When do we file against ABA?

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Southpaw said:
Also far too lazy to look up. I did go so far to look up the board of directors at the ABA. Almost all looked > 50. I don't know how lifetime cert is/was granted or when it was phased out, but most docs I know > 50 are not required to do MOC.

I cannot fathom a single reason why guys like @algosdoc or @BLADEMDA do MOC. Out of the goodness of your heart? Caring nothing about $$$? Certainly you shouldn't feel obligated. I find it a complete and total waste of time, resources, and $$$. The ABA could easily require we do anesthesiology-specific CME, of which the ASA has great resources, for MOC. I do feel we should do something, but the current setup feels like a scam and treats us like children.
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Potential reasons:

1. Considering changing jobs. Might be a brownie point when applying and many med staffs require MOC for new members. Old farts who have been there awhile get grandfathered in.

2. Employers of docs might tie participating in MOCA to some incentive pay. Or more accurately disincentive pay for not participating. I know of one that does this.

3. If you want to get or maintain subspecialty certification, they require participation in MOCA.
 
lol- I do it primarily for educational value. I certainly will not be changing jobs as this is my retirement job and have nothing left to prove nor desire advancement of any kind. My job is not tied to MOC nor is my income.
 
Mman said:
every doc in my group is participating in MOC and 2/3 of them are over 50
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not required. they're doing it for other reasons. unless they didn't apply for lifetime cert? Those who finished before 2000 I think are lifetime certified, if the Karen Sibert article on MOC is correct.
 
That appears to be correct according to the ABA. In 1995 the ABA approved a policy of time-limited certificates, whereby candidates taking the exam after Jan 1,2000 would have a 10-year expiration date on their certificates. It also provided that a diplomate who passed the exam prior to 2000 could take the recertification exam voluntarily, with no risk of losing diplomate status, even if the recertification exam is not passed.
 
https://www.mayoclinicproceedings.org/article/S0025-6196(14)00338-3/fulltext

"With little evidence in hand to support the MOC process, recent ABIM leadership has dusted off a 10-year-old study of patient attitudes to justify pushing ahead MOC changes. Perhaps the ABIM would bolster its credibility if it would keep its message straight. If the purpose of the MOC process is to benefit patients, why wasn’t grandfathered status addressed in 2003? If it’s about physician quality, where is the strong evidence to support such a claim?

Unfortunately, the ABIM diplomates remain caught in the middle of a costly, time-consuming MOC process that fails to pass even the most basic evidenced-based scrutiny. Further, the ABIM leadership team has decided to provide patients with inadequate information about the recertification status of their physicians."
 
Southpaw said:
not required. they're doing it for other reasons. unless they didn't apply for lifetime cert? Those who finished before 2000 I think are lifetime certified, if the Karen Sibert article on MOC is correct.
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I'm aware they are not required. They are aware they are not required. Lifetime certification is real but all our docs are choosing to participate. I'm assuming the ones working at the ABA are all participating.
 
CopaceticOne said:
https://www.mayoclinicproceedings.org/article/S0025-6196(14)00338-3/fulltext

"With little evidence in hand to support the MOC process, recent ABIM leadership has dusted off a 10-year-old study of patient attitudes to justify pushing ahead MOC changes. Perhaps the ABIM would bolster its credibility if it would keep its message straight. If the purpose of the MOC process is to benefit patients, why wasn’t grandfathered status addressed in 2003? If it’s about physician quality, where is the strong evidence to support such a claim?
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My understanding is that there is no legal way to address “grandfathered” docs. Remember when they got certified they paid for initial certification with exam fees ( just like us). So they purchased a certification that was indefinite. You can’t just turn around and revoke that. The boards would be sued and lose...
 
dannyboy1 said:
My understanding is that there is no legal way to address “grandfathered” docs. Remember when they got certified they paid for initial certification with exam fees ( just like us). So they purchased a certification that was indefinite. You can’t just turn around and revoke that. The boards would be sued and lose...
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All true. But nothing prevents employers of anesthesiologists, hospital medical staffs, and payers from “encouraging” MOCA participation.




