More extortion; ABPMR to transition to continuous MOC **EXTORTION** in 2018

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Ligament

Interventional Pain Management
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I cannot believe what a leech the ABPMR has turned into.

"continuous certification model is being recognized as a best practice across the medical field"

Um...no. Complete absence of MOC extortion is best practice. You mean this continuous certification model is the best practice to extort more money from your members, ABPMR. Shame on you.

Dr. Sliwa is a well respected physician, but I'm saddened to see him stand behind member abuse and extortion.

Dr. Sliwa; indentured servitude of your members is not what we want, nor what patients need. This MOC scam leads to massive opportunity cost for physicians, loss of time in clinic, loss of care for patients, and frankly loss of quality of live for physicians already under attack from all sides.

Our choices now come down to having a hobby OR doing MOC scam work. Having a vacation OR traveling to medical conferences to meet MOC extortion requirements. Those of us in private practice do not have the luxury of paid CME and "admin" time you academics and employed physicians do. But, that's probably the point of MOC, isn't it; To further push us private practice physicians into employed models and realize the vision of socialized medicine and governmental control.

The ABPMR should be ashamed to be extorting its members. We know you do not exist to support us or represent us; you exist to steal time and money from us, pure and simple. Shame on you.

____


ABPMR to transition to continuous certification in 2018



The Maintenance of Certification (MOC) Program of the American Board of Physical Medicine and Rehabilitation (ABPMR) will be transitioning to a more continuous model in the next few years.


“Our application to offer continuous certification was approved by the American Board of Medical Specialties (ABMS) this year, but to ease the transition for our diplomates, it won’t go into effect until 2018,” says James Sliwa DO, chair of ABPMR’s MOC Committee.


All certificates issued by the ABPMR in 2018 and beyond will no longer have an end date. ABPMR diplomates’ certificates will be considered current and valid as long as the diplomate continues to meet requirements.


So, what does the continuous certification process look like?


Actually, it looks a lot like the current ABPMR MOC Program. Many requirements will remain the same as they are now, except that instead of a 10-year cycle, the continuous certification process will emphasize ongoing learning with more progress checks along the way. These “mid-stage performance checks” will also result in changes to the board certification status reported by the ABPMR.


“Continuous certification really gets more to the intention of certification, which is to demonstrate competence, professionalism, and expertise continually throughout a career, rather than at just one point in time every decade,” says Dr Sliwa. Increasingly, the continuous certification model is being recognized as a best practice across the medical field. Many other ABMS boards have already transitioned to continuous certification or are in the process of doing so.


In 2018, the new rules will begin to be phased in for existing diplomates.


“We are working hard to ensure the transition to continuous certification will be a smooth one,” says Dr Sliwa. “Our diplomates will have a clearer picture of continuous certification details and how it may affect them as we get closer to implementation.”


At this time, the ABPMR is releasing only these basic facts about the transition to continuous certification, with the knowledge that some of the proposed details may change before 2018. More information, roadmaps, and FAQs will be released throughout the next three years, starting in 2015.

American Board of Physical Medicine and Rehabilitation
3015 Allegro Park Lane SW
Rochester MN 55902-4139
507-282-1776 / Fax 507-282-9242 [email protected]

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Welcome to the club of the Extorted. It is a painful club to be in. Been subject to this for 10 years now, from my "board." They just keep adding more busy work and hoops to jump through every year. It's mainly about them collecting the fees that you must pay to have the pleasure of keeping your piece of paper.
 
So let's boil all of this down to something simple:

1) Year over year, by what percentage has (or do you expect) your income to decrease?

2) Is private practice viable? Will it be in the future?

3) What is a reasonable income for a pain physician working ~50hrs per week in a decent metro (Seattle, SF, Boston, Miami)?

4) What about cash?

