Friday, October 20, 2017

What is MOC®? Why Is This Important?

What is Maintenance of Certification® (MOC®)?

Is it an educational program for physicians? If you think so, you are wrong.

MOC® has almost nothing to do with physician education, but according to the contract we must sign, involves "certain health care service operations, including practice assessment and evaluations." Most importantly, it allows physicians' personal and practice data to be shared with an unlimited number of third parties through a HIPAA Business Agreement.

Let me be clear. MOC® is not really about physician education. Instead, MOC® allows a physician's personal data to be shared with data registries and large corporations who profit from those data. For instance,  our MOC® and survey data are shared with (sold to?) Premier, Inc. (PINC, the $4.3 billion owners of CECity, Inc.), the largest healthcare performance improvement company that serves 3,900 hospitals and health systems and approximately 150,000 other providers and organizations." (Remember, Christine Cassel, MD, former President and CEO of the American Board of Internal Medicine, served on the board of Premier, Inc at one time and earned plenty of money and stocks in that capacity while at the ABIM.)

It also allows physician data to be sold to ABMS Solutions, LLC, a for-profit wholly-owned subsidiary of the American Board of Medical Specialties that is based in Atlanta, Georgia, who then sells your MOC® status, updated every 24-hours, to others, and a company never mentioned in disclosures published in our major medical journals. They will also plan to share these data with the Disciplinary Action Notification System database owned by the privately-held non-profit Federation of State Medical Boards that solicits "Affiliate Members, Official Observers, and Courtesy Members."

Again, MOC® is not about physician education. It is about collusion with multi-billion dollar companies, including Wolters Kluwer, and Pearson, LLC, and even our own politically-powerful American College of Cardiology that who owns the NCDR procedural registries and sells access to them to hospitals with MOC® as its demographics supplier (a full explanation of how this works is available here).

Why is the understanding of this "definition" of MOC® so important?

Multiple states are enacting legislation to prevent MOC® as a cudgel to limit a physician's ability to hold hospital credentials, be on insurance panels, or obtain state licensure. Our physician data are that important to these companies they will stop at nothing to be sure we sign that MOC® agreement.

What if the ABMS re-brands MOC® to some other "product" at their December 4th meeting with all of those state medical societies frustrated with what MOC® has become? Might the American Board of Medical Specialties and their collaborators skirt existing "anti-MOC®" legislation? Current anti-MOC® legislation anticipate this and not include "MOC®" but "MOC® or any other health care serve operation, including practice assessment and evaluations that requires signing a HIPAA Agreement" in their language.

Physicians enacting anti-MOC® legislation need to understand the legal definition of MOC®. That way they can write legislation that is lasting, meaningful and enforceable, irrespective of how MOC® is ultimately re-branded.

MOC® is broken and must end. Not because it's a failed physician education experiment. It's broken because of its threats to physician civil liberties and threatens the doctor-patient relationship at it's most intimate level, thanks to the age old business motivators, money, power, and greed.

-Wes

Wednesday, October 18, 2017

Why the IRS Needs to Investigate the ABIM

Monday, the bureaucratic side of the House of Medicine, via the American Board of Internal Medicine, announced their new-and-improved fee structure for Maintenance of Certification®. Lots of fancy corporate spin was used to justify the need for cash, with even some "discounts" (that failed to include the test facility fee as before) were promised for those silly enough to pre-pay for their strongarmed fees.

According to ABIM's publicly reported mission statement:
"THE AMERICAN BOARD OF INTERNAL MEDICINE (ABIM) SEEKS TO ENHANCE THE QUALITY OF HEALTH CARE BY CERTIFYING INTERNISTS AND SUBSPECIALISTS WHO DEMONSTRATE THE KNOWLEDGE, SKILLS AND ATTITUDES ESSENTIAL FOR EXCELLENT PATIENT CARE...MOST DIPLOMATES CERTIFIED PRIOR TO 1990 ARE STRONGLY URGED TO PARTICIPATE IN MOC BUT ARE NOT REQUIRED TO DO SO TO REMAIN CERTIFIED.FOR ALL DIPLOMATES, IN ADDITION TO REPORTING BOARD CERTIFICATION, ABIM WILL REPORT IF THEY ARE PARTICIPATING IN THE MOC PROGRAM (I.E., ENGAGING IN MOC ACTIVITIES FREQUENTLY)." (From their IRS Form 990)