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dannyboy1 said:
You can actually blame this one on the lawyers.
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I don't know that we can blame this on the lawyers... it's not like the lawyers decided that speciality boards had to invent the concept of usurious re-certification... and how would the lawyers argue that we should re-certify if such a thing never really existed in the past?

I think the specialty boards and ABMS came up with this on their own. Just like the ABA invented the OSCE exam and the (money grubbing) bifurcation of the Basic/Advanced exams. It's not unrelated to the rest of credential creep and the scourge of economic credentialing across all medical specialities and medicine as a whole. Why do I need a flunky EMT to tell me how to bag mask at a nonsensical BLS class? I have to because AHA and the hospitals came up with a nonsensical credentialing scheme and conned everyone into participating. IMO if this stuff never existed, the lawyers wouldn't invent it de novo. But since it does exists, they'll pin you for now participating when you could/should have.

"We" did it to ourselves.
 
kidthor said:
I don't know that we can blame this on the lawyers... it's not like the lawyers decided that speciality boards had to invent the concept of usurious re-certification... and how would the lawyers argue that we should re-certify if such a thing never really existed in the past?

I think the specialty boards and ABMS came up with this on their own. Just like the ABA invented the OSCE exam and the (money grubbing) bifurcation of the Basic/Advanced exams. It's not unrelated to the rest of credential creep and the scourge of economic credentialing across all medical specialities and medicine as a whole. Why do I need a flunky EMT to tell me how to bag mask at a nonsensical BLS class? I have to because AHA and the hospitals came up with a nonsensical credentialing scheme and conned everyone into participating. IMO if this stuff never existed, the lawyers wouldn't invent it de novo. But since it does exists, they'll pin you for now participating when you could/should have.

"We" did it to ourselves.
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Most of credentialing is really a CYA move by hospitals to show that they have done “due diligence”, in the hope that when a physician screws up they don’t get dragged into the lawsuit. Once that became widely accepted the specialty boards realized that they had a monopoly on a required part of the credentialing process, the result was inevitable. IMO we need a competing board to offer certification, kind of like JHCAO now has to deal with DNV and other organizations...
 
dannyboy1 said:
Most of credentialing is really a CYA move by hospitals to show that they have done “due diligence”, in the hope that when a physician screws up they don’t get dragged into the lawsuit. Once that became widely accepted the specialty boards realized that they had a monopoly on a required part of the credentialing process, the result was inevitable. IMO we need a competing board to offer certification, kind of like JHCAO now has to deal with DNV and other organizations...
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I totally agree. Now that it all exists - you have to participate or you're the malpracticing outlier.

An alternative specialty board (like NBPAS) is a viable, sensible route. Competition will help.
 
dannyboy1 said:
IMO we need a competing board to offer certification, kind of like JHCAO now has to deal with DNV and other organizations...
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NBPAS is doing great work.

Unfortunately they're not an option for me as my employer (the US gov) doesn't recognize them.

I hope in time they will grow to be a viable option. For now, I'll pay to play MOCA.
 
kidthor said:
I don't know that we can blame this on the lawyers... it's not like the lawyers decided that speciality boards had to invent the concept of usurious re-certification... and how would the lawyers argue that we should re-certify if such a thing never really existed in the past?
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Did you really just call something that costs like $200 a year "usurious"?

I mean I'm not a fan of the way MOCA is handled, but let's not act like it's a financial hardship on anybody.
 
Mman said:
Did you really just call something that costs like $200 a year "usurious"?

I mean I'm not a fan of the way MOCA is handled, but let's not act like it's a financial hardship on anybody.
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It’s like that subscription to Hulu you forgot about and don’t use. It’s not enough for you to notice, but it’s enough to make them rich.
 
Mman said:
Did you really just call something that costs like $200 a year "usurious"?

