Rand Paul Chooses National Board Of Ophthalmology Certification instead of ABO

[exPCM]

Rand Paul's Doctor Credentials Questioned for Lacking Top Board's Certification

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LOUISVILLE, Ky. -- Rand Paul, who touts his career as a Kentucky eye doctor as part of his outsider credentials in his campaign for U.S. Senate, isn't certified by his profession's leading group.

He tried Monday to bat away questions about it by calling it an attack on his livelihood, saying the scrutiny stems from his challenge of a powerful medical group over a certification policy he thought was unfair.

The libertarian-leaning Republican helped create a rival certification group more than a decade ago. He said the group has since recertified several hundred ophthalmologists, despite not being recognized the American Board of Medical Specialties -- the governing group for two dozen medical specialty boards.

Questions about Paul's certification as an eye surgeon first arose in a story published Sunday in The Courier-Journal of Louisville.

Paul, who is continuing to practice in Bowling Green during the campaign, chafed Monday at questions about his certification.

"It's a personal assault on my ability to make a living," Paul told The Associated Press in a telephone interview.

Paul, whose father, Ron Paul, is a Texas congressman and former presidential candidate, said he is a good physician with thousands of patients. Paul casts himself as a political outsider spent years building his medical practice in Bowling Green before making his first run for elective office.

By focusing on an internal struggle within his profession, he said, "you vilify me and make it out to sound, 'Oh, ... there's something wrong with him as a physician because he chose not to register" with the American Board of Ophthalmology.

Paul said he helped formed the rival group because the established organization exempted older ophthalmologists from recertification. He likened it to members of Congress passing laws that don't apply to themselves.

The campaign for his Democratic rival, Kentucky Attorney General Jack Conway, said the episode raises serious questions about Paul's character. Conway's campaign said it shows Paul doesn't want to be held to the same standards as other doctors.

"It is clear that Rand Paul does not think the rules apply to him," Conway campaign manager Jonathan Drobis said in a statement Monday.

Paul, a graduate of Duke University's medical school , said he was board certified under the American Board of Ophthalmology for a decade. Paul has been licensed to practice in Kentucky since 1993.

In the late 1990s, Paul was a driving force behind forming the National Board of Ophthalmology to protest the ABO's exemption policy.

"I don't think that some people should recertify and others shouldn't," he said. "And I don't choose to give my money to a private group that discriminates."

Paul has been certified through the National Board of Ophthalmology since 2005. He is listed as the group's president; his wife, Kelley, is listed as vice president; and his father-in-law is listed as secretary. Paul and his relatives receive no salaries from the organization, his campaign said.

Beth Ann Slembarski, administrator for the American Board of Ophthalmology, said less than 5 percent of the nation's practicing ophthalmologists aren't certified through her organization.

Slembarski said that certification through the ABO reflects "an extra commitment by physicians to demonstrate their knowledge and skills in this specialty."

Before 1992, ABO certification had no expiration, she said. After that, it started issuing certifications that lasted 10 years, but ophthalmologists certified before 1992 were grandfathered in, meaning they didn't have to be recertified.

Neither group has anything to do with medical licensure, which is handled by state boards.

Paul shrugged off his group's lack of recognition by the American Board of Medical Specialties.

"Do you think that they're going to recognize a competitor?" he said.
http://www.foxnews.com/politics/201...lacking-boards-certification/?test=latestnews

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[ronaldo23]

In addition, this politico article has additional details about the battle rand fought in the 90s against the ABO.

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"Randy" Paul had been a "friendly pleasant good resident - nothing special, but nothing negative," recalled Dr. Bruce Shields, who had been a professor and mentor of Paul's at Duke University, and then served on the ABO board. Suddenly he was writing "militant" letters to the board, threatening secession, and "challenging the establishment of medicine."

Paul invoked the same deep belief in the freedom of private organizations that nearly derailed his campaign when, soon after winning the nomination, he briefly defended the rights of private businesses to discriminate by race.

"ABO is a private group and creates any rules they wish (even discriminatory policies based on age)," he said. "Having all its members recertify is not illegal -- just impractical, because the older ophthalmologists will vote against it."Paul wasn't the only one to object.


ABO "is besieging ophthalmology" and "should be stopped before it sows such terrible disunity that our profession never recovers!" wrote a Florida opthamologist, Stanley Braverman, wrote in 2004. Braverman, Paul, and others also attacked the organization's motives. It was more interested, they said, in self-preservation than the quality of medical care.