Board certificaiton, and MOC® in particular, are no longer voluntary for US physicians. I believe (and I do not say this lightly) placing such a statement on an IRS form in this day and age constitutes fraud. MOC® has been cleverly incorporated into hospital bylaws and insurance panel requirements thanks to (1) the public sharing of Margaret O'Kane on the National Quality Forum and the American Board of Medical Specialties board and (2) Richard Baron, MD's work at the Seamless Care Model Group of CMS. Clever corporate inner dealings have benefitted their self-proclaimed corporate partners at FigMD, Kaiser Foundation and Hospital Group, the now defunct IPC The Hospitalist Company, Premier, Inc,, CECity, Inc., ABMS Solutions, LLC, the NEJM Group, Wolters Kluwer, and Pearson Education. As such, ABIM is no longer a charity organization, it is a for profit business. They have never shown improved quality of care no prevented injury to the public (state medical boards address poor quality and behavior by physicians). Rather, like many successful for-profit companies, the organization has promoted the self-inurement of its leadership, board of directors, and academic affilitates through political influence and self-dealing. It is now well-documented that at LEAST $78 million dollars from ABIM diplomates were secretly funneled to the ABIM Foundation for their benefit. Condominium purchases, health club memberships, spousal travel, Cayman Island Investments, a lavish $1.2 million golden parachute for Christine Cassel, MD and an annual salary from Richard Baron that approached $850,000 in fiscal year 2016 are realities and not usually the hallmark of a legitimate charitable organization that provides voluntary benefit to the public. Neither is the repeated convenient misreporting on tax forms from 2008 through 2013 that has occurred, including (at a minimum) misreported dates and place of origin of the ABIM Foundation, lack of disclosure of depreciation of the condominium or the disclosure of lobbying of Congress on those forms either.

At the very least, it is time for the Internal Revenue Service to reevaluate the non-profit status of the ABIM. Taxpayers (and physicians who have no choice but to participate in this costly charade) deserve no less.

-Wes

Monday, October 16, 2017

Hurting for Money, ABIM Raises Fees 12%

(Click image to enlarge)
The American Board of Internal Medicine, over $57 million in debt on paper (or, said another way, with only $13.6 million in remaining in its consolidated assets when combined assets of its shady ABIM Foundation are included), had the nerve to publish its 2018 fee schedule today and it's a doozy.

Without answering the evidence supporting corruption and self-dealing made before the Ohio legislature on 11 October 2017, the ABIM and its leadership continue to market their shakedown of US physicians as providing "Choice. Flexibility. Value." They're even bragging that if you bend to their extortion and pre-pay, you'll be getting a good deal.

Physicians are not idiots.

I would encourage physicians to use the National Board of Physicians and Surgeons (NBPAS.org) instead of the ABIM Maintenance of Certification for documentation of their commitment to life-long education. This ridiculous charade has to end.

-Wes

Wednesday, October 11, 2017

My Remarks Before the Ohio Health Committee On MOC®

Here is the testimony I delivered today at the Ohio Health Committee hearing on Ohio House Bill 273 sponsored by Representative Teresa Gavarone in Columbus, Ohio. (Each committee member was handed this evidence packet to refer to before I spoke):
Dear Honorable Committee Members:

Thank you for the opportunity to speak and to provide evidence to the citizens of Ohio regarding my remarks today. My name is Westby G. Fisher, MD. I am a triple ABMS Board-certified practicing internist, cardiologist, and cardiac electrophysiologist from the Chicago Metro area representing Practicing Physicians of America, a group I co-founded that represents over 40,000 frontline practicing US physicians of all specialties and from all 50 states (including Ohio). We vigorously support Ohio’s House Bill 273 that restricts the hospital and insurance industry’s ability to prevent experienced physicians from practicing their trade on the basis of an unproven, costly and time-consuming proprietary marketing product called “Maintenance of Certification.”

I stand before you, on behalf of my working colleagues, as a bedside treating physician with a valid state license. I am not a paid lobbyist. I do not have a political agenda to serve. I do not have hundreds of millions of dollars of funding behind me. I represent the doctor see when you walk in a hospital or a clinic office, feeling scared, vulnerable, or sick.