I mean I'm not a fan of the way MOCA is handled, but let's not act like it's a financial hardship on anybody.
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This is an absurd defense. It could be $7 and it would still be wasted money that we are forced to pay. You could blow it off with better style by saying $210/year is only 57 cents per day, "less than a cup of coffee" and that would also miss the point.

For one cycle of MOCA, there are ten $210 payments for MOCA Minute ($2100), a CME requirement that you're going to do anyway[1], and two Part 4 requirements that amount to a choice between either some MASSIVE time sinks or doing a pair of simulator exercises to the tune of $1600 each (plus a day off work, perhaps travel - $2000 more in lost wages and costs?).

So yeah, I'd call $9300+ for a bunch of garbage that isn't making me a better doctor "usurious" ...


And I'll ask again: We all know of bad doctors who have been removed from practice (or who quietly voluntarily "retired") because of action by state licensing boards or hospital credentialing committees. These mechanisms exist and they work. They have the benefit of existing law, independent third parties charged with protecting the public, and actual individual peer review. I don't believe any bad doctor in the history of ever has left practice because of MOC - so what good is it actually doing?


[1] It used to be that a large chunk of the CME the ABA would accept was required to be from overpriced (albeit admittedly high quality) ASA products, which was a shady kickback scheme in and of itself, but at least that's no longer the case. Progress! Yay!
 
pgg said:
This is an absurd defense. It could be $7 and it would still be wasted money that we are forced to pay. You could blow it off with better style by saying $210/year is only 57 cents per day, "less than a cup of coffee" and that would also miss the point.

For one cycle of MOCA, there are ten $210 payments for MOCA Minute ($2100), a CME requirement that you're going to do anyway[1], and two Part 4 requirements that amount to a choice between either some MASSIVE time sinks or doing a pair of simulator exercises to the tune of $1600 each (plus a day off work, perhaps travel - $2000 more in lost wages and costs?).

So yeah, I'd call $9300+ for a bunch of garbage that isn't making me a better doctor "usurious" ...


And I'll ask again: We all know of bad doctors who have been removed from practice (or who quietly voluntarily "retired") because of action by state licensing boards or hospital credentialing committees. These mechanisms exist and they work. They have the benefit of existing law, independent third parties charged with protecting the public, and actual individual peer review. I don't believe any bad doctor in the history of ever has left practice because of MOC - so what good is it actually doing?


[1] It used to be that a large chunk of the CME the ABA would accept was required to be from overpriced (albeit admittedly high quality) ASA products, which was a shady kickback scheme in and of itself, but at least that's no longer the case. Progress! Yay!
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1) I never said it was well done
2) I've done it for less time and/or money than you imply
 
ABA Directors and Oral Board Examiners (and I think Question writers) are required to be MOCA participants regardless of time unlimited status. That has been a longstanding policy. There is a lot of room for improvement in the process, but a lot of progress has been made. I think the process is overly bureaucratic, too expensive, and has too much busy work stuff. However, the ABIM is downright corrupt, so we are far luckier than the internists. Although I do not agree with all of the ABA's policies or methods, in my heart, I do not believe them to be corrupt like the ABIM (the only thing that makes me second guess that is them being a little too much in cahoots with the ASA with the selling of products to satisfy the part 4 stuff). They fill a need that American medicine has deemed to be required. They don't do it perfectly, but few bureaucracies do. I remain open to alternatives if they gain a good enough foothold. The other part of me says, I worked too darn hard to get ABA certified and I don't ever want to lose that status. I wish I could keep it for less money and a more streamlined MOCA process without busy work.
 
GravelRider said:
It’s like that subscription to Hulu you forgot about and don’t use. It’s not enough for you to notice, but it’s enough to make them rich.
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but who gets rich off it? It's not like the ABA is paying $3M a year salaries.
 
Gern Blansten said:
in my heart, I do not believe them to be corrupt like the ABIM.
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You have to be kidding!!'

