ABPN and ABMS refuses to repeal MOC part IV

[Neurologo]

Read about this in Neurology Today 4/2/15 issue.
AAN pushed for repealing MOC part IV at least but Lois Margaret Nora, MD, JD, the CEO of the ABMS is staunchily defending its usefulness and refusing to budge against the overwhelming voice against it from AAN and practicing neurologists.

I would like to know how she got voted into the position, if voted, and how long is her term as well as the rest of the ABPN board members. They should be held accountable especially if they are getting any payments for their positions. How can we make this board more responsive to the voices of the practicing neurologists? Several of attendings at my institutions are also against some parts of MOC.

It looks like many other specialties are clamoring and clashing against their own specialty boards.
This should not go on unchanged. Something needs to be done. At the least any abuse of authority for personal gains should be legally prevented.

Let's hear what you think about this issue.

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[typhoonegator]

She's actually trained as a neurologist herself, although it's hard to tell how much she has practiced in literally forever. The ABMS is sort of a microcosm of the overall zero-sum game that physicians are faced with from many directions these days. Remember, her role is to consolidate the authority of the ABMS in the name of improving education. She's paid to do that -- it's literally her job. She certainly wouldn't improve her organization's position by ceding authority over MOC to her supposed constituency.

It's kind of funny that on her ABMS page it says she "is participating in maintenance of certification". The stars, they're just like us! Whoop de doo. Her job is so different from mine that she might as well be a helicopter pilot.

And you forgot to mention that she also has an MBA, to go along with her JD and MD. Those degrees help her understand what is best for us. Hey, it's not like these MOC activities represent an enormous funding source with a complete lack of transparency among key stakeholders. It's also not like these requirements aren't proven to be beneficial, with those benefits shown to outweigh the financial, opportunity, and time costs associated with them.

Make sure you all renew your Continuum, everybody! Quarterly quizzes are what makes you into leading clinicians.

All that aside, I really don't think she has direct financial ties to the MOC requirements -- that would be too easy to uncover. I'm sure she's well-paid to be the ABMS CEO, and the lines of power, favor, and influence go far beyond simple financial compensation. She's probably even convinced that this is what's best for the common good. It's hard to believe she's been playing some sort of long-con all through the years serving her administrative leadership roles just so she could reach this position and stick it to everybody and buy a yacht floating on the sweat off our brows. But I didn't elect this person, and I wouldn't have elected this person. So why does she get to choose how much of my paycheck gets poured down the MOC pipeline?

 

[neglect]

I'm going to be boarded by the National Board of Physicians and Surgeons. In part I hope to support the competition, and I consider Dr. Tierstein a hero, so I hope to support him and his organization. I also have no interest in recertifying under what I believe to be the bankrupt and distracting process of MOC, so I'm not doing it. They can lower the requirements or not, at this point I don't care. They've already forced me out.

Let me tell you what's going to happen to me then: nothing at all. I gain nothing from being BC through ABPN, except some patients think I'm a psychiatrist. No-one else cares: patients, hospitals, insurers, state, trail sponsors. I'll be board certified, so I can click that box.

There was a single person, a senior internal medicine guy, who believed I should bite the bullet and prepare to be raped (and ripped off out of time and money). But he could not justify this at all. He just said it was a risk for a young(ish) guy with decades of practice ahead. I found this spookiness non-compelling. If doctors are so risk averse (and where is this risk?) as a group that we're not willing to make a stand against professional tyranny, there is no hope for us.

I urge everyone who reads this to do as their conscience dictates. I am.

 

[Neurologo]

I'm going to be boarded by the National Board of Physicians and Surgeons....

Let me tell you what's going to happen to me then: nothing at all. I gain nothing from being BC through ABPN, except some patients think I'm a psychiatrist. No-one else cares: patients, hospitals, insurers, state, trail sponsors. I'll be board certified, so I can click that box.

There was a single person, a senior internal medicine guy, who believed I should bite the bullet and prepare to be raped (and ripped off out of time and money). But he could not justify this at all. He just said it was a risk for a young(ish) guy with decades of practice ahead. I found this spookiness non-compelling. If doctors are so risk averse (and where is this risk?) as a group that we're not willing to make a stand against professional tyranny, there is no hope for us.