Paul's hostility to the change, his uncompromising tone, and his public campaign against his profession's leaders took them by surprise, and won him abiding enmity at the top of his profession.

Dr. Wilkinson recalled "nasty letters to the board" and a "very very negative tone" from Paul. (ABO accepted a written request for Paul's letters, but didn't respond immediately."

"He attempted to organize a rump group of malcontents to oppose the whole thing and to stick their heads in the sand," said Wilkinson
.
"He was trying to paint the board in a pretty dark light," recalled Dr. Denis O'Day, an ophthalmologist at the Vanderbilt Eye Institute in Nashville who was its executive director through the recertification battle and recalled being "under attack" from Paul.

"He felt that the position I was taking was wrong and he had no hesitancy in saying that," O'Day said

And in the end, Paul lost.

For all Paul's passion, his National Board remains something like the Libertarian Party of ophthalmology. Registered in Kentucky and governed by Paul and two family members, it continues – Paul spokesman Jesse Benton said – to run a formal, confidential recertification process for ABOP dissidents that is much like that of ABO itself. The group has no website and no public presence, but it most recently recertified a doctor just two weeks ago, Benton said. Paul, in his statement, suggested that the American Board of Medical Specialties had refused to embrace his rival group to protect ABOP, one of it charter members, though there's no evidence Paul ever seriously sought formal recognition.

The National Board of Ophthalmology "never quite caught fire like Rand and the 200 other ophthalmologists had hoped, but it continues to offer quality, trustworthy certifications for ophthalmologists," said Benton. (A spokesman for the Bowling Green hospital where Paul practices suggested to the Courier-Journal that his certification isn't a concern.)

As for the shift to what's called maintenance of certification, "the debate's over – we're in the implementation phase," said O'Day, Paul's old antagonist.

Paul's admirers and his critics alike see the war with the ABO as a window into the candidate's deeply anti-Establishment politics.

"It speaks to the kind of person that Rand is," said Benton, the spokesman. "He doesn't like the arbitrary and unfair use of power. He likes fairness, he likes equality under the law, and when these older opthamologists used their power to turn things in their favor, Rand stood up." "


http://www.politico.com/news/stories/0610/38530_Page3.html

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[orbitsurgMD]

In addition, this politico article has additional details about the battle rand fought in the 90s against the ABO.

"

"Randy" Paul had been a "friendly pleasant good resident - nothing special, but nothing negative," recalled Dr. Bruce Shields, who had been a professor and mentor of Paul's at Duke University, and then served on the ABO board. Suddenly he was writing "militant" letters to the board, threatening secession, and "challenging the establishment of medicine."

Paul invoked the same deep belief in the freedom of private organizations that nearly derailed his campaign when, soon after winning the nomination, he briefly defended the rights of private businesses to discriminate by race.

“ABO is a private group and creates any rules they wish (even discriminatory policies based on age),” he said. “Having all its members recertify is not illegal -- just impractical, because the older ophthalmologists will vote against it.”Paul wasn’t the only one to object.


ABO “is besieging ophthalmology” and “should be stopped before it sows such terrible disunity that our profession never recovers!” wrote a Florida opthamologist, Stanley Braverman, wrote in 2004. Braverman, Paul, and others also attacked the organization’s motives. It was more interested, they said, in self-preservation than the quality of medical care.

Paul’s hostility to the change, his uncompromising tone, and his public campaign against his profession’s leaders took them by surprise, and won him abiding enmity at the top of his profession.

Dr. Wilkinson recalled “nasty letters to the board” and a “very very negative tone” from Paul. (ABO accepted a written request for Paul’s letters, but didn’t respond immediately.”

“He attempted to organize a rump group of malcontents to oppose the whole thing and to stick their heads in the sand,” said Wilkinson
.
“He was trying to paint the board in a pretty dark light,” recalled Dr. Denis O’Day, an ophthalmologist at the Vanderbilt Eye Institute in Nashville who was its executive director through the recertification battle and recalled being “under attack” from Paul.

“He felt that the position I was taking was wrong and he had no hesitancy in saying that,” O’Day said

And in the end, Paul lost.

For all Paul’s passion, his National Board remains something like the Libertarian Party of ophthalmology. Registered in Kentucky and governed by Paul and two family members, it continues – Paul spokesman Jesse Benton said – to run a formal, confidential recertification process for ABOP dissidents that is much like that of ABO itself. The group has no website and no public presence, but it most recently recertified a doctor just two weeks ago, Benton said. Paul, in his statement, suggested that the American Board of Medical Specialties had refused to embrace his rival group to protect ABOP, one of it charter members, though there’s no evidence Paul ever seriously sought formal recognition.

