The AMA calls for an immediate end to MOC

Shhh. I think this is supposed to be a secret, but this Wednesday at the super-elite AMA House of Delegates meeting in Chicago, where only the mostly highly connected and AMA devoted doctors get to attend, they actually stood up for us.  It is now AMA policy that the AMA opposes mandatory ABMS recertification exams.

Crazy, right?  News of this random act of fortitude trickled out to us on Twitter by the small handful of delegates who very helpfully tweet updates for those of us on the outside.  But other than those little tweets, no word from the AMA on this incredibly good news.  This is HUGE folks! The AMA opposes ABMS recertification exams! It’s time for celebration, and press releases, and emails asking us to rejoin the AMA.  And yet, no word from the AMA.

It’s not listed in the Top 10 Stories from the AMA 2016 Meeting.  It’s not mentioned in the coverage of the MOC resolutions that passed. By looking at the AMA website and news coverage, the only MOC resolutions that passed were the typical mushy kind.  Here’s how the AMA reported their “newsworthy” MOC resolutions.  Hold on to your knickers, these are some groundbreaking resolutions.

“Delegates adopted policy to further these efforts, including:

  • Examining the activities that medical specialty organizations have underway to review alternative pathways for board recertification
  • Determining whether there is a need to establish criteria and construct a tool to evaluate whether alternative methods for board recertification are equivalent to established pathways
  • Asking the American Board of Medical Specialties to encourage its member boards to review their MOC policies regarding the requirements for maintaining underlying primary or initial specialty board certification in addition to subspecialty board certification to allow physicians the option to focus on MOC activities most relevant to their practice.”

Whoa Nelly. And the AMA wonders why they’re bleeding membership. Nearly every doctor in the real world is saying “STOP MOC”. And the AMA flitters about asking for more studies and playing footsie with the ABMS. In defense of the authors, these resolutions probably started out strong. But once the board-member packed committees hacked them to impotent pieces, there’s no meat left.

So what about that resolution opposing ABMS testing?  Well, if you go to the AMA website and create a secure login and scroll through the hundreds of pages of amended resolutions from the nine reference committees, you’ll find … Resolution 309 presented by Florida, California, Georgia, Pennsylvania, Washington, New York, & Virginia hidden in Reference Committee C.  The language is strong:

RESOLVED, That our American Medical Association call for the immediate end of any mandatory, recertifying examination by the American Board of Medical Specialties (ABMS) or other certifying organizations as part of the recertification process (Directive to Take Action);
and be it further
RESOLVED, That our AMA support a recertification process based on high quality, appropriate CME material directed by the AMA recognized specialty societies covering the physician’s practice area, in cooperation with other willing stakeholders, that would be completed on a regular basis as determined by the individual medical specialty, to ensure lifelong learning
(Directive to Take Action); and be it further
RESOLVED, That our AMA reaffirm Policies H-275.924 and D-275.954 (Reaffirm HOD Policy);
and be it further
RESOLVED, That the AMA voice this policy directly to the ABMS and other certifying organizations (Directive to Take Action); and be it further
RESOLVED, That there be a report back to the AMA HOD by the 2017 Annual Meeting. (Directive to Take Action)

Awesome, right? Well, as soon as the committee got ahold of it, they butchered into,

RESOLVED, That our American Medical Association call for the immediate end of any mandatory, recertifying examination by continue to work with the American Board of Medical Specialties (ABMS) to encourage the development by and the sharing between specialty boards of alternative ways to assess medical knowledge other than by a secure exam or other certifying organizations as part of the recertification process (Directive to Take Action);
and be it further
RESOLVED, That our AMA support a recertification process based on high quality, appropriate CME material directed by the AMA recognized specialty societies covering the physician’s practice area, in cooperation with other willing stakeholders, that would be completed on a regular basis as determined by the individual medical specialty, to ensure lifelong learning
(Directive to Take Action); and be it further
RESOLVED, That our AMA reaffirm Policies H-275.924 and D-275.954 (Reaffirm HOD Policy);
and be it further
RESOLVED, That the AMA voice this policy directly to the ABMS and other certifying organizations (Directive to Take Action); and be it further
RESOLVED, That there be a report back to the AMA HOD by the 2017 Annual Meeting. (Directive to Take Action)

Funny how that works.  The resolution was dead. Gutted.

But between testimony in Reference Committee C on Sunday, and final voting on Wednesday, the Pennsylvania Medical Society melted the meeting down with a blistering two hour exposé on the abuses of the ABIM and the boards in general.  It was standing room only, with Dr. Wesby Fisher and Charles Kroll presenting their financial data, Dr. Bonnie Weiner discussing NBPAS, and Dr. Scott Shapiro announcing the PA Medical Society’s vote of “no confidence” in the ABIM and plans to pursue legal action against the boards.  Full report on the meeting and PowerPoint presentations can be found here.

With a much-needed boost in morale and the data to support strong action, the full house convened on Wednesday and the delegates soundly rejected the Committee’s butchering of the resolution, extracted it to a full vote on the house floor, and restored the strong language of the first resolved.  It passed easily.

RESOLVED, That our American Medical Association call for the immediate end of any mandatory, secured recertifying examination by the American Board of Medical Specialties (ABMS) or other certifying organizations as part of the recertification process for all those specialties that still require a secure, high-stakes recertification examination.

Boom. This is amazing!  So why isn’t the AMA announcing this from the rooftops? Why is this hiding in hundreds of pages of resolution verbiage, only accessible via secure login?

Because they’re hoping you don’t know. If you don’t know, then they can ignore this policy exists and they won’t have to fight their friends at the ABMS on your behalf.  But now you do know. You know that your colleagues from Florida, California, Georgia, Pennsylvania, Washington, New York, & Virginia wrote a strong resolution and fought it to the end. Now their resolution is policy. Bravo to Texas and Michigan standing strong as well.

Obviously, I’m not good at keeping secrets, and I hope the rest of my physician colleagues spread this secret policy far and wide. While I’m not yet ready to jump on the AMA bandwagon, I am warming to the realization that the AMA is made up of individual doctors. If we fill the AMA with the right physician delegates who will fight for us, we might actually win a few battles.

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

Image credit: Shutterstock.com

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