I urge everyone who reads this to do as their conscience dictates. I am.

This is a very new information to me. So far I have been let to believe that without the ABPN board certification, I won't be able to get full privilege in many hospitals or that they would choose those with it over me. Is there really no disadvantage in private world?

I was able to get a rapid review on NBPAS from this web page of theirs.
https://nbpas.org/faqs/

They truly align with my reason and conscience as Neglect mentioned. Also they are totally transparent and all board advisors are volunteering without pay and are of respectable credentials. See the list here. https://nbpas.org/faqs/

But it looks like we need to be certified by ABPN first to qualify for NBPAS board. Still this is exciting.

One of the seasoned attending was shocked and disturbed to learn about an MD, JD who probably does not do clinical works, is ruling on the issue that affects all practitioners.

 

[neglect]

This is a very new information to me. So far I have been let to believe that without the ABPN board certification, I won't be able to get full privilege in many hospitals or that they would choose those with it over me. Could you enlighten us more about NBPS board? Is there really no disadvantage in private world?

One of the seasoned attending was shocked and disturbed to learn about an MD, JD who probably does not do clinical works, is ruling on the issue that affects all practitioners.

Yeah, probably doesn't do clinical work. You could say that I probably don't do deep water plasma welding either.

I'm amazed you haven't heard about this. Here's the skinny..Here's the NBPS.

Do note that NBPS is only for MOC, not first certification. I do know fine doctors who didn't pass the boards for whatever reason, and are doing well in practice, industry, and even academics. But like all tyrannies and all rackets, eventually they take things too far (although they did do away with the oral boards, which were expensive, stressful, and didn't really add much). I wouldn't be at all surprised to find competition for first certification soon. I think getting on the job evaluations from a shadowing doctor would be a terrific way of not only helping maintain quality but also creating a fellowship among docs. Or we just use internet rating sites.

 

[bustbones26]

Just a few thoughts to consider.

1) The Continuum

Let's be honest, they give you the answers to the quiz, so you are essentially buying your MOC and there is no way to verify that you actually read all of the articles and did not "cheat" on the quiz. I actually do read the articles, but admit, not all of them. For example, if they release a Neuromuscular Continuum tomorrow, I would definitely read an article, "Current Management of Myasthenia Gravis" but probably would pass over the article, "Religious views of Buddhists on long term endotracheal ventilation". Unfortunately, more and more of these "nonsense" articles are included in the Continuums.

2) The American Headache Society

Don't forget that they have a nice PIP module on their website that does count and it is FREE!

3) What about subspecialists?

Let's imagine that you are an academic epileptologist for a living. How many strokes do you admit/take care of? When is the last time you prescribed Tysabri to an MS patient? How on Earth are you supposed to do PIPS in anything other than epilepsy?

4) Competitors?

Nice try, I do applaud their efforts but unfortunately ABMS is the gold standard. Some state medical boards stipulate that you cannot promote yourself as a board certified physician unless your certificate comes from an ABMS/ABOMS. Yes, I was on staff at least one hospital that refused to offer privileges to physicians that were not board certified.

That being stated, I support the grass root efforts of the ABPS and perhaps with time, their certification will be on equal with ABMS.

 

[Neurologo]

Just a few thoughts to consider.
4) Competitors?

Nice try, I do applaud their efforts but unfortunately ABMS is the gold standard. Some state medical boards stipulate that you cannot promote yourself as a board certified physician unless your certificate comes from an ABMS/ABOMS. Yes, I was on staff at least one hospital that refused to offer privileges to physicians that were not board certified.

This is what I am afraid of.

 

[neglect]

Nice try, I do applaud their efforts but unfortunately ABMS is the gold standard. Some state medical boards stipulate that you cannot promote yourself as a board certified physician unless your certificate comes from an ABMS/ABOMS. Yes, I was on staff at least one hospital that refused to offer privileges to physicians that were not board certified.

That being stated, I support the grass root efforts of the ABPS and perhaps with time, their certification will be on equal with ABMS.

Tyrants win until some of us grow from sheep to humans. Change is hard, but some causes are worth it. You want the next generation to pay double in time and money for professional extortion? Eventually some of us have to take a stand.

