NBPAS- Opt Out of MOC

[deleted50478]

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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.

That's fine but they should respond to feedback and get rid of simulation at the very least.

 

[JustSomeMD]

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.

Again, this is a baseless talking point argument that the ABMS boards like to use. Choose from the lubed or the unlubed dildo.

I choose neither. On second thought, I call that bluff-- bring on the government regulators; they can't be any worse or less responsive than the ABMS has been.

And point number 2 is that the current executives making these decisions are on par with the politicians with law degrees that you say you don't want making these decisions. They are often politicians with a law degree and medical degree as well. They're no better. See Lois Nora, MD, JD, president/CEO of the ABMS who, as of the day she assumed the top job overseeing the entire ABMS, was not enrolled in MOC.

 

[OB1🤙]

Here's the thing- the lay public has NO IDEA what board certification is, what it means, and how you get it. NO IDEA.

They especially don't know what recertification is.

You hear a lot from the boards about all this public demand for board certification. Where is it? Show me the demand. IT ISN'T THERE. They don't know what it is, let alone demand it.

 

[norwood]

You hear a lot from the boards about all this public demand for board certification. Where is it? Show me the demand. IT ISN'T THERE. They don't know what it is, let alone demand it.

Seriously. The same public that can't tell an MD from a CRNA is supposed to suddenly be fascinated with the minutiae of our board certification?

 

[Psai]

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.

My parents have been going to a DO and didn't know that their doctor was a DO. I've never chosen between pilots, never even thought about how much simulation training they had. I just buy an airplane ticket and go to wherever I have to go, depending on price and availability. Similarly, I don't care about health department regulations as long as the food tastes good and the price is right. MOC is an expensive waste of time

 

[Mman]

Seriously. The same public that can't tell an MD from a CRNA is supposed to suddenly be fascinated with the minutiae of our board certification?

It's irrelevant what the public thinks. If we don't regulate ourselves, somebody else will. And that somebody else will make it more expensive and more painful and probably even less useful.

 

[deleted50478]

It's irrelevant what the public thinks. If we don't regulate ourselves, somebody else will. And that somebody else will make it more expensive and more painful and probably even less useful.

We can regulate ourselves without expensive pointless simulation training. A computer simulation online, like ACLS and PALS online but with anesthetic emergencies, would provide any simulator benefit at less than 5% of the cost.

 

[Mman]

We can regulate ourselves without expensive pointless simulation training. A computer simulation online, like ACLS and PALS online but with anesthetic emergencies, would provide any simulator benefit at less than 5% of the cost.

Then go design that system. Sitting back and complaining about the current setup doesn't help fix the problem. If you dislike it, work on making it better.

 

[deleted171991]

Apparently the Internal Medicine board is listening and already changing things: http://www.kevinmd.com/blog/2015/02/abim-announces-immediate-changes-moc-program.html

Dear Internal Medicine Community:

ABIM clearly got it wrong. We launched programs that weren’t ready and we didn’t deliver an MOC program that physicians found meaningful. We want to change that.

ABIM is listening and wants to be responsive to your concerns. While ABIM’s Board believes that a more-continuous certification helps all of us keep up with the rapidly changing nature of modern medical practice, it is clear that parts of the new program are not meeting the needs of physicians like yourself.

We got it wrong and sincerely apologize. We are sorry.

Emphasis theirs, not mine.

 

[seinfeld]

Yes, these are the ideas that I am talking about transitioning to. You could even make it fun, have patient safety, SEE, ACE questions mixed in. It would Cheaper (mainly from lack of travel requirements), easily accessible but still requires one to go through the paces. There has to be some Anesthesia person out there who can write code for a video game style CME.

Can you imagine how forward thinking and 'cool' is would be to play a game and earn CME. I have the idea but no expertise to make it happen. Remember day 2 of Step 3 when we had to do those clinical scenarios? I would love to move my Avitar around the operating room having to find the issue, have a surgeon or CRNA ask me questions from SEE or ACE, or be part of a resuscitation, and then debrief by answering questions. CME credits could be based on how many points you achieved.

