More ASA frustrations

[Noyac]

I know many of you are far from needing to participate in MOCA. However, it is coming your way. It is the most frustrating part of my practice second only to big business medicine which is creeping our way like a 150 thousand ton freight train full steam ahead. So the ASA in their infinite wisdom have come up with another way to leech money from its constituents with yet more insulting requirements. Insulting because as I work my way through the patient safety requirement in MOCA 2, I am constantly insulted with the amount of knowledge they assume I don't possess. Not to mention the time they feel I have to sit in front of an old fashion computer to fulfill this crap of a requirement. When I say old fashion computer, I mean one that allows "pop-ups". Who in their right mind still allows pop-ups? I don't and my wife's new computer doesn't either. So I had to find a 8 yr old computer in order to access the stupid program. Oh, and what *****s write a program that can't be used on a tablet these days? I'll tell you who, our f'n ASA, that's who. Seriously, we can't use an iPad to do the program. What in the world are they thinking? Oh, I know. They are thinking, if we create another meaningless requirement for our enslaved followers to fulfill we can charge them more money, $160 for this one, so we can sit our fat arses in our finely decorated new offices and never have to touch another pt again.

I am so sick of these trolls.

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[Consigliere]

Phenomenal post, sir!

 

[deleted171991]

It's not the ASA; it's the ABA. (And together they form the ABSA.)

 

[soorg]

Amen. Soon we'll be re-certifying on Atari 2600 emulators sponsored by Netscape.

The worst part about MOCA are the different categories of credits we have to complete. Really? Just make it simple! And the fact that the old geezers don't have to recertify is the biggest load of poop ever.

 

[Noyac]

It's not the ASA; it's the ABA. (And together they form the ABSA.)

Yes but the program I am directly referring to comes from the ASA.

 

[sevoflurane]

I know many of you are far from needing to participate in MOCA. However, it is coming your way. It is the most frustrating part of my practice second only to big business medicine which is creeping our way like a 150 thousand ton freight train full steam ahead. So the ASA in their infinite wisdom have come up with another way to leech money from its constituents with yet more insulting requirements. Insulting because as I work my way through the patient safety requirement in MOCA 2, I am constantly insulted with the amount of knowledge they assume I don't possess. Not to mention the time they feel I have to sit in front of an old fashion computer to fulfill this crap of a requirement. When I say old fashion computer, I mean one that allows "pop-ups". Who in their right mind still allows pop-ups? I don't and my wife's new computer doesn't either. So I had to find a 8 yr old computer in order to access the stupid program. Oh, and what *****s write a program that can't be used on a tablet these days? I'll tell you who, our f'n ASA, that's who. Seriously, we can't use an iPad to do the program. What in the world are they thinking? Oh, I know. They are thinking, if we create another meaningless requirement for our enslaved followers to fulfill we can charge them more money, $160 for this one, so we can sit our fat arses in our finely decorated new offices and never have to touch another pt again.

I am so sick of these trolls.

I think this is appropriate here:

 

[deleted171991]

By the way, any browser allows pop-ups, as long as one knows how to disable the pop-up blocker.

 

[Noyac]

By the way, any browser allows pop-ups, as long as one knows how to disable the pop-up blocker.

Yes I know this. But my issue isn't really with the browser on the computer. It's with the lack of tablet support. Really? In today's environment we can't use a tablet.

But in my wife's new Mac when I go under Safari there isn't a "pop-up" listing. So I search and search and nothing turns up. I figure that there is a way but why am I having to do this?

And the bigger issue is that I have to waste time and money proving to the ASA and ABA for some reason that I understand what a "Root Cause Analysis" is. I sit in meeting after meeting with nurses and administrators who have nothing better to do than to regurgitate this crap over and over again. But they don't even understand how we ever got to the point in the discussion. I have nearly 15 yrs of experience in this crap so why do I have to complete the same tasks as someone right out of residency?

 

[Noyac]

By the way, any browser allows pop-ups, as long as one knows how to disable the pop-up blocker.