5) How bad is the charting/paperwork, etc..., about which you speak above?

thanx
 
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I can't imagine the damage physicians would do to patients without all of these advocates (AMBS, ABPMR, Fed, State, Insurance, etc...)
 
if they get rid of a meaningless and ridiculous exam every 10 years, i actually think it is a step in the right direction. after all, we should all be reading and learning constantly.

some of your ire is appropriate, but to go so far as to say that this is a conspiracy to push people into an employed model is a bit extreme. im sure you dont want to think about the implications of extending your assumptioms - that academic/employed doctors have more time to learn and more up to date on their medical knowledge, etc.

the point of MOC is to make money and to make sure the docs under that board arent stuck in the 1980s - well, excluding hairstyles...
 
if they get rid of a meaningless and ridiculous exam every 10 years, i actually think it is a step in the right direction. after all, we should all be reading and learning constantly.

some of your ire is appropriate, but to go so far as to say that this is a conspiracy to push people into an employed model is a bit extreme. im sure you dont want to think about the implications of extending your assumptioms - that academic/employed doctors have more time to learn and more up to date on their medical knowledge, etc.

the point of MOC is to make money and to make sure the docs under that board arent stuck in the 1980s - well, excluding hairstyles...
So you're saying you have an '80s mullet? Business in front, party in back.
 
i tried getting a new haircut once. went to a salon, spent like $50.

the only person who noticed any difference was my barber, who gave me heck for going to a salon....
 
if they get rid of a meaningless and ridiculous exam every 10 years, i actually think it is a step in the right direction. after all, we should all be reading and learning constantly.

some of your ire is appropriate, but to go so far as to say that this is a conspiracy to push people into an employed model is a bit extreme. im sure you dont want to think about the implications of extending your assumptioms - that academic/employed doctors have more time to learn and more up to date on their medical knowledge, etc.

the point of MOC is to make money and to make sure the docs under that board arent stuck in the 1980s - well, excluding hairstyles...

I agree we should be reading and learning all the time, which we do, on our own. We don't need some useless organization making money off that!

Also, these useless MOC topics have very little relevance to sub specialists like myself, who have not done an EMG nor inpatient rehab since residency. MOC exercises are not going to aid me with improving my gasserian RF knowledge base ...thats what I need to spend my time on. I'm absolutely sure the MOC topics won't improve my knowledge on Pain Medicine. I'm absolutely sure MOC exercises won't teach me how to create and implement a HIPPA compliant capable email and cloud based medical records system without getting raped by EMR companies (that took over 100 hours of my labor). I'm absolutely sure MOC exercises won't help me market my practice, learn how to find a good accountant and grow my business. I'm absolutely sure MOC exercises won't teach me how to build a website, blog, and how to steam videos.

I understand your extension of logic re: academic docs. I'd put another twist on it; they have more time to *waste* on useless busywork with protected and paid CME/MOC time. Such time does not mean they are more up to date or such busywork makes them better doctors.

Why do you feel the MOC is required to ensure that we physicians do what we naturally do; read, study, discuss on our own. We don't need a vampiric organizations like the ABMS to make money off that. I'd rather see the ABMS and ABPMR advocate for us in Washington and BENEFIT us vs. focus their energy on taxing us and subjugating us.
 
The way I read it is if you recert prior to 2018 you will have a certificate with a 10 year end date. I am taking my exam as early as possible-next Feb- and should then have a certificate til 2028. I'm done after that anyway.
 
The way I read it is if you recert prior to 2018 you will have a certificate with a 10 year end date. I am taking my exam as early as possible-next Feb- and should then have a certificate til 2028. I'm done after that anyway.

I hope you are right, but the way I read it is that you cannot ride on 10 year certificates past 2018; you have to take yearly and routine MOC BS or you loose your certificate. ie. cant recert and coast 10 years until you retire. This is likely why they made this change; to capture MONEY from docs such as yourself who want to spent the last 10 years of your professional life without submitting to extortion.

Yep, I think they were specifically targeting docs planning on retirement within their last 10 year cert cycle. They were loosing a lot of extortion money with you folks. Bastards.
 
because i know docs, particularly from before MOC.

they dont read. they dont keep up to date.

ive been watching and working with doctors since 1988. i understand them, and i am one of them. you get busy with practice. you get busy with life. you cut corners on time, and when you are in the hospital 60+ hours a week, you cant cut family any more. so most doctors cut out reading/studying/learning, saving it for conferences, etc.

i dont know about PMR, and i had some similar feelings about anesthesiology. BUT....

they recently released a 60 credit CME online course for pain. excellent review course. i dont want to get in trouble with the Board, but here is a sample answer response, and i am only posting the first 1/3 of the page:

Discussion
Neck pain, defined as pain in the area between the base of the skull and the first thoracic vertebra, is common in the general population, with a 12-month prevalence that ranges from 30% to 50% and is highest among middle-aged women. Risk factors include smoking and genetic predisposition.

