselves “board certified” in print or on the Web if they don’t do MOC, so getting certified through the National Board of Physicians and Surgeons is probably a wise move if you still want to call yourself “board certified.” Note that you can still keep the “FAAP” in your title, even if you don’t do MOC, as the AAP only requires initial board certification to be a fellow.

2. If you think you need MOC to practice, please make sure. Check your insurance contracts. Check your hospital privileges. We had a local pediatrician harassed by the children’s hospital when he didn’t participate in MOC.  Turns out, our staff bylaws only require initial board certification. The harassment was completely unfounded.

3. If MOC is required for your job, insurance contracts, or hospital privileges … this is where the fun starts and is going to require more information than I can give in this post. It’s going to require politics, organized medicine, and some hard work.  I will post soon on exactly how this is done, but for now, if you’re really forced into MOC just start by asking questions. Call up your state medical society to see if they have written policy opposing MOC and resources to help. Find a few colleagues, and ask if hospital policy or office policy can be changed to either only require initial board certification or NBPAS as an alternative.  You might be surprised by how much support comes out of the woodwork.

And finally a word to those who are “grandfathered” and exempt from MOC. I harbor no bitterness toward my grandfathered colleagues. Indeed, the requirements enjoyed by grandfathered pediatricians should be the standard for all.  But to those grandfathered doctors who now know what is happening to your younger colleagues, yet turn your back on us or even worse, enforce MOC requirements for our employment but not yours, I do hold you accountable.

There is a reason the “grandfathered” class exists. Established in your careers, and trained in an era that encouraged oppositional defiance, MOC wouldn’t have lasted two months if you were included. You would have fought and shamed the ABP into immediate apology and retraction.  Instead, they targeted younger doctors facing significant education loans, newly employed with young families, just trying to make partner and not interested in making waves.

We all want to leave medicine better than we found it and this is the chance for our grandfathered doctors to step up in your circle of influence. It is likely you or your contemporaries are in hospital administration and on medical society boards.  You or your contemporaries are the ones making employment guidelines for your university department or private practice. Rather than breathe a sigh of relief that you’re exempt or nearing retirement, fight for us. Don’t show solidarity with us by voluntarily participating in MOC, show leadership by fighting for our right to self-education without coercion. Use your hard-earned status and influence to end MOC employment requirements for all pediatricians.

It’s no wonder the ABP has been successful at pushing us so far, yet listening so little. Pediatricians are a tolerant lot.  We have nearly unending patience. We can tune out incredible distractions to get our job done. We are literally pooped on every day, yet we show up day after day, with white coat pockets full of Star Wars stickers and love our jobs.

It’s because we’re viewed as such tolerant, happy doctors that I started to worry what my patients would think if they read my letter as it was spreading quickly on social media.  A friend forwarded a comment one of my patients made on the article, something I wasn’t intended to see.  The mom said, “A doctor that fights this hard, will fight for us if we need her to.”

See, that’s what the American Board of Pediatrics forgot.  Pediatricians have devoted our lives to fighting tirelessly for the little guy. And this time, we’re the little guy.  If we can give even a fraction of that passion, tenacity, and love fighting for our fellow pediatricians, the ABP better hold on. They’re in for one bumpy ride.

Meg Edison is a pediatrician and can be reached on Twitter @megedison.  This article originally appeared in Rebel.MD.

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