Do you know how many board certification exams have cropped up in the past 10 years? Its like 12 exams that the ABA administers. All of a sudden there is a pediatric exam where historically there was none.
And each of those have a MOC component.
That is not even mentioning what they do to the residents now. They broke up the written exam into 2 parts to collect the exam fees. Now the residents not only have to deal with the challenging tast that is learning anesthesia and how to navigate those landmines but now they have to worry about jumping through some more hoops. All with an extra fee, where historically there was none. For what? to feed a ravenous beast named "certification", MOC and the associated greed associated with it.

We have to put the brakes on this. We should have fought harder when it was being rolled out. They were smart though, they grandfathered the existing people not to have outrage. How someone cannot see the massive corruption in this, is beyond me.

Corrupt is not the word!

And @pgg is correct in his/her assessment.

It is not the amount that matters.
200 dollars there, 100 dollars there, 650 there, 200 for cme, 400 for license renewals. etc etc etc .. At the end of the day (we are being fleeced).
 
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Mman said:
1) I never said it was well done
2) I've done it for less time and/or money than you imply
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So it sounds like you think MOCA is garbage, but not worth the effort to resist or change. I.e. an acceptable annoyance that you tolerate because you have better things to do. That's OK ... I pay my money and waste my time playing the MOCA game too. I just don't get why you're critical and dismissive of the people who are fighting it.
 
To address Mr. S's comment:
The extra expertise in subspecialty certification is something that a lot of people actual wish to have to show the extra expertise gained in their fellowship. Not all, but a good portion. For example, a subspecialty exam after cardiac fellowship does not exist through the ABA. What did most cardiac anesthesiologists do? They got TEE certified through the NBE by taking the PTEeXAM. Their was a void in the certification process, and another certification group filled it. It was never thought to be mandatory, but just a way to set yourself apart from others for a skill that you possess. People clamored to sign up to take the exam even when they did not have to.
As others have mentioned, re-certification is going to happen and it is better that we police ourselves instead of letting the government get into that business. The ABA is not perfect. Nobody claims that they are. There are tons of ways they could improve the processes, as I mentioned (more streamlined, less busy work, cheaper, etc). As I stated, I do not think they are corrupt. I do think their offices are too extravagant, their executive salaries could likely be shaved down and their expenses could be trimmed and there are many other ways they could cut costs to pass the savings on to the diplomates. Subspecialty certification is something that many people actually desire, and now hospitals are getting in the mix and desiring (perhaps demanding it) it for their physicians.
My main point, however, is that I do not believe that the ABA is corrupt like the ABIM. If you have not read the articles in Newsweek (I think??) about the corruption of the ABIM, then I suggest you do that. I have never heard of things of that nature going on with the ABA, so I am happy about that. As I said, lots of room for improvement. I think the ABA is responding to what a lot of subspecialty trained anesthesiologists wanted. Similarly, the splitting of the written exam into Basic and Advanced is something that many in the academic realm had been asking for. They were in close communication with the Program Directors about that decision. It was not unanimous by any stretch (I voted against it), but it got an overwhelming majority vote to proceed. The desired effect was for the residents to have a reason to study harder and earlier during their residency as opposed to not reading or preparing until the final year. The boost in ITE scores since has shown that the desired effect has occurred.
The ABA is a member board of the ABMS. The ABMS mandated many years ago that MOC had to be a part of the process if they wanted to continue to be an ABMS member board. Losing ABMS status would have been suicide for the ABA, so they complied. The ABMS also mandated that the fail rate on the recert exam had to be higher than 0.5% (or whatever the rate for the exam was many years ago-basically, all passed) or it was not considered a legitimate recert exam. The ABA complied and the fail rate increased as the exam got slightly tougher. The exam was eventually replaced with the MOCA Minute.
As I mentioned, I am not a huge fan of the ABA either, but they provide a service. If they did not provide it, someone else would. Quite possibly the government would do it. I would much rather have the devil that we know versus the devil we don't know. If an alternate board gains enough of a foothold to do the job effectively, at a lower cost, and with wide acceptance, then I am all for it.
I don't think our viewpoints are that far apart on this issue. I just think that I am approaching it from a slightly different perspective with a little skepticism about what might happen if the ABA were to suddenly no longer exist. Some entity would fill that void.
 