Btw, do me a favor and go to the MOCA-Fundamentals of Patient Safety. Use your favorite tablet and tell me how things go for you.

 

[BLADEMDA]

The reason I won't recertify again is that the ABA has made the process burdensome and unreasonable. Those of us fortunate enough to avoid the recertification process are unwilling to put up with the cost and B.S. of this MOCA program.

FYI, I know all the MOCA requirements and have completed most of them with the exam remaining in a year or two. I'm not planning on recertifying again because I see NO VALUE in it from a professional or educational perspective.

MOCA:

CME- good idea
Simulator- Unnecessary expense. Simply do it online at home and then take a test.
Practice Improvement- More B.S. Provide a checklist of ideas/concepts for discussion to the group/hospital.
ASA safety CME- pure money maker B.S.
Exam- I agree with the exam.

Essentially, the only parts of MOCA I agree with are the CME and Written Exam. The other stuff is bogus.

 

[IlDestriero]

Fortunately I only have one more to go, then I'll be out. The expense is criminal.

 

[aneftp]

The reason I won't recertify again is that the ABA has made the process burdensome and unreasonable. Those of us fortunate enough to avoid the recertification process are unwilling to put up with the cost and B.S. of this MOCA program.

FYI, I know all the MOCA requirements and have completed most of them with the exam remaining in a year or two. I'm not planning on recertifying again because I see NO VALUE in it from a professional or educational perspective.

MOCA:

CME- good idea
Simulator- Unnecessary expense. Simply do it online at home and then take a test.
Practice Improvement- More B.S. Provide a checklist of ideas/concepts for discussion to the group/hospital.
ASA safety CME- pure money maker B.S.
Exam- I agree with the exam.

Essentially, the only parts of MOCA I agree with are the CME and Written Exam. The other stuff is bogus.

Totally agree with you. Just paid $1600 for the simulator to be taken soon. Rip off. I am the 2005-2015 cycle.

I do the ACE (which is ipad compatible surprisingly!). Although the ipad app does kinda of suck for the ACE, and the ACE still works for a regular mobile safari browser.

ABA recert is still a work in progress. If you've seen the requirements; They keep changing the requirements every 3-4 years. It's like they don't know what they are doing. The only thing guaranteed is they add more required stuff.

Those who certified between 2000-2003 only had to take the written exam. Those 2004-2007 had to take written exam plus either of the simulator or case eval Those 2008 and later have to do both case report, simulator and patient safety crap.

 

[IanMcGalt]

The reason I won't recertify again is that the ABA has made the process burdensome and unreasonable. Those of us fortunate enough to avoid the recertification process are unwilling to put up with the cost and B.S. of this MOCA program.

FYI, I know all the MOCA requirements and have completed most of them with the exam remaining in a year or two. I'm not planning on recertifying again because I see NO VALUE in it from a professional or educational perspective.

MOCA:

CME- good idea
Simulator- Unnecessary expense. Simply do it online at home and then take a test.
Practice Improvement- More B.S. Provide a checklist of ideas/concepts for discussion to the group/hospital.
ASA safety CME- pure money maker B.S.
Exam- I agree with the exam.

Essentially, the only parts of MOCA I agree with are the CME and Written Exam. The other stuff is bogus.

CMEs are required to maintain my state medical license, so that narrows down the worthwhile parts of MOCA to just the exam. What a joke.

Why is the ABA completely unresponsive to valid criticism? Who do they work for anyway?

 

[BLADEMDA]

CMEs are required to maintain my state medical license, so that narrows down the worthwhile parts of MOCA to just the exam. What a joke.

Why is the ABA completely unresponsive to valid criticism? Who do they work for anyway?

It's all about the money. They disguise their profit motive around patient safety and skill improvement yet they have no evidence that any of their crap accomplishes a damn thing. MOCA should be CME, online review of important O.R. events which is similar to the simulator course and an Exam. Anyone who believes doing a 1 day course will make one proficient in critical events or core skills is delusional.

I'm doing one final recertification then I'm done as mine are voluntary. The ASA/ABA has totally botched MOCA in my opinion in order to keep the money flowing in.

