Board Re-certification and MOC is a SCAM!

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Ligament

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I found this on Sermo and thought I should share;

Here’s my column in this month’s Emergency Medicine News. by Edwin Leap
"In 1994 I was thrilled to become certified by the American Board of Emergency Medicine. I had worked very hard. I studied and read, I practiced oral board scenarios and even took an oral board preparatory course. It was, I believed, the pinnacle of my medical education. Indeed, if you counted the ACT, the MCAT, the three part board exams along the way and the in-service exams, it was my ultimate test. The one that I had been striving for throughout my higher education experience.
I am now disappointed to find that my certification was inadequate. In fact, all of us who worked so hard for our ABEM certification find ourselves facing ever more stringent rules to maintain that status. And it isn’t only emergency medicine. All medical specialties are facing the same crunch. Our certifying bodies expect more…and more…and more.
And the attitude is all predicated on the subtle but obvious assumption that those of us in practice are not competent to maintain our own knowledge base. Despite spending decades in education that we are not to be trusted. That we are not interested in learning. That we do not attempt to learn and that our practices are not, in fact, the endless learning experiences they actually are. They assume we need more supervision, despite demonstrating (by our continued practice) that we are willing to do hard work, in hard settings, and do the right thing.
Unfortunately, the rank and file is very unhappy. There is remarkable discontent, and considerable anger, among the lesser physicians. That is, the test takers, thephysicians in practice subject to the new rules, the ones who have to add one more rule, one more activity, one more form, one more check to their already busy lives.
That discontent, that anger, that frustration on the part of practicing physicians is, in my opinion, very rational. It’s a tough time in medicine. Our regulatory burden grows by leaps and bounds every year. We are watched and harassed, by CMS, by JCAHO, by our state medical boards, by our insurers, by our hospital staff offices and now, most painfully, by our own specialties.
Of course, all of it comes in the context of falling reimbursements, a federal government licking its lips for any spurious allegation of fraud and a system in which EMTALA forces physicians of all specialties to see patients for free, even as government insurance programs pay less than the over-head to see their patients (and fulfill the regulatory guidelines required for the privilege of doing so).
In light of all of this, I have to ask ABEM and every other board certifying body, a simple question:
‘What are you people thinking?’
Here’s the reality. Our certifying bodies should be our greatest, most passionate advocates. When the Institute of Medicine issued a report some years ago that saidphysicians were killing people on a scale consistent with the holocaust, ABEM should have looked at the data and refuted it. ABEM, and ABIM and all the others should have taken our fees, run out and found the best PR firm they could afford. ‘We stand by our physicians and we have serious questions with these research results and the way they are being interpreted.’ That would have been a good use of my dues. That would have merited high salaries for everyone in every board that stepped up for its members.
Instead, at every step, ABEM seems to argue that ‘the public’ wants us to be watched more closely and tested more frequently. Except, I’m not confident that’s true. The public never cares where you went to medical school. The public thinks most emergency physicians are interns hoping for a ‘real practice’ someday. The public wants affordable, quality care. The public, in practical terms, doesn’t know the difference between a physician, a PA and a nurse practitioner, and often calls all of them ‘doctor.’ The public, furthermore, tends to believe that mid-level providers are more attentive to their needs. (Despite their lack of board certification; shocking indeed!)
More poignantly, more ironically, our policy-makers and academics often say that public needs a European-style health-care system with better outcomes and lower costs. Whether that is ultimately true or not, the funny thing is that Canadian and European physicians don’t have to do ongoing board-certification activities. Hmmm.
More irony: medical practice is supposed to be evidence-based. So where’s the data that board certification makes a difference in patient outcomes? Maybe it does, maybe it doesn’t. But even if it does, we’ll need to break it down to see if ongoing certification matters, if repeat testing matters, who sponsored the study. etc. Our certifying bodies should be eager to see independent evaluations of the question. Or would that be a problem?
It might be a problem from a financial standpoint. Is ABEM, or ABP or ABS or the ABMS simply ‘too big to fail?’ Do they employ too many people to cease to be relevant? Is there a financial imperative for them to continue doing what they do? With director salaries in the $200,000 to 800,000 range (depending on board), is there a potential hint of conflict of interest?
How is this different from the financial conflicts of big pharma? Their drugs help people, even if their techniques are shady. Is this an uncomfortable question for everyone to ask?
It’s a time of changing paradigms in the world at large. Print books are succumbing to electronic ones. The Internet is an unfettered land of free expression, uncontrollable by government entities or hospital administrators. People text more and talk less.
It may be time for us to look critically at the entire concept of board certification. It may be time for alternate boards to emerge. It’s certainly time for our boards to be our friends, our advocates, and thereby justify their cost. And it’s likely the future will not look like the present, when it comes to the way we certify physicians. In an era of impending physician shortages and fewer reasons to enter medicine as a whole, I hope that we can remove some obstacles and stand up for one another.
That’s a change I can get behind. And that’s a change that would make me much happier to write that check to ABEM when the time comes."