I said above to go with your conscience. We all have to make that choice. Allow an evil status quo or act to effect change. Hard choice and hard to do. But it was a bit rougher going on the march from Selma to Montgomery. I accept the consequences of refusing the bull**** MOC and will be perfectly candid.

 

[Neurologo]

That ABMS is "gold standard" is simply because there has not been any alternative. As more individuals join NBPS movement and its number rises, standard will have to change.

One clarification. So I will have to get the initial ABPN certification. Then apply for NBPS within 10 yrs which would make MOC irrelevant. Does this mean I do not need to take recertification w/ ABPN when the initial 10 yrs runs out? Well, I cannot take it anyway without fulfilling MOC requirements.

 

[Neurologo]

So this may be the reason why the staunch refusal to repeal MOC.
Quoted from the recent separate topic by NOSfan:

"For your review: most recent Form 990 for your policy makers.
Please note that these are public documents readily available to anyone.
ABMS president and CEO made almost $780,000!!
ABPN president and CEO made almost $870,000!!"

 

[807crash]

So this may be the reason why the staunch refusal to repeal MOC.
Quoted from the recent separate topic by NOSfan:

"For your review: most recent Form 990 for your policy makers.
Please note that these are public documents readily available to anyone.
ABMS president and CEO made almost $780,000!!
ABPN president and CEO made almost $870,000!!"

Interesting..... I wonder what the call schedule is like. 24/7, I assume.

 

[neglect]

Bump and update.

The local hospital forced me to take the ABPN boards, although I reject it as meaningless. I continue to be a proud member of NBPS. I’m not aware of insurance companies ever asking for BC. It was only our hospital, mostly full of middle management spineless wankers.

So about the MOC work. It is 100% bull. You attest that you did some work on a stroke center - that is seemingly the easiest way. It has NOTHING to do with patient care or personal excellence as a neurologist. I’d actually have been incredibly impressed if they’d asked for my best and average door to needle time. Or for a paper. Or for how many subjects I enrolled into clinical trials. Nope.

Use one of the many, many self directed CME activities out there. This will get you dozens of CME hours and is painless.

Now, the test. I refused to study for it. I tried my best while taking it, obviously, but some part of me kinda hoped I’d fail and I could then tell the hospital that I tried, ‘now whatcha gonna do, kick me out?’ Given their need of neurology coverage and my personal devotion to being as helpful as possible when on call, I’d have liked to see the non-patient-facing admins deal with that one.

The test itself is meaningless and worthless. I was struck by the fact that the test is a mockery of itself. It is one of those tests that loves the zebras and hates the horses. It is a test made by old men who have decided what knowledge gets admitted into the pantheon (pediatric untreatable diseases), while ignoring clinical practice. Not one question about the most remarkable advances in neurology over the past 20 years. For example, no SMA or Spinraza question! That’s just a minor litmus tests, but it holds water I think. What used to be a horrible fatal disease is now treatable. And it isn’t even questioned.

But the biggest problem, I believe, is that these tests no longer test anything of value. I can guess B and game it so I’m more right than not. But how do I behave on the phone at 2 AM with a stupid resident who mistakes change in MS with an acute stroke? Do I properly and promptly and kindly and firmly diagnose ALS, PD, MS or AD when the patient is in the office, or do I torture them with uncertainty while they get tests that won’t change anything? Do I try to relieve suffering and promote health? Do I ignore a stroke risk factor like smoking? Do I ensure my notes actually communicate what I think?

Anyway, the entire process was a waste of time. I left the testing place happy to have it done and fairly confident in a pass. But I was also full of horrible thoughts. There are better ways of doing this. If I was struggling with burnout, lack of confidence, stress, then this wouldn’t have helped me, or helped me help my patients. All it did was to enrich administrators who don’t deserve to be enriched. I’d be much more open to a lifelong mentoring program. But who has time or inclination as we feed the EMR more data?

 

[NOSfan]

AAN pushed for repealing MOC part IV at least but Lois Margaret Nora, MD, JD, the CEO of the ABMS is staunchily defending its usefulness and refusing to budge against the overwhelming voice against it from AAN and practicing neurologists.

Wonder why she is such a strong proponent.....in 2015 alone she made almost $750,000.

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