Up to 78% of asymptomatic people have been found to have degenerative changes on magnetic resonance imaging (MRI) accompanied by positive findings such as disc bulging and protrusion, foraminal stenosis, and abnormal spinal cord contour. This evidence suggests that degenerative findings are common in both asymptomatic and symptomatic individuals, increase linearly with age, and cannot be assumed to be the definitive cause of neck pain in symptomatic individuals. Neck pain following whiplash-associated disorder (WAD) is common (3 in 1,000 annually).

WAD may occur following a rapid deceleration-acceleration type injury...
theres even pic diagram of the distribution of the facet joint pain and a drawing of the posterior approach to a cervical MBB. and there are 100 questions in this CME.
 
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because i know docs, particularly from before MOC.

they dont read. they dont keep up to date.

ive been watching and working with doctors since 1988. i understand them, and i am one of them. you get busy with practice. you get busy with life. you cut corners on time, and when you are in the hospital 60+ hours a week, you cant cut family any more. so most doctors cut out reading/studying/learning, saving it for conferences, etc.

i dont know about PMR, and i had some similar feelings about anesthesiology. BUT....

they recently released a 60 credit CME online course for pain. excellent review course. i dont want to get in trouble with the Board, but here is a sample answer response, and i am only posting the first 1/3 of the page:


theres even pic diagram of the distribution of the facet joint pain and a drawing of the posterior approach to a cervical MBB. and there are 100 questions in this CME.

Just to clarify, I'm in strong opposition to MOC extortion. CME extortion is another issue and I don't feel as strongly about that.

This 60 credit CME pain course sounds interesting. Who offers it?
 
I hope you are right, but the way I read it is that you cannot ride on 10 year certificates past 2018; you have to take yearly and routine MOC BS or you loose your certificate. ie. cant recert and coast 10 years until you retire. This is likely why they made this change; to capture MONEY from docs such as yourself who want to spent the last 10 years of your professional life without submitting to extortion.

Yep, I think they were specifically targeting docs planning on retirement within their last 10 year cert cycle. They were loosing a lot of extortion money with you folks. Bastards.

Revenue cycle management pure and simple.
 
The best way to help patients is to help doctors, and by staying out of their way. Doctors need support, not mandates. The same is true with teachers and other professionals. Docs who practice with outdated techniques and get poor results will eventually be unable to compete with those with better skills. The amount of CME credits you have makes ZERO difference in your quality as a physician.
 
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you are right, hyperalgesia. the current cme methodology is flawed, but it is currently the only pathway. one that encourages learning (through stipends, pay, etc. via multimedia platforms) would probably be much more effective, but continued learning without a doubt leads to better patient care.

Case in point:
http://www.ncbi.nlm.nih.gov/pubmed/24032064
Can Urol Assoc J. 2013 Jul-Aug;7(7-8):266-72. doi: 10.5489/cuaj.378.
The effectiveness of continuing medical education for specialist recertification.
Ahmed K1, Wang TT, Ashrafian H, Layer GT, Darzi A, Athanasiou T.
Author information
Abstract

Evolving professional, social and political pressures highlight the importance of lifelong learning for clinicians. Continuing medical education (CME) facilitates lifelong learning and is a fundamental factor in the maintenance of certification. The type of CME differs between surgical and non-surgical specialties. CME methods of teaching include lectures, workshops, conferences and simulation training. Interventions involving several modalities, instructional techniques and multiple exposures are more effective. The beneficial effects of CME can be maintained in the long term and can improve clinical outcome. However, quantitative evidence on validity, reliability, efficacy and cost-effectiveness of various methods is lacking. This is especially evident in urology. The effectiveness of CME interventions on maintenance of certification is also unknown. Currently, many specialists fulfil mandatory CME credit requirements opportunistically, therefore erroneously equating number of hours accumulated with competence. New CME interventions must emphasize actual performance and should correlate with clinical outcomes. Improved CME practice must in turn lead to continuing critical reflection, practice modification and implementation with a focus towards excellent patient care.