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The issues with this is that ABMS specialty certificaiton is the only game in town. They thus have monopoly.

Every other pofession, including nursing has two certifying bodies. RNs can take there boards w/ one of them, and then fail, and then can tk it w/ another one and pass.

On the flip side, having two certifying bodies would initiate 'competition' between the two. Essentially they would be striving for our business in making the most streamlined process for certifying physicians. The article has a point in the sense that most of us have done many years of undergrad, med school, residency, fellowship,etc. This is almost 12 -13 years added education to the general population.
 
The issues with this is that ABMS specialty certificaiton is the only game in town. They thus have monopoly.

Every other pofession, including nursing has two certifying bodies. RNs can take there boards w/ one of them, and then fail, and then can tk it w/ another one and pass.

On the flip side, having two certifying bodies would initiate 'competition' between the two. Essentially they would be striving for our business in making the most streamlined process for certifying physicians. The article has a point in the sense that most of us have done many years of undergrad, med school, residency, fellowship,etc. This is almost 12 -13 years added education to the general population.

In Pain Medicine, there are several competing boards that will "certify" you. One even accepts chiros, nurses, naturopaths, etc.
 
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this is spot on.....and whoa...i didnt know that kind of coin was being paid to board directors or members.
 
In Pain Medicine, there are several competing boards that will "certify" you. One even accepts chiros, nurses, naturopaths, etc.

i am gonna with that one, hahah!

i dont think there is any way i could pass an anesthesia board at this time, just to take another re-cert for pain...
 
In Pain Medicine, there are several competing boards that will "certify" you. One even accepts chiros, nurses, naturopaths, etc.


yes but only one is "ABMS" recognized.


I think at this time, not all hospitals are requiring ABMS board certifications. The only one that is actually ABMS is the ABA one, but as someone mentioned, that's somewhat difficult if we do not practice anesthesiology for a longer period of time.

I wish one of the Pain Boards were ABMS, that would be very helpful for those of us doing solely Pain Mangement.
 
Oh, that has been tried several times over the past decade. The American Board of Pain Medicine actually sued the ABMS for failure to consider recognition of their board but it was a moot point. The ABMS contends pain is a symptom and not a discrete systemic disease. Of course evolving clinical and neuroscientific data now refutes the symptom only model as uninformed and naive, but no one ever accused the ABMS of being rocket scientists except in the case of finance with respect to MOC and their push by the ABMS towards MOC being linked to licensure. There is little evidence MOC does anything except enrich the coffers of the ABMS and their boards.
 
