NBPAS- Opt Out of MOC

[OB1🤙]

All,

The anti-MOC movement is a little more prominent on Sermo than it is here, but I think a new development deserves everyone's attention.

In response to MOC impositions across medical specialties, some physicians have been fighting back, with the belief that MOC has no quality evidence of efficacy, is expensive, is time-consuming, and serves only to benefit those boards that administer the programs.

Please refer to this recent piece in the NEJM by Dr. Paul Teirstein- http://www.nejm.org/doi/full/10.1056/NEJMp1407422 . In it, Dr. Teirstein details many of the problems with the MOC process. I would invite you all to visit www.changeboardrecert.com for a wealth of additional information.

Dr. Teirstein and a board of highly respected physicians (http://nbpas.org/board/) have created a new Board, the National Board of Physicians and Surgeons (NBPAS), which can serve to certify physicians who wish to opt out of the MOC process.

The requirements are primary certification in an ABMS specialty, and evidence of 50 CME hours over the past 2 years. As of now, the cost is $169 for 2 years, which may be adjusted up or down depending on their operating costs moving forward.

While anesthesiology is not yet offered as an option, this is only because of minor logistical decisions that NBPAS has to make while starting this entity, and it will be offered soon.

I have approached the hospital leadership of the facilities my group services, and asked them to consider allowing NBPAS certification to be considered valid. I believe that given the requirement for initial ABMS board certification, along with ongoing CME, that they will agree that this is a completely valid alternative system.

I would encourage all of you to spread the word about this entity, to everyone in medicine that you interact with, and I will update this post once anesthesiology is made available. All questions and comments would probably be beneficial to them as they get this thing off the ground.

If you believe that MOC is overly burdensome and expensive, without providing any value to you or your patients- this is the mechanism by which you can opt out of that system. If your hospital medical staff requires board certification to maintain credentials, forward them this form letter- http://nbpas.org/sample-letter/ - and ask that they recognize this new pro-physician entity.

I wish that none of this was even necessary, and that hospitals would just allow physicians who do not believe in MOC to allow their board certification to lapse. However, they have been very reluctant to do so. Here's the mechanism by which we can move forward with a national, multi-specialty movement against MOC.

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[BLADEMDA]

Great news for you guys. I've Voluntarily recertified once and entered MOCA the second time. I will recertify via MOCA and the ABA in the next few years but I'm unlikely to do it a third time. It just doesn't add anything to my clinical practice and is a total waste of time (not to mention money as well).

 

[norwood]

MOC has no quality evidence of efficacy, is expensive, is time-consuming, and serves only to benefit those boards that administer the programs.

Oh, that's not true at all! It also benefits politically-connected programs and vendors!

 

[Mman]

Hypothetical here.

What happens if your hospital chooses to allow NBPAS certification and you choose to do that and not participate in MOCA and then you later go looking for another job? You will no longer by ABA certified since your time limited certification will have expired. Will they make you go back and get additional residency training to again be eligible for ABA certification? Will you just have to redo oral and written boards? Would this restrict you to trying to find another job at a hospital that accepted NBPAS?

Seems like a bit of a risky maneuver to let your ABA certification expire since maintaining it with MOCA is easier than ever getting it back if you needed it.

 

[musli]

MOC is mostly a move to satisfy regulators and lawmakers that medicine is capable of policing itself. Groups like the ABMS and the AHA are scared of the public perception that medicine isn't able to deal with incompetent (or merely low-quality) doctors. The worst-case scenario would be additional federal legislation, and so the various boarding agencies started MOC programs as a visible quality-checking measure.

If you think about it, this isn't bad argument: more regulation with the force of law would definitely stink. I agree that MOC has become a monster in many fields. But the sensible long-term strategy is to find a less-bureaucratic, less-expensive, less-onerous system that still satisfies outside policy makers, rather than just trying to kill MOC. If you kill it, you're likely to get something worse.

 

[criticalelement]

MOC is mostly a move to satisfy regulators and lawmakers that medicine is capable of policing itself. Groups like the ABMS and the AHA are scared of the public perception that medicine isn't able to deal with incompetent (or merely low-quality) doctors. The worst-case scenario would be additional federal legislation, and so the various boarding agencies started MOC programs as a visible quality-checking measure.

If you think about it, this isn't bad argument: more regulation with the force of law would definitely stink. I agree that MOC has become a monster in many fields. But the sensible long-term strategy is to find a less-bureaucratic, less-expensive, less-onerous system that still satisfies outside policy makers, rather than just trying to kill MOC. If you kill it, you're likely to get something worse.

If you really believe what you just wrote I have a bridge in brooklyn to sell you.

MOC is a money making, power scheme designed to create another whole industry and enrich those who invented it. HAS ZERO to do with quality.

I dont need another self serving agency asking me if i abuse alcohol or drugs..