pgg said:
So it sounds like you think MOCA is garbage, but not worth the effort to resist or change. I.e. an acceptable annoyance that you tolerate because you have better things to do. That's OK ... I pay my money and waste my time playing the MOCA game too. I just don't get why you're critical and dismissive of the people who are fighting it.
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I know you were not addressing me, but I am definitely not critical of those who are fighting it. I have followed the process for several years and I hope that one day, there will be choices instead of a monopoly. I am happy that there are those willing to fight that fight. I also feel that some do not know the entire story. I suspect that you have been around long enough that you have a very good understanding of the processes. Your description of the "acceptable annoyance" is a good description of my attitude. I just don't have the energy or will to fight this at this time. But I support those who wish to take up the fight to make things better.
My viewpoint is that there are ways the ABA could improve and be more affordable and less onerous with busy work, but at least we have it way better (in my opinion) than IMed, or pedi, or whoever else you may want to name. In general, I think the ABA has been far more responsive to demands for change that other specialty boards. Not perfect, but better.
 
Gern Blansten said:
To address Mr. S's comment:
The extra expertise in subspecialty certification is something that a lot of people actual wish to have to show the extra expertise gained in their fellowship. Not all, but a good portion. For example, a subspecialty exam after cardiac fellowship does not exist through the ABA. What did most cardiac anesthesiologists do? They got ACCTEE certified through the NBE by taking the PTEeXAM. Their was a void in the certification process, and another certification group filled it. .
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I don't think that is fair. Not a cardiac guy, but from memory from a lecture I went to way back when... The ASA/ABA/SCA wanted a way to recognize skill in intraoperative echocardiography among anesthesiologists and considered their own exam for certifying anesthesiologists in perioperative TEE. But we wanted ACC buy in for certifying anesthesiologists. This would avoid a turf war with the cardiologists and adding the imprimatur of ACC would be meaningful. Thus the NBE was born. Going from memory from a lecture 20 years ago..... Anesthesiologists are guaranteed a certain number of seats on the NBE Board, but a super majority of votes in excess of the percentage of cardiologists on the board were required to change bylaws. As a non cardiac guy, I don't think that the reasoning was flawed then or now.
 
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pgg said:
So it sounds like you think MOCA is garbage, but not worth the effort to resist or change. I.e. an acceptable annoyance that you tolerate because you have better things to do. That's OK ... I pay my money and waste my time playing the MOCA game too. I just don't get why you're critical and dismissive of the people who are fighting it.
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I think MOCA is necessary. I do not think it is currently well done. I find complaints about the relative pittance of a cost to be amusing.
 
Gern Blansten said:
The other part of me says, I worked too darn hard to get ABA certified and I don't ever want to lose that status. I wish I could keep it for less money and a more streamlined MOCA process without busy work.
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I agree that my ABA certification is valuable and I want to keep it. But I feel like it's mine. I don't want to pay rent or taxes to keep it. Even if the rent is low.

The only useful bit of MOCA that I've done in the last 8 years has been the CME, and I was already doing some of that for state license renewal and the rest because it was intrinsically valuable to me.



Mman said:
I think MOCA is necessary.
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What purpose does it serve, that is not already served better by state medical boards and hospital credentialing committees?

Mman said:
I do not think it is currently well done. I find complaints about the relative pittance of a cost to be amusing.
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Fair enough.
 