Hear Hear Ligament ! - I completely agree with you - and then some.
I got boarded once - in my first specialty - but now
2 residencies and 2 fellowships later -
Sorry, not planning to do it again. Not the recert - nor the new specialty certs.
Boards are one of the biggest money wasting scams
ever perpetrated on the community. The medical and lay community.
Not too long ago, no one but the academics did them. And for what - to best one
another. Ego driven. Now it's a cash-cow the "boards" can't let go of. And has become
a ball and chain for us all, and a very evil tool of 'big medicine' that's taking us over
and driving costs through the roof.
Solid Medicolegal analysis (see below) has pointed out that boarding proves nothing*,
and even the boards are very careful to never say that the
boarded docs are any better than non-boarded for this very reason.
I will continue to advocate that new grads boycott the boards.
How much regulatory burden do you want to heap on yourselves? Haven't you been
through enough years of education then testing? I know I have.
And I think hospitals should shun JCAHO as well - another huge money wasting
constant increasing burden on the community.
And by the way - JOIN the AAPS - the ONLY voice of the private practice physician.
(Association of American Physicians and Surgeons - since 1943)

* - a legal analysis of 'private credentialing of healthcare personnel' from the
American Journal of Law and Medicine - which was evaluating the anti-trust
implications of private credentialing:

"....although specialty board certification is generally considered indicative
of superior technical competence, the boards and associated specialty societies
are careful in the claims they make, disclaiming any intent to draw invidious distinctions.
Yet because such disclaimers are not widely heard, questions may be raised concerning
the validity of the information that certification conveys. Medical practice is a complex
mixture of science and art, and it is not clear that certifying bodies are capable of measuring
all the factors that determine professional competence. Some studies question whether the
ability to pass the examinations offered by the boards correlates with high-quality medical practice....".
 
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I was wondering if there has been any cost analysis for board certification, and then maintenance of certification/PIP/CME etc. Including calculations that consider time lost from seeing patients, flights, hotel cost etc. Over my ~30 year career will I spend 100K or more to do all of this?
 
Hear Hear Ligament ! - I completely agree with you - and then some.
I got boarded once - in my first specialty - but now
2 residencies and 2 fellowships later -
Sorry, not planning to do it again. Not the recert - nor the new specialty certs.
Boards are one of the biggest money wasting scams
ever perpetrated on the community. The medical and lay community.
Not too long ago, no one but the academics did them. And for what - to best one
another. Ego driven. Now it's a cash-cow the "boards" can't let go of. And has become
a ball and chain for us all, and a very evil tool of 'big medicine' that's taking us over
and driving costs through the roof.
Solid Medicolegal analysis (see below) has pointed out that boarding proves nothing*,
and even the boards are very careful to never say that the
boarded docs are any better than non-boarded for this very reason.
I will continue to advocate that new grads boycott the boards.
How much regulatory burden do you want to heap on yourselves? Haven't you been
through enough years of education then testing? I know I have.
And I think hospitals should shun JCAHO as well - another huge money wasting
constant increasing burden on the community.
And by the way - JOIN the AAPS - the ONLY voice of the private practice physician.
(Association of American Physicians and Surgeons - since 1943)

* - a legal analysis of 'private credentialing of healthcare personnel' from the
American Journal of Law and Medicine - which was evaluating the anti-trust
implications of private credentialing:

"....although specialty board certification is generally considered indicative
of superior technical competence, the boards and associated specialty societies
are careful in the claims they make, disclaiming any intent to draw invidious distinctions.
Yet because such disclaimers are not widely heard, questions may be raised concerning
the validity of the information that certification conveys. Medical practice is a complex
mixture of science and art, and it is not clear that certifying bodies are capable of measuring
all the factors that determine professional competence. Some studies question whether the
ability to pass the examinations offered by the boards correlates with high-quality medical practice....".


Hey Kvetch-

what's your source for the quotes you made? Do you have a link?

Although I'm boarded in my primary specialty thus far and have done a fellowship,etc I'd love to have this information to throw at admin,etc...
 
what he says is nice and all, but...

go ahead take a stand. dont get boarded.

but be prepared to tell your creditors why you chose not to get boarded. and we shouldnt be going back to the wild west of having any doc advertise themselves as experts in whatever specialty they want because they stayed at a Holiday Inn last night is not tenable.