 

[Noyac]

I just sent this letter to my CMO and Chief of Staff.

 

[musli]

Seriously, I don't think it measures quality either. It's a PR measure for the outside world.

Sure, the ABA makes money on it, but that's not why it was invented.

 

[BLADEMDA]

Seriously, I don't think it measures quality either. It's a PR measure for the outside world.

Sure, the ABA makes money on it, but that's not why it was invented.

With today's technology why can't it all be online MOCA? Also, what does a written exam prove these days? I use my smart phone to look up anything I don't know in an instant. The test should be open book but timed to reflect real world practice.

 

[Psai]

MOC is mostly a move to satisfy regulators and lawmakers that medicine is capable of policing itself. Groups like the ABMS and the AHA are scared of the public perception that medicine isn't able to deal with incompetent (or merely low-quality) doctors. The worst-case scenario would be additional federal legislation, and so the various boarding agencies started MOC programs as a visible quality-checking measure.

If you think about it, this isn't bad argument: more regulation with the force of law would definitely stink. I agree that MOC has become a monster in many fields. But the sensible long-term strategy is to find a less-bureaucratic, less-expensive, less-onerous system that still satisfies outside policy makers, rather than just trying to kill MOC. If you kill it, you're likely to get something worse.

The public is accepting of lesser trained nurse practitioners and physician assistants who don't undergo a residency, never mind MOC requirements.

 

[criticalelement]

The public is accepting of lesser trained nurse practitioners and physician assistants who don't undergo a residency, never mind MOC requirements.

No kidding right? I mean a "NURSE" CMON. They are ok with a NURSES education to be independent. An advanced physics class or chemistry class is not even required to become a nurse. And they are independent. Yet they are making up all of this Horse S... for us to do..

 

[Noyac]

With today's technology why can't it all be online MOCA? Also, what does a written exam prove these days? I use my smart phone to look up anything I don't know in an instant. The test should be open book but timed to reflect real world practice.

There are no studies showing practice improvement with these tests. And another issue with the test is that there is no feedback as to areas of deficiency. Just pass or fail. What purpose does that serve other than fill the pockets of the ABA and ASA for that matter.

 

[norwood]

Seriously, I don't think it measures quality either. It's a PR measure for the outside world.

Sure, the ABA makes money on it, but that's not why it was invented.

Gimme a break, ABA sold out.

Everybody and their dog comes up with onerous requirements, and ABA's idea is to come up with expen$ive products and services to "help us comply"?

With friends like that, who needs enemies?

 

[Mman]

Gimme a break, ABA sold out.

Everybody and their dog comes up with onerous requirements, and ABA's idea is to come up with expen$ive products and services to "help us comply"?

With friends like that, who needs enemies?

It isn't the ABA that sold out, it's all medical specialties. We aren't the only ones.

 

[OB1🤙]

I would also call everyone's attention to the article that Dr. Paul Kempen, an anesthesiologist at the forefront of the anti-MOC movement, wrote in A&A last year- http://changeboardrecert.com/documents/KempenANesAnalg.pdf

 

[musli]

Y'all think I'm saying something that I'm not.
--No, I don't think that MOCA is a great test of competence.
--Sure, ABA makes money on it.

But MOC, just like Milestones, was conceived out of a desire to convince, principally, CMS and Congress that medical credentialing wasn't a case of the fox guarding the henhouse. And this is a reasonable worry. If you want to propose blowing up MOC, then great. But you also need to come up with other strategies to allay regulators' fears.

 

[OB1🤙]

IF the ABA made the MOC program a single, open-book, online, low-cost module done every so often that captured all of the landmark, practice-changing literature published in the years prior, AND NOTHING MORE, I might find that useful.

I find no value in the practice improvement modules. These are busy work and nothing more.

I find no value in the simulator requirement. I live on a rock in the middle of the Pacific ocean. To complete this I need to pay for a flight to the mainland, stay in a hotel, pay the exorbitant fee, JUST TO GET CREDIT FOR SHOWING UP. Meanwhile, instead of taking two days off of work or vacation, I could be actually taking care of very sick patients, like how I do EVERY SINGLE DAY.

Every patient we take care of is the test. Every sick patient that we see safely through surgery represents passing the test. It really should be that simple. Along with pertinent CME, previously board certified consultant physicians should not need to demonstrate more.

I do not plan on maintaining my ABA certification if they do not radically change the format of MOCA. They say changes are underway, but unless they do what I outlined above, it will not have gone far enough.