 

[pgg]

It's the classic self-licking ice cream cone. The ABA bureaucracy has little useful work to actually do, so they make the examination and certification process excessively complicated to create work for themselves and justify their own existence. Why else would they split the written into multiple exams? What problem is being solved? What need is being filled?


Regarding MOCA - the CME requirement isn't too different than what I already have to do just to maintain a state license, but the ABA mandating that a large portion of it be purchased from the ASA always struck me as more than a little shady. The "patient safety" CME is garbage. I did the ASA-branded stuff first (10 hours) and later did the Healthstream package (which turned out to be 20 hours of credit, so I didn't need to pay ASA after all). It's all terrible material. At least the ACE modules are high quality.

I did the practice improvement (case evaluation) bit of MOCA two years ago. It took quite a bit of time to pick through my cases and crunch the data. It was a lot of effort. Maybe I overdid it and could've gotten away with submitting something less worthy ... I'd bet money that a lot of people just fabricate numbers to put on their 1-page fax to the ABA to get the box checked. I agree with that requirement in principle - we SHOULD be critically examining what we are doing as individuals and looking for ways to improve outcomes. There are a lot of anesthesiologists who never open a book or journal after passing the oral, and board certification ought to encourage if not compel SOME kind of self-analysis. It was still a painful requirement to check off.

I have never in my life gone through either a simulator or so-called standardized patient encounter that I felt was worth my time. I hated them in med school. I hated them as an intern. I hated them as a resident. In a couple years when I'm in the 2nd half of the MOCA window I suspect I'll hate what the ABA forces me to do. I hate these things more than I hate PBLDs, which is saying a lot, because I hate few things as much as sitting around a table staring at other human beings who either (a) want to be there even less than me

I'm all for the written exam every 10 years. But if they made us do the oral over and over I think I might start diverting sufentanil.


So, I think MOCA sucks. However. It used to be that board certification was purely optional. But we've long been trending toward a world where employment, credentialing, and reimbursement will require board certification. There's a lot of societal and political pressure for more regulation and oversight and quality control in medicine. Ultimately I think physicians are better off with self-regulation than external regulation. The ABA sure has conjured some obnoxious **** with MOCA, but they're probably better than the alternative. At least it's not those AMA wankers telling us what to do.

 

[Noyac]

CMEs are required to maintain my state medical license, so that narrows down the worthwhile parts of MOCA to just the exam. What a joke.

Why is the ABA completely unresponsive to valid criticism? Who do they work for anyway?

They work for themselves. $700,000/yr salaries with no call and no weekends or holidays. How do I get that job?

The ASA is therefore told what the requirements are. They then devise ways for their members to fulfill these requirements. They have no stake in it. They just make money off of it.

In my opinion, the ASA should be focused on creating way for members complete these requirements with minimal cost and time burden. Their IT programs need to be up-to-date. They need to create ways for practicing docs to have their practice performance reviewed by the ABA by using EHR's since all this information is in there. We should not have to submit the same information over and over again.

If a physician has held leadership roles in their groups, they should get credit for this. If they sit on state societies they should get credit for this. If they have practiced for 5 or more years without any malpractice claims then they should get credit for this. This would also encourage more state and local participation.

 

[Noyac]

. The ASA/ABA has totally botched MOCA in my opinion in order to keep the money flowing in.

Yes but I have been told through some recent emails from ASA delegates, VP of scientific affairs, and others that the ASA has heard our complaints and is currently working hard to improve this process. We will see what comes of it. They are readdressing the financial implications, meaning most of the funds are coming from members of the ASA but the attempt was to increase revenue from non members therefore, they may address the costs to members. They are also looking very closely at the simulator process. Hopefully it will go away completely.

Also, the ABA is addressing their criticisms. I have less faith here that they will do anything significant.

 

[IlDestriero]

What purpose does the sim really serve? We already practice anesthesia every day, put out fires, deal with emergencies, codes, traumas, do annoying ACLS and PALS recerts every 2 years.
Make the >50% office based/ASC guys take it and leave the rest of us alone. The price of this "experience" is also criminal.