The National Board of Ophthalmology “never quite caught fire like Rand and the 200 other ophthalmologists had hoped, but it continues to offer quality, trustworthy certifications for ophthalmologists,” said Benton. (A spokesman for the Bowling Green hospital where Paul practices suggested to the Courier-Journal that his certification isn’t a concern.)

As for the shift to what’s called maintenance of certification, “the debate’s over – we’re in the implementation phase,” said O’Day, Paul’s old antagonist.

Paul's admirers and his critics alike see the war with the ABO as a window into the candidate's deeply anti-Establishment politics.

"It speaks to the kind of person that Rand is," said Benton, the spokesman. "He doesn’t like the arbitrary and unfair use of power. He likes fairness, he likes equality under the law, and when these older opthamologists used their power to turn things in their favor, Rand stood up." "


http://www.politico.com/news/stories/0610/38530_Page3.html

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He has created a board of one. Unfortunately many hospitals require a certification by a board that is recognized by the ABMS, the board of boards. The National Board of Ophthalmology board is not.

I don't like the fact that the ABO grandfathered in older members either, and they could have done more for the time-limited certificate holders to distinguish the more recent certificates from the grandfathered ones. If the time-limited certificates are in fact for the purpose of promoting higher standards among the holders than existed under the terms enjoyed by the unlimited certificate holders, then those who have met those standards should be better recognized for having met the higher standard. The ABO did not bother to do that, and in fact, to the untutored, a time-limited certificate might seem less valuable and of lower merit than one that is of unlimited term. It would not have been that hard for the ABO to create a distinctive certificate for those who met the new standard (other than one that has an expiry date); if American Express can do that I don't see why the ABO couldn't. And no one is excluded from the new certification; anyone is allowed to re-certify, including the "grandfathered" certificate holders, if they chose to, but it is only those with the time-limited certificates that are required to do so every ten years.

The re-certifying members are paying the freight at the ABO, both with the high fees they pay for initial certification and through the MOC fees. It is truly disturbing to see how the older members, who contribute nothing toward the revenues of that private organization have held so much sway.

 

[PBEA]

ouch! why don't you tell us how you really feel . This is a bit off-topic, but I like to hear this kind of discussion because Optometry is also considering some kind of MOC, etc. Now w/o questioning any motives and avoiding any innuendo, I'd just like to hear what you as an OMD feel about the value of MOC, etc. I've read alot of heartache and hand wringing by various physician groups, and want more personal comments and perspective. Are you decidely supportive of such? I hear lots of people talk about the benefit to patients, etc, but I'm not convinced. On the surface it sure sounds beneficial, but isn't this just another set of tests on mainly academic minutia, or esoteric topics? How clinically relevent were your re-cert tests? I've heard many complain that it wasn't necessarily hard, but not really useful either. I've also heard that much of this amounts to a "cash grab" for the administering parties, and have actually felt that way myself. Any/all comments welcome.

 

[gaspasser2004]

Rand Paul's fight about recertification has implications across the medical specialties. I'm not an opthamologist, but I am a board certified anesthesiologist who participates in MOC (graduated residency in 2008).

For the older members of my specialty and opthamology, I can see their perspective about their unlimited certificate. They were promised an unlimited certificate when they certified. It is wrong to go back and take away what was rightfully promised to them.

For the younger members of my specialty and those older members who choose to voluntarily recertify, I can see their perspective too. A time-limited certificate subject to recertification has more value than a 30 year-old certificate collecting dust. Those participating in MOC have made a commitment to life-long learning and advancing self growth in their practice.

The solution to this problem is time. Over time, practitioners who hold time unlimited certificates will retire from practice. The younger practitioners who hold time limited certificates will start to populate the executive medical staff and credential boards of hospitals. Eventually, everyone will be required to recertify their board certification for hospital privileges. It is already happening at some hospitals for leadership positions (at Walter Reed, the anesthesia speciality division chiefs have to recertify to keep their posts, even if they have a time unlimited certificate). Furthermore, the practitioners who will then be in their 60's and 70's will look even more ridiculous when they refuse to recertify.