Mman said:
but who gets rich off it? It's not like the ABA is paying $3M a year salaries.
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I’m not sure about the ABA, but they are not fighting lawsuits. The ABIM, on the other hand, is as corrupt as they come. There was a story a few years about the ABIM and fancy limousine rides to multimillion dollar condos.
 
dr doze said:
I don't think that is fair. Not a cardiac guy, but from memory from a lecture I went to way back when... The ASA/ABA/SCA wanted a way to recognize skill in intraoperative echocardiography among anesthesiologists and considered their own exam for certifying anesthesiologists in perioperative TEE. But we wanted ACC buy in for certifying anesthesiologists. This would avoid a turf war with the cardiologists and adding the imprimatur of ACC would be meaningful. Thus the NBE was born. Going from memory from a lecture 20 years ago..... Anesthesiologists are guaranteed a certain number of seats on the NBE Board, but a super majority of votes in excess of the percentage of cardiologists on the board were required to change bylaws. As a non cardiac guy, I don't think that the reasoning was flawed then or now.
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It sounds like you are aware of things that I am not. I don't claim expertise in all of this, it is just something I have followed over the years and there is usually more to the story than what we know individually. Lack of knowledge on issues can lead to strong feelings against certain things based on what we think we know. As I have been doing this a while, I have fluctuated between being very pro ABA, to very anti ABA, to now somewhere in the middle. I know many of their people and I feel that the intent is good. The delivery may miss the mark many times, but I don't think their is ill intent. As stated, with the ABIM, I do not share the same feelings. I think there is a great deal of, perhaps, criminal intent with the ABIM. So my point, I guess, is that, as bad as many of you think the ABA is, at least it is not the ABIM.
 
Mman said:
I think MOCA is necessary. I do not think it is currently well done. I find complaints about the relative pittance of a cost to be amusing.
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PM me so I can send you my address. 200 dollars in cash or check is fine since it's such a small amount for you.
 
There are two camps.

If you view board certification as a static credential then you share my view
If you view board certification as a dynamic credential that can and should be taken away, then you think moca is great.

moca minute is useless.
I would get better value coming on here and hashing it out here
 
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Mr.S said:
There are two camps.

If you view board certification as a static credential then you share my view
If you view board certification as a dynamic credential that can and should be taken away, then you think moca is great.

moca minute is useless.
I would get better value discussing an interesting case with one of the directors.
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I want primary certification to be hard to attain. I want it to be a meaningful credential and accomplishment.

Given that some of us have a narrow practice area post training, the lack of proven utility of MOCA and the environment in which we are in, I want MOCA to either go away or to be a meaningless, painless, and inexpensive rubber-stamp for those of us who attained primary certification. I would like the ASA to use whatever influence that it has with ABA to make it so.
 
i also understand the aba also wants to know all of your state license and you have sixty days to report any sanctions on your license to them.

What does the ABA has to do with medical license sanctions?
 
Some further reading. As others have pointed out, licensing and certifying exams are a huge and growing business. Apparently the NBME will soon add “health and wellness coaches” to the physicians and veterinarians they already certify. It’s a $450 test discounted to $350 for the first 2 rounds, a bargain to be HWCCCE certified:laugh:

Thankfully I have a permanent certificate, don’t participate in MOC, and don’t plan to.

Health & Wellness Coach Certifying Examination

The cost of taking the USMLE exams is staggering

A physician investigates the American Board of Internal Medicine
 
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Mr.S said:
3 million of that goes to salary! would love to see the break down of that and what is the compensation of the directors.
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It is included in the link provided by nimbus. The form 990 is where it is shown. I was surprised that it was not as much as I thought. Pretty big time commitment and lost opportunity for clinical income.
 
Mr.S said:
3 million of that goes to salary! would love to see the break down of that and what is the compensation of the directors.
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Wow, the president of the ABA got $23K in salary for the year for his estimated 400 hours of work. OMG! $160K in travel expenses for the entire year for everybody combined!!!! Somebody get a reporter on this right away.
 
Mman said:
Wow, the president of the ABA got $23K in salary for the year for his estimated 400 hours of work. OMG! $160K in travel expenses for the entire year for everybody combined!!!! Somebody get a reporter on this right away.
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Do they get another salary from an ABA Foundation like ABIM?
 