The other thing we all need to be mindful of is the attempt by the FSMB to require MOC to maintain your state license (i.e. Maintenence of Licensure, or MOL). Yes, seriously. They want to go state by state and get in on this regulatory capture action while the getting is good. They try to sugarcoat it by saying that some aspects of MOC won't be required (like the tests), but other aspects will be required, such that the only way to really be compliant with MOL will be to do your MOC. http://library.fsmb.org/pdf/mol-fast-facts.pdf

Ask Noyac- they're coming for Colorado now. http://www.cms.org/communications/maintenance-of-licensure-taking-shape

WE MUST PUT A STOP TO THIS, AND WE CAN. Combat MOL through your local AMA chapter, as ghastly as that probably sounds to you, or your state legislature if it comes to that. The AMA (to its credit) actually released a statement late last year that was sympathetic to the anti-MOC/MOL movement- http://www.ama-assn.org/ama/pub/ama...dopts-principles-maintenance-of-certification which importantly included this item- "The MOC program should not be a mandated requirement for licensure, credentialing, payment, network participation or employment."

A number of state medical societies have made statements against MOC/MOL, if yours has not, I encourage you to contact them and pressure them to do so. Now that the AMA has made its statement, it should be no problem for state societies to do the same.

Combat MOC by opting out. Once the option is available, I encourage everyone to join NBPAS, until such time as the ABA recognizes that its constituency does not want or need what it is forcing on them.

Watch Paul Kempen's videos on all this here- http://changeboardrecert.com/moc-tv.html

Pass this information along to everyone you can, in all medical specialties.

 

[OB1🤙]

MOC, just like Milestones, was conceived out of a desire to convince, principally, CMS and Congress that medical credentialing wasn't a case of the fox guarding the henhouse. And this is a reasonable worry. If you want to propose blowing up MOC, then great. But you also need to come up with other strategies to allay regulators' fears.

Why is that a resonable worry? What was the problem that existed before MOC came along that needed to be solved?

If this was a drug or medical intervention, it would be rejected out of hand by everyone. It is an extremely expensive intervention that lacks proof of efficacy and is being aggressively marketed by its creators. All "evidence" to back it up is published by the entity that created it or by their paid consultants.

The excuse that this is just out there to allay regulators' fears doesn't fly with me.

NBPAS will probably ask for us to demonstrate active hospital privileges. Why? Because if you, previously board-certified physician, who participates in CME, is on a medical staff and has not been sanctioned by the peer-review process and have maintained your hospital credentials, it stands to reason that you are a competent physician.

That should be enough. For me, for the patients, and for the regulators.

 

[OB1🤙]

Hypothetical here.

What happens if your hospital chooses to allow NBPAS certification and you choose to do that and not participate in MOCA and then you later go looking for another job? You will no longer by ABA certified since your time limited certification will have expired. Will they make you go back and get additional residency training to again be eligible for ABA certification? Will you just have to redo oral and written boards? Would this restrict you to trying to find another job at a hospital that accepted NBPAS?

Seems like a bit of a risky maneuver to let your ABA certification expire since maintaining it with MOCA is easier than ever getting it back if you needed it.

No, if you have been previously certified and you let it lapse, NBPAS will certify you still. They would, however, require 100 hours of CME in the previous 24 months rather than the 50 hours they otherwise require.

 

[Mman]

No, if you have been previously certified and you let it lapse, NBPAS will certify you still. They would, however, require 100 hours of CME in the previous 24 months rather than the 50 hours they otherwise require.

You misunderstand.

I'm saying what if you leave your current gig and need ABA certification for your new job? If you let your ABA certification expire, you are essentially screwed and it's going to be painful to get it back.

So it's OK to be big and tough and get the NBPAS if your current hospital allows it and flip the bird to the ABA, just don't ever go looking for another job.

 

[OB1🤙]

Yes. That is a risk you would take, no question about it. So those who are very set and secure with their jobs and location could think about doing this. It would be very inadvisable for someone in a less-than-completely stable position, at least at this time.

Hopefully this becomes widely accepted and that won't be an issue. The only way to make that happen is a grassroots effort to encourage hospitals to accept this.

Look at the institutions represented by the NBPAS board. Harvard. Stanford. Mayo. NYU. Columbia. Scripps. UMass. Why should Average Hospital, USA not accept NBPAS if those institutions will?

Whoever agrees with this, forward the letter to your administration- http://nbpas.org/sample-letter/ .

 

[seinfeld]

After taking doing the simulator part of MOCA I have to say that some of our colleagues are NOT up to date and DO NEED to intermittent reminders of how to code a patient and how to critically think without turning into a yelling, frantic mess. I wish that given where our video game technology has come, that an Anesthesia video game (a type of simulator) could be made. Fun platform, would stress critical thinking, and repetition for rare events could be played out. I wish the simulator we less expensive and more wide spread.

I do NOT believe MC exams have any value once you are in practice. Bing and purge.
I do NOT believe practice improvement project are of any value, time to get creative and make stuff up

I DO believe that every anesthesiologist should be presented with new information that is critical to practice and demonstrate and understanding.