Go with me on this. You see a patient preop for a lap appy, you review this hx and do a physical exam. You learn the patient has a hx of anaphylaxis to zemuron. An article then pops up about latest review of anaphylaxis under anesthesia. You read the article, answer 3-5 questions. Once complete you click ready to move to OR. Patient go to OR, you prescribe the induction and then on induction you discover an unanticipated difficult airway. You work through algorithm as you would normally. After that another article pops up reviewing the the ASA difficult airway chart. Articles and questions about mask ventilation and difficult airways are answered. Then as the case proceeds uneventful, you get a lose of wall Oxygen warning more questions. But all along the patient reacts as it would be expected, ie desaturation with loss of oxygen, Low BP with too much gas or hemorrhage.

We will have an easier time molding MOC into what we want if we act on the premise of "what can we do to improve the care we deliver patients". The public and more importantly the politicians/advisory boards would buy it . Start this process with an eye on being data and outcome driven and then we know what exaclty works and doesnt. If we are to create a new board certification process it has to have value to get hospitals and DNV/JACCHO to buy in, so make it better for all not just less work for us.

IDK, i get what eveyone is saying is bad about MOC, but what I see bad about it is the cost, the busy work, and the lack of real feedback education.

 

[GA8314]

I don't know why the country with the worst malpractice system in the civilized world needs MOC. If you harm the patient, and even if you don't, you get punished big time in court. So what's the need for MOC, when there is a way bigger incentive to be well-prepared professionally?

I read regularly not because of MOCA or bureaucrats, but because I don't want to make any mistake, and I want to offer my patients the best care (in that order). Besides intellectual curiosity, of course.

FFP, do you have a go-to text which you like to read? You mentioned in another thread that you love reading about anesthesiology and that it's very interesting to you.

Do not get me wrong, I love my profession. I do read quite a bit, and regularly as well. I was just impressed by the way you phrased it all and was wondering what you're reading these days. Online? Journals? Texts? All of the above?

One of the aspects of being an attending I'm really enjoying is reading for a more PURE sense of intellectual curiosity and more focused reading as pertains to my practice.

 

[OB1🤙]

Apparently the Internal Medicine board is listening and already changing things: http://www.kevinmd.com/blog/2015/02/abim-announces-immediate-changes-moc-program.html



Emphasis theirs, not mine.

That is fantastic.

We all need to write to the ABA and demand a similar immediate change.

 

[OB1🤙]

seinfeld, I agree with that direction.

If the ABA stripped this whole thing down to an interactive online module, AND NOTHING MORE, I would be behind that.

No simulator. No PPAI bullcrap. No high-stakes secure exam. Just a meaningful, useful online module to refresh and reinforce recent landmark literature.

I'd be down with that.

The big question is- would they be willing to give up their revenue stream from all this stuff to show that to happen?

Until I see it myself, I am very skeptical they'll do it. The money is just too good for them under the current system.

 

[norwood]

Then go design that system. Sitting back and complaining about the current setup doesn't help fix the problem. If you dislike it, work on making it better.

Do you honestly think ABA would approve it as an MOC exercise? I have to say I'd be surprised.

 

[painstop]

Do you honestly think ABA would approve it as an MOC exercise? I have to say I'd be surprised.

Actually I was at the last ASA Practice Management Conference in Atlanta and the current president of the ASA stated that the ABA is considering switching the in-person simulation to a "high-fidelity" simulation (I think that was the verbiage he used, which in my mind corresponds to an online format). After the ABIM's admission of their abysmal failure, hopefully we see an announcement about this soon.

 

[Noyac]

Yes the ASA is planning to unveil some changes. But now that the ABIM Has opened the door to full accountability of wrong doing, I sure hope the ASA's statement on new format is drastic or else it will be completely overshadowed by the ABIM' s statement of failure, complete failure.

 

[OB1🤙]

NBPAS is now live for anesthesiology.

 

[G0S2]

My application is in.