 

[cme2c]

ouch! why don't you tell us how you really feel . This is a bit off-topic, but I like to hear this kind of discussion because Optometry is also considering some kind of MOC, etc. Now w/o questioning any motives and avoiding any innuendo, I'd just like to hear what you as an OMD feel about the value of MOC, etc. I've read alot of heartache and hand wringing by various physician groups, and want more personal comments and perspective. Are you decidely supportive of such? I hear lots of people talk about the benefit to patients, etc, but I'm not convinced. On the surface it sure sounds beneficial, but isn't this just another set of tests on mainly academic minutia, or esoteric topics? How clinically relevent were your re-cert tests? I've heard many complain that it wasn't necessarily hard, but not really useful either. I've also heard that much of this amounts to a "cash grab" for the administering parties, and have actually felt that way myself. Any/all comments welcome.

Personally I don't see the MOC process of improving patient care much in my situation. As someone who practices general opthalmology, I think I could pass the MOC test with ease, so I won't go studying much for it. I can see how the test could force someone in say retina to study a bit, since I believe you have to choose two subject areas. The recert exam for ophthalmology is not a rehash of the minutia, it is very clinically oriented. I think the CME requirements for MOC are a little more than my state is for maintaining license, so in that sense some may be forced to get more hours of CME, but I get plenty of CME, so that doesn't affect me.

I do think the biggest issue is the hypocrisy. To say that MOC is a necessary thing blah blah blah... and to cave and not make everyone recertify just seems slimy. I actually admire Paul for standing up for that. In my opinion it would be different if the test was tougher, but as it is, it kind of seems like a grab for money.

 

[ronaldo23]

to the older opthamlogists...was this a big issue in the 90s when the board decided to grandfather older people in and require everyone else to recertify every 10 years? In response to criticism, Rand claims he led a nationwide protest that was well publicized in the medical community in the 90s.

 

[200UL]

Rand Paul is a bit crazy, but the ABO should have made everyone take the test.

As ophthalmologists, we should be pushing for certification / re-certification by testing. To sit for the written boards, one must complete an accredited residency. To sit for the oral boards, one must pass the written boards. This process is one of the many factors that distinguishes us from optometry. It proves that those that hold the certification have knowledge. I know re-certification pass rates for the MOC are high, but the written an oral boards are no joke with high failure rates. Finally, if one cannot pass the MOC exam, they should not be practicing in my opinion.

While Rand Paul had a point, his board is irrelevant.

 

[Mirror Form]

The re-certifying members are paying the freight at the ABO, both with the high fees they pay for initial certification and through the MOC fees. It is truly disturbing to see how the older members, who contribute nothing toward the revenues of that private organization have held so much sway.

Rand Paul's got my vote now. If the ABO got funding from the government to pay for all these exams, then that would be one thing. But as a young ophthalmologist, spending thousands and thousands of dollars on these exams is a burden. And it just doesn't make sense when medicaire continues to reduce our income toward that of a teacher's salary. It's all about increasing the ABO's bottom line at the expense of the physicians as usual.

My theory: in 20 years from now when all the people who were grand-fathered in have retired, the re-cert exams will be significantly tailored back.

 

[bucknut101]

Rand Paul's got my vote now. If the ABO got funding from the government to pay for all these exams, then that would be one thing. But as a young ophthalmologist, spending thousands and thousands of dollars on these exams is a burden. And it just doesn't make sense when medicaire continues to reduce our income toward that of a teacher's salary. It's all about increasing the ABO's bottom line at the expense of the physicians as usual.

My theory: in 20 years from now when all the people who were grand-fathered in have retired, the re-cert exams will be significantly tailored back.

I agree completely. Spending $1800 to register for each of these exams is quite high. And that doesn't even include the travel costs for the oral boards. In addition it's frustrating that I passed my written boards in March and have to wait till June 2011 to take the oral boards. That's a lot of time in between studying. I wish they could make it like other specialties (i.e. radiology) and have us take the boards at the end of residency.

 

[bucknut101]

Also the MOC exam must be easy. Otherwise I don't how the "cataract jockeys" (you know, the docs who do nothing but cataract surgery and refer everything else out the door) would be able to pass it.

 

[FutureCTDoc]

I can understand why Rand Paul was pissed, consider the programs 30 years ago, there were a lot of subpar ones that were closed. Grads of those programs have unlimited licenses, while todays grads face tougher entry standards into residency, are more current and are forced to recertify. Think about it, there really are no "bad" programs. While there are some amazing ones i.e. Bascom, Will's, Wilmer, Stein, the other programs are all good or better. The ABO should lift this requirement and continue to issue unlimited certs.

 

[Visionary]

Also the MOC exam must be easy. Otherwise I don't how the "cataract jockeys" (you know, the docs who do nothing but cataract surgery and refer everything else out the door) would be able to pass it.