The hospital credentialing process, and malpractice system should be identifying those practitioners who fall consistently below the bar.

We need something to ensure practitioners are up to date, if we don't the payers (mainly the government) will tell us what to do.

Interestingly despite what physicians know is best practice, most studies on compliance rates with known beneficial therapies (think B blocker in heart failure, early abx in sepsis) are often not optimized. When the government starts withhold payments when not done all of a sudden compliance goes up. Therefore I am not a believer that all physicians are as motivated to read, study and learn as would be assumed based on "professional" obligation.

 

[criticalelement]

After taking doing the simulator part of MOCA I have to say that some of our colleagues are NOT up to date and DO NEED to intermittent reminders of how to code a patient and how to critically think without turning into a yelling, frantic mess. I wish that given where our video game technology has come, that an Anesthesia video game (a type of simulator) could be made. Fun platform, would stress critical thinking, and repetition for rare events could be played out. I wish the simulator we less expensive and more wide spread.

I do NOT believe MC exams have any value once you are in practice. Bing and purge.
I do NOT believe practice improvement project are of any value, time to get creative and make stuff up

I DO believe that every anesthesiologist should be presented with new information that is critical to practice and demonstrate and understanding.

The hospital credentialing process, and malpractice system should be identifying those practitioners who fall consistently below the bar.

We need something to ensure practitioners are up to date, if we don't the payers (mainly the government) will tell us what to do.

Interestingly despite what physicians know is best practice, most studies on compliance rates with known beneficial therapies (think B blocker in heart failure, early and in sepsis) are often not optimized. When the government starts withhold payments when not done all of a sudden compliance goes up. Therefore I am not a believer that all physicians are as motivated to read, study and learn as would be assumed based on "professional" obligation.

YOu have been officially brainwashed by the ABA and ABMS. What does yelling and frantic mess have to do with B blocker therapy .
MOC is untested and has very flimsy to no evidence behind it.
IF you want to improve a clinicians composure. A bull***multiple choice test is no way to go about it. It just will make the clinician MORE pissed off the next cycle. He/She will yell louder and will become increasingly more frantic the more exams you throw out there.

 

[seinfeld]

You were able to quote my post but you were unable to understand it. (One of my favorite seinfeld episodes was when Jerry was at the car rental place and they didn't have a car available for him. To paraphrase "you know to take a reservation but you have to HOLD the reservation, thats the most important part of the reservation"

Then again perhaps I am confused and don't understand your retort.

Beta Blockers have nothing to do with becoming unhinged during a Code. Practice , in this in the form of a simulator, can improve performance. Every single athlete practices to improve skills, improve muscle memory and compete at higher levels. Do we need evidence based data to show that? I am sure you're better at central lines and intubations after 1000 than after 10, right? How many times have you given dantrolene? Coded a csection for amniotic fluid embolism? Every day life tells me that the more i do it the better i become at it. Should it be as expensive, as limited in availability. NO. thats why I propose that someone smarter and more talented than me with computers designs a video game we can all play. Although not a perfect substitute its something. We physicians are not infallable.

 

[OB1🤙]

I agree with most of what you're saying, seinfeld. But I disagree that a single exposure to a simulator session will make an incompetent anesthesiologist competent, especially when you get credit for just showing up.

That is, despite the high cost of the simulation, the exercise is unlikely to remove poor physicians, and the single exposure won't make them magically better, so what value does it add to the health system?

 

[criticalelement]

You were able to quote my post but you were unable to understand it. (One of my favorite seinfeld episodes was when Jerry was at the car rental place and they didn't have a car available for him. To paraphrase "you know to take a reservation but you have to HOLD the reservation, thats the most important part of the reservation"

Then again perhaps I am confused and don't understand your retort.

Beta Blockers have nothing to do with becoming unhinged during a Code. Practice , in this in the form of a simulator, can improve performance. Every single athlete practices to improve skills, improve muscle memory and compete at higher levels. Do we need evidence based data to show that? I am sure you're better at central lines and intubations after 1000 than after 10, right? How many times have you given dantrolene? Coded a csection for amniotic fluid embolism? Every day life tells me that the more i do it the better i become at it. Should it be as expensive, as limited in availability. NO. thats why I propose that someone smarter and more talented than me with computers designs a video game we can all play. Although not a perfect substitute its something. We physicians are not infallable.

Hawaiian got it exactly right. If you suck, you are gonna suck before the test and after the test. Doesn't matter. One single exposure will not make you better. My friend went to one of the worst residency programs in the country. That is a fact. But he us better and has more composure and understands things better than most that went to ivy league institutions. How do you explain that?

 

[seinfeld]

Points well taken.

The question then remains, How do we as an Anesthesiology society ensure that all patients who need an anesthesiologist have a competent one that you can trust your own life with? Do we have to be better on the local level (medical staff ) policing our own.