(i.e. see http://forums.studentdoctor.net/showthread.php?t=911305 )
 
i don't mind the boards so much --- we do become complacent with our medical knowledge, and taking re-cert exams is a good/healthy thing in my mind...
 
i don't mind the boards so much --- we do become complacent with our medical knowledge, and taking re-cert exams is a good/healthy thing in my mind...

agreed. why does it need to cost 2 grand?
 
because they know that most doctors will pay that amount...

alternatively you could send in a check for $50 and become "boarded" by AAPManagement....
 
Hi All - It's been a little while now - and this topic is RIPE again -
As we predicted - A certain Eastern State has tied Cert and MOC to keeping your license!
This previously "voluntary" ego-driven one-up-manship of the academics ("board cert") has now flourished
into the hydra we knew it would. We're all screwed - depending on the outcome of the restraint of trade law suit
the AAPS is bringing against the State of NJ.
http://www.aapsonline.org/index.php/article/aaps_takes_moc_to_court

I say again loud and clear - BOARD CERTIFICATION IS A SCAM - and FOLLOW THE MONEY.
Why do you think the MOC idea came up? Because it wasn't enough MONEY for the "boards"
to just get most everyone certified - THEN it wasn't enough MONEY to get everyone
RE-certified every 10 years. NOW they want us to CONTINUALLY give them MONEY
and jump through UNPROVEN UNNECESSARY HOOPS to just keep our licenses to practice!
It is CRIMINAL! I truly suspect they are giving kick-backs to the States Boards that are considering
tying this into our licenses.

I don't know about you - but I'm trying to care for my patients and run a practice by myself -
I don't have the time or money to give in to these regulatory burdens foisted upon us.
I make less than most PA's I'd wager - because of my practice model - and spending the
necessary time with my patients, and doing everything else in the office. But it's what's right - for me.
And to add insult to injury - they are letting the "less expensive" nurse pracs and PA's do our jobs - with
much less training and responsibility held for their actions. Maybe that's the idea -
Drive doctor out of medicine and "make it cheaper" - but it won't, it will just give temporarily
more profit to our "leeches", like the ABMS, 3rd party payors, and now the Govt with Obamacare.
THAT'S why medicine has become "unaffordable" - ever since 1965, with govt intrusion and the
3rd party payor system. We let go of the control of our profession, our calling, and gave it to the
bean counters and bureaucrats, and money changers. LET'S TAKE IT BACK! WE CAN DO IT!
And I say again - BOYCOTT THE BOARDS! - TAKE BACK CONTROL OF OUR FIELD!
and JOIN THE AAPS!

Oh - and to answer Ducctape above - who's worried we will be in the wild west of medicine if we stop 'boarding' -
Would you call the UK / England's system the wild west? They don't have specialty boards.
They get the training for their specialties and practice them well - VERY well. Better than you and I - I'd wager -
because their training excelled in bedside diagnostics and didn't depend on high tech tests on a whim, and silly multiple choice exams to test them.
Example: Queen's Square and Neurology, amongst many others. I'd rather a sheepskin from there than any ABMS rag on my me-wall.
Just like we USED to have here - respect for quality medical education and training institutions - if a medical school, residency, fellowship training program is good
and passes you - you are "certified" and qualified in the true sense of the word. The only sense of the word that actually has any evidentiary proof of validity.
Unlike the "boards" which have NONE. Now we seem to have lost trust in our own training programs - likely because of the over-reach of the RRC and the like.

BOYCOTT THE BOARDS ! If we all do it - we can regain control. If not - the ship sinks and we all drown. Say hello to your friendly
nurse prac or PA 'cardiothoracic surgeon' hovering over you with a scalpel, about to kill you, or your wife or kid, with full govt backing and protection.
You think this is a reach? I already have heard of PA's doing cardiothoracic surgery here in AZ. It is INSANE. But if 3rd world medicine is what they want,
obamacare will give it to them.