From what I've seen and heard, you're absolutely correct. Check out the MOC practice questions on the AAO site. That's why I've recommended against anyone using those to study for OKAPs or WQE. You could expand your point about "cataract jockeys" to include other subspecialists, though. Pure oculoplastics docs, for instance, may never look at the fundus. Retina docs, like me, are not likely to keep up with the latest in cataract/refractive, either. The CME requirement makes complete sense to me, but the MOC does not. Looks like a nice revenue stream, and that's about it.

 

[200UL]

I believe the MOC questions on the AAO website are tremendous in OKAP / Boards prep. While the questions themselves are not terribly challenging, the explanations have everything one needs to know about the subject in question. These are a must in boards preparation.

 

[vanelo]

An Open Letter to the American Board of
Ophthalmology (ABO)
JANUARY 1998
Having recently passed my boards, I would be remiss if I did not follow up on a
resolution I made while studying for them: to bring attention to shortcomings of
the current system.
The ABO certification process suffers from three major flaws: 1) it tests minutiae,
2) it is given long after completion of residency, and 3) its failure rate is too high.
Unlike the oral boards, the written boards still tests minutiae, rather than focusing
on items of clinical relevance. One favorite recurrent written question asks, "What
is the diameter of a Goldmann applanation tonometer?" and gives as possible
answers: 3.04 mm, 3.06 mm, 3.08 mm, and 1.53 mm. This type of question does
nothing to test a candidate’s knowledge of the Fick principle; rather, rote
memorization is rewarded at the expense of conceptual understanding.
Not surprisingly, several senior attendings, when asked if they recalled the Fick
principle, gave the same reply: "No, all I remember is “3.06”--but that’s all you
need to know."
Secondly, why are the written boards given 1 year, and the oral boards 2 years
after residency? Is there a valid reason, other than blind tradition? Most other
specialty boards are given a year earlier, soon after completion of residency--a
more logical time-frame.
Some might argue that testing candidates 2 years after residency allows for the
acquisition of clinical skills, or tests knowledge retention. Such arguments ignore
two facts: 1) residency provides all the skills necessary to be a good
ophthalmologist, and 2) most candidates admit that they "forget everything, then
cram for the written and oral tests."
An analogy to the current system highlights its fallacy. Suppose you were to
design a system for certifying airline pilots. Would you have them finish flight
school, then go out and practice flying jumbo jets for a year before taking a
written test of their knowledge, and another year later finally give them the oral
test that determines whether to grant them their wings?
I propose that the 3rd year OKAPs be eliminated, replaced with the written
boards. The oral boards would then be given shortly after residency. Adopting
this system would save significant time and money. To further reduce travel
expenses, the written boards should be given in each city with a residency
program. What works for the SAT can work for the ABO.
Finally, I question if it is necessary to fail over a quarter of candidates on the
written and oral boards. To determine the "proper" failure rate, one needs to
examine the goal of certification.
The only reasonable goal of certification is to allow only qualified specialists to
practice ophthalmology. Rephrased in the negative, the goal is to prevent
unqualified candidates from injuring the public. Therefore, if the certification
process functioned as advertised, all candidates who failed would be unqualified
to practice, and would be prevented from doing so.
Patently, this is not the case. Most candidates who fail simply study a little harder
and then pass, thereby undermining the argument that they were ill-qualified.
One cannot honestly argue that memorizing a few magic numbers like "3.06" can
make for a better diagnostician or surgeon.
Furthermore, those candidates who do fail the test multiple times, and even
those who never pass, are in no way prevented from practicing. (What does
grandma call the ophthalmologist who has just failed his written boards for the
second time? "My cataract surgeon.")
The desire "to reduce the oversupply of ophthalmologists" should never be given
as justification for a high failure rate. The proper way to address this issue is to
decrease the number of residency positions, however impolitic this may be. It is
grossly inefficient, and even immoral, to waste three years of a young physician's
life merely to meet a Rand Study quota.
Adopting these measures would significantly improve the current system.
Additional remedies (e.g., eliminating the entire oral component, which is largely
redundant as a quality assurance measure; having residents sit on the Board)
may be considered later.
As members of the oldest American Specialty Board, we should strive to be
instruments of innovation, not ossification.
The ideas in this open letter could have been submitted privately to the ABO.
They were not in order to promote debate and facilitate change. That is what all
good editorials, and all good gadflies, do. The undersigned are admitted gadflies,
too.
Sincerely,
Emil William Chynn, MD