 

[JustSomeMD]

There's video of a recent PA Medical Society meeting about MOC that everyone who has an opinion on MOC what certification needs to watch:
http://www.pamedsoc.org/MainMenuCategories/Education/MOC/Video-MOC-Debate.html



and is reported on by an attendee here http://jedismedicine.blogspot.com/2014/12/abim-has-lost-its-way.html

It just speaks to the misaligned incentive system that the 'Medical Certification Machine' has put into place which taints the entire process. What we currently have bears little resemblance to what we set out to achieve and certainly doesn't help the public in any tangible way. It just costs a lot of money and time while enriching an inbred sect of medical executives.

As a concept there's nothing wrong with MOC. Unfortunately the reality is that MOC has mutated in its implementation and has become a cancerous growth feeding off of the system instead of helping it. Fixing the problem will ultimately require not allowing the ABMS to have 100% marketshare in the "certifying physicians" game.

 

[criticalelement]

Readingand watching the above about MOC makes my blood boil......

“We have met the enemy and he is us!”

 

[criticalelement]

As a concept there's nothing wrong with MOC. .

As a concept, EVERYTHING is wrong with MOC. Everything my friend. Stop drinking the Kool AId and listening to the self serving and think independently please.

 

[Mman]

As a concept, EVERYTHING is wrong with MOC. Everything my friend. Stop drinking the Kool AId and listening to the self serving and think independently please.

There is nothing wrong with the idea that a physician should be required to continue to attain knowledge of the field as their career progresses in order to maintain their board certification.

 

[norwood]

There is nothing wrong with the idea that a physician should be required to continue to attain knowledge of the field as their career progresses in order to maintain their board certification.

Board certification should be a lifetime thing. Full stop. If it's good enough for the older docs, it's good enough for the younger ones.

Of the bad docs I've run across in my life, I say with complete confidence that I expect exactly 0% of them would fail MOC. Their problem isn't an inability to do onerous paperwork, it's an inability to take care of sick people.

 

[seinfeld]

Many people are saying MOC doesn't work as intended, well how do we get it to work as intended? Everywhere in life we have agencies that protect consumers such as the FAA and FDA. Should we stop having health checks for our restaurants because who would ever sell spoiled food to another human being? If we were not so bad at policing our own this wouldn't be such an issue. Anyone besides me have the experience of firing an attending because he/she was not competent or continued to make multiple poor decisions?

Overall we need a system that both assesses and improves/maintains cognitive and physical abilities to ensure the continuation of safe and effective care. Thats why i favor frequent required readings (not exams) similar to ACE/SEE questions. As well as some type of simulation. I reiterate how surprised i was that some people's ability/inability to handle fake life and death situations during my simulation course. I do admit that once every 10 years is probably not effective but if we work toward a cheaper more accessible simulation experience maybe it would be effective.

 

[inmyslumber]

There's video of a recent PA Medical Society meeting about MOC that everyone who has an opinion on MOC what certification needs to watch:
http://www.pamedsoc.org/MainMenuCategories/Education/MOC/Video-MOC-Debate.html



and is reported on by an attendee here http://jedismedicine.blogspot.com/2014/12/abim-has-lost-its-way.html

It just speaks to the misaligned incentive system that the 'Medical Certification Machine' has put into place which taints the entire process. What we currently have bears little resemblance to what we set out to achieve and certainly doesn't help the public in any tangible way. It just costs a lot of money and time while enriching an inbred sect of medical executives.

As a concept there's nothing wrong with MOC. Unfortunately the reality is that MOC has mutated in its implementation and has become a cancerous growth feeding off of the system instead of helping it. Fixing the problem will ultimately require not allowing the ABMS to have 100% marketshare in the "certifying physicians" game.

Trying to keep my SDN anonymity, but I was there also. Glad this was posted as I was surprised this meeting was not as well-attended as I anticipated.

 

[Mman]

Board certification should be a lifetime thing. Full stop.

So you believe a 30-40 year career should not require any additional learning beyond your residency training?

Got it.

And unlike you I have met board certified anesthesiologists from decades past that would/could/should update their knowledge base.

 

[OB1🤙]

Europe delivers high quality medical care. They don't have MOC. Why should that be?

Lawyers don't need to recertify. Why should that be?

Consultant physicians keep up with medicine. It's what we do, or we lose our patients and our jobs. I reject the idea that we require additional bureaucracy, at outrageous cost, to "prove" it, when that proof has no studied validity.

 

[Mman]

I reject the idea that we require additional bureaucracy, at outrageous cost, to "prove" it, when that proof has no studied validity.

If we don't regulate ourselves, somebody else will. And if regulating yourself is that passing your boards is a 40 year pass on ever taking another examination of any kind, well let's just say that probably won't go over well with non physicians.