All you "need" to stay up to date and maintain MOC are the ACE/SEE booklets. The ABA can use the material published by the ASA every year to maintain certification.
That's 120 credits per year for the ACE/SEE and they could be used in place of the current MOCA minute. The other stuff is pure fluff and a money grab. 120 credits per year for $720 is plenty of money to steal from the membership. But, the CME from the booklets is plenty in terms of credit hours.

I've gone through a full MOCA cycle and it added nothing to my practice. I won't bother to enter into MOC again because it adds no value over the ACE questions which count towards my CME.

MOCA as it exists today is a legalized scam.
 
MOCA is a scam and a joke. The MOCA minute thing is almost hilarious. I rarely bother to read the question. Just look at the answers and pick the one that is not like the others, and I hover between 77-80%

Last time I talked to them, they still couldn’t tell me what a passing grade was. ¯\_(ツ)_/¯

Pretty sure we eliminated the scam sim portion, but haven’t checked recently.

I’ll stay MOC participating just because it’s needed for many hospital credentials and I’m lookin into doing more locums in the future.
 
The sim center is by far the easiest way to satisfy some if the requirements. So it is not required but the easiest path.
 
ryanjmy said:
I don't mind the questions, cme or even the money. Some of that is helpful. The points system is the rediculous part. A simulator is a complete waste of my time. As is documenting an improvement project
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I do simulation education for the residents and fellows, though I haven’t made it a cornerstone of my promotion and career, and I’ve done the MOCA sim course. I think well done simulation with realistic scenarios and experienced staff has educational benefit. You’re not likely to see these scenarios in your career with any regularity and it helps to go through the scenarios and review during the debriefing. We also do it for the post op nurses, OR nurses, mass casualty, etc. I don’t want to face an extraordinary rare, yet potentially catastrophic event for the first time on a real patient with a room full of people that have never seen anything like that before either. YMMV.
 
BobBarker said:
The sim center is by far the easiest way to satisfy some if the requirements. So it is not required but the easiest path.
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If you're already doing something that could possibly be twisted/argued into something resembling a QI project, that's an easy zero cost option. The criteria are pretty vague. The documentation is required is extremely short.

If you do anything tangentially related to ERAS protocols where you work, that can be leveraged into 15 hours as a worker bee or all 25 if you're the one driving it.

If you're at an academic place every hour of didactics you do could be documented as an hour of part 4.
 
The VA has a free difficult airway sim course online for, I think 6 hours of part 4. I got studying for CC boards to count for 10 hours of self-directed learning for part 4. Despite how easy it was to get 25 points without doing the sim center, part 4 MOCA activities are pure trash, and should be entirely eliminated.

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I say get rid of it all.

Medical Schools dont ask you for your medical license.. Neither should this thing.

And it should have ZERO dollars associated with it. ZERO.

Im done shelling out money for nothing. Seriously.

Im drafting my own comments
 
The sim is insanely expensive for those of us practicing in BFE.

Worthwhile? ¯\_(ツ)_/¯ 8 years out of training, I’ve seen two MH cases, one LAST case, two intraoperative PEs, 2 or 3 post-op MIs, multiple post op delirium, multiple post op respiratory failure, high spinal...

I haven’t seen anaphylaxis or perioperative stroke. I have no idea what other scenarios are drilled at the sim center.

What’s most important isn’t having seen and managed a specific scenario, it’s keeping a clear mind and thinking through the problem at hand. Simulation can help with that, especially if you didn’t come into medicine from a career that requires similar cool thinking under fire. However, no sim can prepare you for every possible scenario that can happen in real life.

You mentioned doing sims with your PACU nurses etc. Bully for you. Do you expect me to shut down my ORs and fly my nurses to Seattle with me? Why not let me fulfill the requirement by having actual drills with my actual staff, instead of paying some “expert” to host and evaluate.

As far as I’m concerned, Sim is bull**** for practicing anesthesiologist, unless you’re in a practice limited to ASA 1s an 2s in an ASC setting. It probably has some value in resident training.
 
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