 

[OB1🤙]

What purpose does the sim really serve? We already practice anesthesia every day, put out fires, deal with emergencies, codes, traumas, do annoying ACLS and PALS recerts every 2 years.
Make the >50% office based/ASC guys take it and leave the rest of us alone. The price of this "experience" is also criminal.

Agree 100%.

The simulator component is extremely obtrusive, expensive, and pointless. It should be removed asap.

Like Noy said, if you've been practicing for years without malpractice claims or negative peer review, what's the point?

Lots of CME and a written test i'm fine with. The current monstrosity? A shameful, exploitive, money-motivated sham. Abolish it, now.

 

[BLADEMDA]

FYI, the simulator cost is very expensive:

$1700 course
$300 transportation costs
$100 food costs
$100 hotel cost
Value of my time at $130 per hour x 9 hrs: $1170

Total cost: $3370

If the simulator portion remains going forward I'm finished with MOCA. I did all the crap this time but I won't enter the program again unless the ABA abolishes the requirement for simulation at a site vs doing it online at home.

 

[Noyac]

So all this back and forth is fine. But what is the real solution? We can sit here and bash these guys all day long but if we don't come up with ways to improve "our" system then we are no better.
My ideas:
1) ditch the simulator. No excuses here
2) continue with CME requirements. We will need them for licensure anyway and we need to keep current.
3) use EHR to gather data needed for MOCA 4. Don't make me spend my valuable time doing this when it's all right there
4) cost should be next to nothing for ASA members.
5) time requirements need to be minimized.
6) ASA MEETING should be easy for members to attend the lectures and workshops they are interested in while nurses, foreign docs and non members should be offered the leftovers.
7) claiming CME credits at the annual mtg should be easier ( this actually may be resolved, I haven't attended one in years since I was so frustrated with the one I attended)
8) make all web based programs compatible with current technology.

What would you add to this list?

 

[OB1🤙]

At the last ASA meeting they scanned your badge after any moca-credit-giving talk, and the credit allegedly was automatically credited to your moca account. Of course, it didn't work for me.

 

[OB1🤙]

Shoot, you guys are bitching about travel costs- I'm on a little rock in the middle of the Pacific. My travel and opportunity costs are a hell of a lot more than what Blade posted.

 

[seinfeld]

The MOCA really should be about reinforcing a necessary knowledge base so that our patients are getting the best and most appropriate care that is up to date.

-Do exams really test a clinicians day to day practice knowledge. No. They allow for a binge and purge of information.
- Do exams educate clinicians on the recent data and then test there understanding of how to incorporate it into practice. no
- Do exams ensure that important, critical information is understood, no. You only have to get a passing grade to continue being certified.

I envision a MOCA where every 6 months to a year I get a book in the mail with a corresponding question book ( electronic version as well available). This information contained combines elements of basic anesthesia review, new literature reviews, expert analysis, patient safety chapters. There are also videos illustrating case scenarios role played out showing both good and bad responses to OR crisis. The questions are all open book, straight forward with no tricks as to which is the "best" answer. No traditional exams to be taken, no sim courses, no trying to fingering out how best to obtain the combo of ACE/SEE/patient safety credits. This would better ensure that what is felt to be imperative knowledge to a practicing anesthesiologist is reviewed regularly. The information is passed along in a real world setting where a person can you references to find answers. 100% right answers would be required to complete. IN addition it simplifies the process with no need to binge and purge information.

Will this ever happen? My feeling is that it could if everyone continues to push for the reforms. Currently the new certification has changed to where the first time cert exam is taken early in training with the Orals being moved up. I sees this as a move toward making the certification a continually process not an episodic one.

Unfortunately too many lay people believe that anesthesiologist are like pilots. Pilots spend a required time in sim centers before getting allowed to fly. I did my Sim course and I have to say you can tell the difference between those who supervise at output centers to those who work in places like mine doing ASA 4 all day and running many of mine own codes. I did see some value for those not exposed regularly to life and death scenarios.