 

[OB1🤙]

You haven't explained why we should, but European physicians or American lawyers shouldn't. They do just fine in Europe without this. Why should we beg to be regulated?

Again, if there was a cheap, simple, open book, online module covering recent landmark literature that diplomates needed to go through every so often and attest that they had, I'd be fine with that.

All the rest of it is total horsecrap. And at more than $4000 per 10 year cycle, it's ridiculously expensive horsecrap.

 

[JustSomeMD]

If we don't regulate ourselves, somebody else will.

This is one of the talking points that Baron of the ABIM keeps parroting. It's utter BS. There are more options than choosing from the lubed dildo vs the one that's been dipped in sand. Give me the option where a dildo isn't involved at all; if that's not an option I'm going to do my damnedest to make it an option. And to be frank, the ABMS has done such a terrible job and made such a mess of this that I'd welcome someone else taking it over. I call that bluff. Bring on the government boogeyman-- they're both didlos anyway.

Don't forget that the executives on the boards are not our peers. They may hold MD's but by the time they climb the executive ladder high enough to be on the boards of the ABIM/ABMS/ABA/ABP/etc they aren't doctors anymore, but parasites. They've lost sight of what doing this job entails and now they're just pushing paper and taking your money so they can justify their salaries. AND FOR WHAT PURPOSE? To satisfy some phantom demands by 'the public' that they cannot cite? Enough of this.

Where did we lose sight of the idea that medical school, residency, and medical PRACTICE taught us a self-sustaining skillset?

And BTW-- even though the ABIM and other boards and foundations are 'non-profit' organizations, they aren't 'certified' as such. There is something called the "Standards of Excellence" that accredited nonprofit organizations adhere to regarding ethics and fiscal stewardship and NONE of them are accredited. Shouldn't a certifying organization be certified themselves? Maybe if they were certified they would have had the ethical conscience not to buy a $2.3M condo for executive board use with public money?

http://www.pano.org/Resources/Fact Sheet2014.pdf

I'm partially serious about this. I'd love to hear the ABIM's rationale for why they don't certify with the PA Association of Nonprofit Organizatons, the state that they are domiciled in. Too expensive? Too time consuming? Not relevant to their mission?

Hypocrites.

 

[JustSomeMD]

And unlike you I have met board certified anesthesiologists from decades past that would/could/should update their knowledge base.

And MOC will not change that in the future.

 

[JustSomeMD]

Many people are saying MOC doesn't work as intended, well how do we get it to work as intended?

Physician licensure should be left to the states entirely. There should be no centralized governing body such as the ABMS or any of its specialty boards. Each state should 100% decide what they need/require their physicians to do to be licensed and that is the reality. The ABMS boards are a redundant system that accomplishes nothing for patients or physicians and has all of the authority of a novelty "Federal Chick Inspector" badge.

Let me point out a short Twitter discussion I had with Dr. Robert Centor:


So we have a physician who is publicly on record RECOMMENDING AGAINST VACCINATION in the face of a measles outbreak and carries the ABIM's seal of approval as a Boarded physician complying with MOC. Is that system working well?

The ABIM wants the public to make sure that their physicians are certified ostensibly so that they will get the best medical care and advice, right? And we have an utter fail here, right? And according to somewhat of an authority in Dr. Centor he doesn't think it's an ABIM's issue, but maybe a medical board issue (I assume he meant state medical board). So why have ABIM MOC if the state board is left to clean up after this guy's mess anyway? What exactly is the ABIM certification adding here? What is it proving?

It proves he can take a test and pass it and jump through MOC hoops. It doesn't rule out that he's nuts or stupid in other ways or immoral or unethical or otherwise fit to practice.

I know I'm picking one instance of the ABIM failing and that doesn't imply that their system is necessarily entirely broken (though I believe it is). I AM pointing out that they aren't accountable to anybody at all. If they had some balls and went after this guy and threatened to de-certify him I could see an argument that they are true to their state mission about protecting the public interests.

But they won't. You know why? They're chicken-s***. This guy will sue them if they tried that and he would win. Because they have no real authority and don't want any. They have no clothes. They are not built to take action and thus not true to their claimed mission. They just want to float above the fray and collect their tithe from their 'flock' without contributing anything useful back. It's the classic mob protection racket and it needs to stop.

Now, if it costed $5 and took 5 minutes, I wouldn't say anything about it because it wouldn't be worth the hassle. When you start to get to $2000 and 300 hours of my life-- I'm going to start taking a closer look at it.

As far as medical care goes, residency should be the only real credential. MOC is entirely nonsense. Initial certification was only intended to prove that a physician completed specialty residency/fellowship (which is why jobs would advertise for Board Certified or BOARD ELIGIBLE physicians). I don't think anyone is going to make a case that a general internist should be able to get a job as a cardiologist without doing a fellowship. You may not have noticed but the ABMS made a point to say that you can no longer claim to be board eligible for your entire career; that if you don't pass the boards within 7 years of residency you aren't eligible to sit for them and thus cannot claim to be board eligible. They closed that loophole about 7 years ago in anticipation of their MOC plans.