Remember well - that we - the Doctors - the Physicians - are the ONLY REAL PATIENT ADVOCATES.
These self - proclaimed regulatory entities don't give a crap about your patients. They just want their 'pound of flesh' - out of our hide.

From the AAPS website:

"ABMS has a proprietary, trademarked program of recertification, called the “ABMS Maintenance of Certification®” or “ABMS MOC®”,
which brings in many tens of millions of dollars in revenue to ABMS and the 24 allied corporations.
Though ostensibly non-profit, these corporations then pay prodigious salaries to their executives, often in excess of $700,000 per year.
But their recertification demands take physicians away from their patients, and result in hospitals denying patients access to their physicians.
"

Here's another link to a group of ER docs who are pissed too. And quote some refs on
the lack of any proof of utility of cert.
http://www.physicianspractice.com/blog/true-value-board-certification

quoting from the article:

From Dr. Grosch, a former practicing internist and current law school student:

“Patients tend to believe that, if only physicians were well-enough educated, well-enough trained, skillful enough, knowledgeable enough, “certified” enough, all would be well. Physicians could then assure or guarantee clinical outcomes. Because some patients experience bad outcomes, the belief is that their physicians must not be well-enough educated and trained, skillful enough or knowledgeable enough to have produced favorable outcomes, especially if they do not hold board-certification. Comfort through a physician’s assurance (i.e., guarantee) of a pre-determined, certain and favorable clinical outcome is an ancient quest. Patients long for deterministic certainty in our stochastic universe. [1]

‘Certified,’ has Latin roots in certus (true), and facere, (to make), and the term applied originally to attesting authenticity of documents. Certifying authenticity of inanimate documents is rational but certifying physicians in hope of pre-determining their performance is not. Toulmin [2] emphasized the uncertainty and ambiguity that make guaranteeing medical care unfeasible. Katz addressed the ethics of guarantees in medicine:

[Physician and patient] are voyagers on the high sea of uncertainty. . .Acting out of fear that...acknowledgment of medicine’s limitations will drive patients into the arms of quacks has its own dangers. In promising more than medicine can deliver, physicians adopt the practices of quacks ...[3]

ABMS vaguely suggests that board-certified physicians produce more favorable clinical outcomes than noncertified physicians but stops short of guaranteeing it. The AMA’s Code of Medical Ethics forbids making a treatment-fee contingent on outcome of treatment.

Horowitz referred to (naïve) public acceptance of board certification but he carefully evaded any assertion that it improves quality of clinical care because no scientifically credible evidence that it does exists. [4]”

References:
1. Ierodiakonou K, Vandenbroucke JP. Medicine as a stochastic art. Lancet. 1993 Feb 27;341(8843):542-3
2. Toulmin S. (1981) On the Nature of the Physician’s Understanding. Journal of Medicine and Philosophy. February:1(1):32-50 @44
3. Katz J. (1984) Why doctors don’t disclose uncertainty. Hastings Center Report. Feb;14(1):35-44
4. Grosch Eric N. Does specialty board certification influence clinical outcomes? Journal of Evaluation in Clinical Practice. 2006;12(5):473-81
 
just took my recert-anesthesia boards... was not bad at all. I was surprised.
focus on ob/pressors/vent stuff/and hemodynamic senarios (ie. PaO2, CO2, CI, PAP).
good luck. pain boards in year....
 
I can't imagine how I am going to do anesthesia boards. When I take them it will be 10 years since doing any anesthesia. I keep hoping they will change things and I can just recert in pain...
 
The ABA just sent out a survey regarding MOC

Here are some talking points I mentioned:

-the VA, integrated systems, and private hospital admins want the cheapest provider, not the best, so the assertion that it furthers the pre-eminence of our practitioners is not entirely valid
-no evidence that the public really "demands it" or that it improves safety
-diplomates should be able to vote on it, it should not be imposed on us
-
 
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