It's been a little while since I last posted on this forum - and this topic is RIPE -
( forgive me for posting this on two threads - but it is VITAL the word gets out. )
As was predicted by some - a certain Eastern State has tied so-called "Certification"
and "MOC" to keeping your license! (so-called as there's NO evidence it makes better
outcomes or doctors - see below).
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 those who would worry 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
Kvetch, 6 minutes ago Edit Report
#15 Reply
( forgive me for posting this on two threads - but it is VITAL the word gets out. )
As was predicted by some - a certain Eastern State has tied so-called "Certification"
and "MOC" to keeping your license! (so-called as there's NO evidence it makes better
outcomes or doctors - see below).
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 those who would worry 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
Kvetch, 6 minutes ago Edit Report
#15 Reply