Any credentialling beyond proving successful completion of residency is extraneous.

 

[seinfeld]

On most levels we are saying the same thing, MOC fails because it doesn't do what it is supposedly telling the public it does, ensure Physicians are competent. But taking an exam once in a lifetime does not ensure ongoing physician competency. The fact of the matter is that we don't like policing ourselves because we never know on which side we will be, after all we are all fallible and it only takes one missed thought or bad decision to go from King to peasant.

 

[OB1🤙]

MOC is a tax. Unfortunately, it's a tax that we have imposed on ourselves, and until this point we have shrugged our shoulders and accepted it.

We have probably assumed that the people in charge of this had good evidence for it, and had our best interests in mind.

But it turns out there's no evidence, it doesn't benefit us or the patients in any real way, and makes the boards a TON of money. The ABA increased its annual income from certification exams from $5.6 million in 2005 to $12 million in 2012 and climbing. I don't think the anesthesiology workforce has doubled since then, so this is clearly driven by MOCA revenue. Meanwhile, the academic centers that administer the simulation "exams" (and don't get me started on what a BS racket that is) rake in tons of money from that as well.

Take a look at the ABA's tax returns for yourself- https://www.citizenaudit.org/060646523/

 

[JustSomeMD]

On most levels we are saying the same thing, MOC fails because it doesn't do what it is supposedly telling the public it does, ensure Physicians are competent. But taking an exam once in a lifetime does not ensure ongoing physician competency. The fact of the matter is that we don't like policing ourselves because we never know on which side we will be, after all we are all fallible and it only takes one missed thought or bad decision to go from King to peasant.

The exam doesn't ensure competency and was never intended to. It was just a marker to show that you completed residency which meant that you had additional training in your specialty.

Nothing ensures competency in anything. Ever.

As I added to my last post, completing residency is as good as it will get in terms of putting forth good medical care.

Yes, there's room for improvement. There always will be. The question for any improvement program in ANYTHING is going to be "Does the expense, opacity, and acceptability of the proposed plan justify the amount of improvement?" MOC fails on all three points and we've arrived at this crisis point by an unfortunate but inevitable backslide. This will always happen in any regulatory situation and it's hard to figure out where it went wrong.

For example:

Let's look at licensing drivers. I don't have numbers, but I'd venture to guess that car accidents kill/maim more people than doctors do per year by a larger margin. We should improve on that, right? So I will establish a drivers license maintenance program. I first decide that a good number of car accidents are attributed to not understanding the rules of the road. So, I will certify a driver as licensed if they pay a $5 fee to go onto my website where I have a 20 question quiz on the rules of the road. Pass it and you get my stamp of certification (for life!). This is a 100% VOLUNTARY program. To encourage participation, I have arranged with several car insurance companies to give you a discount on your car insurance if you get certified by me as you have demonstrated that you understand how important it is to be a good driver. Additionally, if you have points on your license from previous driving violations, completing the quiz will knock a point or two off.

So we start the program. Running the website costs $50,000 per year so I need >10,000 people to do the quiz to start making money. The first year 10,000 people do the survey so I break even. Year #2 70,000 do it so I make $20,000. Year 3 I make $50,000, and at some point, let's say that I make $100,000 per year and that's a steady income for me. I'm happy to do this as I am making money and helping the public, the people who do the quiz are happy as they are saving money on insurance and points off their license. And it's voluntary, so if you think it's stupid/don't need the points or discount on insurance, you don't have to do it.

But people are still getting in car accidents! I read about a man who crashed his car when he had a stroke. I decide that some people have strokes while driving and lose control of their car. High blood pressure is associated with strokes. So I decide that you have have someone check your blood pressure and people who take the quiz from now on need to enter their BP. I don't tell them this, but if it's 'too high' I will fail them on the quiz (no matter if they get the questions right) so they don't get to be certified and they don't get their $5 back. Oh well-- it was voluntary anyway and $5 isn't much, so there are very few complaints.

Well I haven't solved the car accident problem. They are still happening! And on forums, people are talking about the blood pressure question and are comparing notes and they figure out that I am failing people who have high BP. So they start retaking the quiz and enter 110/60 for their BP, lying.

So I begin to notice that the number of people who have high BP who take the quiz have dropped dramatically. That doesn't make sense. Aha! People have caught on to the BP issue and are lying about their BP. Maybe that's why people are still getting in car accidents. Now I will require that they get their BP checked, signed by their physician, and have the result notarized and faxed to me. So now I need to hire someone to man the fax machine and process the new paperwork; so the test fee goes up to $10 to pay that person (of which I only pay them $2 per quiz and I keep the other $3). Around this time, my "Safe Driver" certification program has achieved critical mass-- a lot of people do it and the car insurance companies have noticed. So they start thinking it's weird when people aren't certified by me. Are those non-certified drivers bad? They must have flunked my test! If you don't know the rules of the road, you can't be a very good driver! So they raise insurance rates on non-certified drivers.