On some sort of benefit from CME:
http://www.ncbi.nlm.nih.gov/pubmed/17764217
Evid Rep Technol Assess (Full Rep). 2007 Jan;(149):1-69.
Effectiveness of continuing medical education.
Marinopoulos SS, Dorman T, Ratanawongsa N, Wilson LM, Ashar BH, Magaziner JL, Miller RG, Thomas PA, Prokopowicz GP, Qayyum R, Bass EB.

CONCLUSIONS:
Despite the low quality of the evidence, CME appears to be effective at the acquisition and retention of knowledge, attitudes, skills, behaviors and clinical outcomes. More research is needed to determine with any degree of certainty which types of media, techniques, and exposure volumes as well as what internal and external audience characteristics are associated with improvements in outcomes.
hest. 2009 Mar;135(3 Suppl):37S-41S. doi: 10.1378/chest.08-2516.
Continuing medical education effect on physician knowledge application and psychomotor skills: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.
O'Neil KM1, Addrizzo-Harris DJ; American College of Chest Physicians Health and Science Policy Committee.

CONCLUSIONS:
CME is effective in improving physician application of knowledge. Multiple exposures and longer durations of CME are recommended to optimize educational outcomes.
 
Just to clarify, I'm in strong opposition to MOC extortion. CME extortion is another issue and I don't feel as strongly about that.

This 60 credit CME pain course sounds interesting. Who offers it?
ASA through their website.
http://education.asahq.org/14SAMPM

30 credit hours. will go directly to MOCA fulfilment for anesthesiology.
you do not have to be an ASA member to pay the exhorbitant price of $429...
 
Docs who practice with outdated techniques and get poor results will eventually be unable to compete with those with better skills.

not true. old docs with established practices and referral patterns, no matter how crappy they are, will do quite well. look at that bozo across the street who will inject anything with a pulse. he's still crazy busy, despite the fact that he's a *****. quality is really not the determining factor in most cases, unfortunately.....
 
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not true. old docs with established practices and referral patterns, no matter how crappy they are, will do quite well. look at that bozo across the street who will inject anything with a pulse. he's still crazy busy, despite the fact that he's a *****. quality is really not the determining factor in most cases, unfortunately.....
Sad but true in some cases. I've seen it happen, too.
 
not true. old docs with established practices and referral patterns, no matter how crappy they are, will do quite well. look at that bozo across the street who will inject anything with a pulse. he's still crazy busy, despite the fact that he's a *****. quality is really not the determining factor in most cases, unfortunately.....
Okay, I agree that quality takes a back seat to establishment, marketing, etc. But on the CME question, this guy has the same number of CME credits we do and he's still a tool.
 
Okay, I agree that quality takes a back seat to establishment, marketing, etc. But on the CME question, this guy has the same number of CME credits we do and he's still a tool.
imagine how backwards he might be if he didnt do the CME.

he'd probably still be doing series of 3, blind, with kenalog (gasp!)

okay, that last part was a little dig at someone..... :rolleyes:
 
imagine how backwards he might be if he didnt do the CME.

he'd probably still be doing series of 3, blind, with kenalog (gasp!)

okay, that last part was a little dig at someone..... :rolleyes:

The CME would not make him a better doctor, and definitely would not prevent him from do a series of 3 blind epidurals...

The CME would simply make him jump through hoops like a monkey, with zero guarantee of retention or insight.
 
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here is your CME for the week - read the 2 above articles that refute your contention that CME does not help improve medical knowledge
 
here is your CME for the week - read the 2 above articles that refute your contention that CME does not help improve medical knowledge
If you can provide the last article text from the Chest Physicians, I'll read it. I don't care what the Canadian Urological Assiociation thinks.
 
not true. old docs with established practices and referral patterns, no matter how crappy they are, will do quite well. look at that bozo across the street who will inject anything with a pulse. he's still crazy busy, despite the fact that he's a *****. quality is really not the determining factor in most cases, unfortunately.....
The other thing is you're not comparing apples to apples. This doc you are referring to is competing against another one who ALSO has the referral base, etc. But this other guy practices quality medicine and has better outcomes. The quality guy wins eventually.

And why are there two docs? Because there is a free market and it is great to be a doctor again. Because the myth of Medicare and the rest of this circus government "bringing down the cost of healthcare" has been exposed. And it's no longer in vogue to mandate the quality right out of the American healthcare system...
 
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