You see where this is headed. At this point, the public is either paying more for car insurance or paying me to get certified. And once I get to this point, I can do whatever I want-- add more health screening tests, make the quiz longer, hire psychometricians to fortify my quiz characteristics, decide that you need to re-take the quiz every 3 years in order to maintain driver certification (no more lifetime certification!), increase the quiz fee to cover those costs (as far as you know. But maybe it's because my board has compared what other CEOs at other companies make and they needed to raise the quiz fee to bring my salary up to the average CEO salary. Of course, I'm the one who appointed all of the board members, so they're trying to make me happy. BTW-- this is how Richard Baron justifies his million dollar salary at ABIM in the youtube videos I posted above VERBATIM) all because people are still getting in car accidents. And as silly as I made this sound, this is the EXACT evolution that board certification has followed. The $5, 20 question one-time quiz that 'seemed like a good idea' can morph into a $200, 100 question quiz which requires a notarized full physical exam (at your expense) that needs to be repeated every 3-5 years. Is my "Safe Driver" program at any stage helpful? Maybe a little (because there are going to be some people who can't pass the 20 question quiz and shouldn't be driving). Was there a point where the program was grossly unjustified? Well, car accidents kill a lot of people and knowing the rules of the road are important, so I don't think so. Should it be stopped when it starts costing $200 every 3 years? Absolutely-- but good luck getting rid of it now that the car insurance companies have found a tool to raise rates.

And what are the chances we'll stop 100% of car accidents by this or any other program?

 

[norwood]

So you believe a 30-40 year career should not require any additional learning beyond your residency training?

Got it.

And unlike you I have met board certified anesthesiologists from decades past that would/could/should update their knowledge base.

Oh, I didn't say I haven't met any anesthesiologists who lacked knowledge. I just said I didn't think MOC would stop them. It will stop all the wrong people, line all the wrong pockets, and hinder good patient care.

If it's so important, let ABMS provide it for free, permanently. Until they do it, it's just a cash grab.

But clearly, you disagree. So please clarify for us: how will the sim center requirement, for example, protect patients? Is there any evidence behind this $1500 requirement, other than the plain evidence that centers with shiny new sim equipment would like more customers?

 

[Mman]

b.

But clearly, you disagree. So please clarify for us: how will the sim center requirement, for example, protect patients? Is there any evidence behind this $1500 requirement, other than the plain evidence that centers with shiny new sim equipment would like more customers?

Perhaps you haven't read what I've actually posted. I've not said anything pro or con to the current setup. I'm merely stating that some form of continuing education and MOC is necessary. As a profession we are obligated to it and if we don't do it ourselves, outsiders will do it to us.

 

[Mman]

You haven't explained why we should, but European physicians or American lawyers shouldn't. They do just fine in Europe without this. Why should we beg to be regulated?

We aren't begging to be regulated, we are regulating ourselves. As for "European physicians", you sure about that? England calls it revalidation. Other countries have similar things to.

Lawyers? Really? Is that your example we should strive for? Besides I think it's fairly obvious that the medical care of patients changes at a far faster pace than how the legal system operates.

 

[deleted50478]

The only worthwhile part of MOC is CMEs and those are already required for maintaining your state license. In other words MOC provides NO ADDED VALUE.

 

[Mman]

The only worthwhile part of MOC is CMEs and those are already required for maintaining your state license. In other words MOC provides NO ADDED VALUE.

Do CME's provide any value at all? I mean some of them can if you choose to. But I can fulfill every CME requirement without learning a thing if I so choose because those can be just as big a scam. I guess it's a scam both ways, though, since I can take tax free vacations to do it.

 

[seinfeld]

Doctors are scientists who focus on independence and Intelligence. The public doesn't care how smart or independent you are ,they only want the best care.

Those who disapprove of any form of MOC fail to realize the fear that the average person has when receiving care. Choosing between 2 pilots both just as experienced, one who has completed 1000 hours of simulation focusing on unusual flying conditions versus one who completed none, who would you want to fly the plane? If you had a restaurant who was inspected by the local heath dept and passed versus one who never gets inspected, which would you choose? Considering that if you kill someone in a car accident you could go to jail , should not there be a system to give drivers the best chance at being safe?

I dont disagree that the current system doesn't work, is too expensive, and lacks in data regarding practice improvement. If we don't figure something out ourselves the government will surely create more regulation. As bad as the ABA is I would rather have other anesthesiologists deciding what may or may not be useful versus a politician with a law degree.