The issue pertinent to this legislation is the proprietary product owned by the American Board of Medical Specialties (ABMS), a private non-profit corporation, and marketed by their 24 subsidiary specialty boards, as “Maintenance of Certification.” Maintenance of Certification is sold above and beyond physician’s initial lifetime Board Certification, a voluntary credential physicians obtain by taking a test to demonstrate competence in their specialty. I stress again, Maintenance of Certification is NOT to be confused with initial ABMS Board Certification, a voluntary once-in-a-lifetime credential analogous to the “bar” examination performed by the legal profession. Most physicians I know, including me, understand the value of initial, lifelong certification with ongoing Continuous Medical Education training. We should note that Ohio physicians have a proud tradition of supporting one of the strongest Continuing Medical Education (CME) requirements after their initial Board certification for maintaining their licensure, requiring 100 hours of CME every two years.

Maintenance of Certification was conceived by the American Board of Internal Medicine, the largest member board of the American Board of Medical Specialties that certifies on quarter of all US physicians, they claimed, to assure “continuous professional development.” Initial voluntary attempts to market this extra distinction failed because doctors already took responsibility for their own Continuing Medical Education and did not see additional centralized Maintenance of Certification testing as helpful or appropriate.

Sadly, this initial failure to voluntarily engage America’s doctors resulted in a new chapter of coercion and threats to physicians that continues to this day. In 1990, the American Board of Internal Medicine abruptly announced the end of life-long Board certification, claiming doctors needed to “keep up” with medical advances and threatened “uncertain circumstances” if they did not participate in Maintenance of Certification. To avoid significant backlash of the entire physician community, they grandfathered senior, predominantly male physicians certified before 1990. Younger doctors, closer to training, reluctantly complied.

Despite 30 years of existence, time-limited certification has never been proven to improve patient safety or care outcomes compared to lifetime Board certification. To be even more clear, let me emphasize that doctors are not picking up their Maintenance of Certification board review packet in order to figure out how to deal with a complicated patient down the hall. This is not the way it works on the ground. Instead, younger, more economically vulnerable, and increasingly female physicians were discriminated against with this change that persists today. The change also converted the once “voluntary” aspect of lifetime board certification to a mandate, since more hospitals insisted their physicians be board certified (as did insurance companies), thanks to their lobbying efforts. Through this clever regulatory capture, employed doctors were left with no choice but to sign a MOC contract that relinquishes their free speech rights and requires they become research subjects without informed consent.

Using the very real threat of the loss of employment, repetitive physician re-certification by way of Maintenance of Certification instantly became a remarkably successful business model for these non-profits, providing the American Board of Medical Specialties $343 million in revenue from certifying and recertifying US physicians in 2011 alone. In fact, the costs of board re-certification for the average physician have mushroomed 244% in the last 15 years, over 4 times the rate of inflation each year.

In 2005, the American Board of Medical Specialties registered the Maintenance of Certification® and MOC® trademarks and insisted all of their member boards end lifetime certification and would only recognize time-limited re-certification as valid while also adding the requirements to perform Practice Assessment, Patient Voice and Patient Safety exercises for physician to perform every 7-10 years, too. These represented even more precious hours of physician time as well as fees. The inevitable consequences of this monetary goldmine were predictable, especially when they operated with little to no oversight for years.

It is important to note that the requirement for time-limited Board certification (as opposed to lifetime Board certification) pre-dated the world wide web. But as the web grew, so did practicing physicians’ ability to fact-check the claims made by the ABMS and their member boards. Many of those facts uncovered are in the packet included before you. By 2013, physicians uncovered inconsistencies between tax filings and ABMS member board web page disclosures. They found bylaw changes that permitted unlimited conflicts of interest. They found undisclosed lobbying. They uncovered the secret funneling of over $77 million of their physician testing fees piecemeal from 1990 to 2007 to create the ABIM Foundation that was supposed to define and promote “medical professionalism.” Excessive salaries, multi-million dollar golden parachutes, first-class and spousal air travel, health club memberships, luxury condominium purchases, and off-shoring of our testing fees for retirement funds doctors learned, were all funded by us. Even a felonious ex-cop who had been fired from the Washington DC police force for inciting reprisals against a journalist was hired to serve as “Director of Test Security” for these organizations making them more akin to a protection racket than a protector of the public. It is no wonder, then, that legal fees at the ABIM and its Foundation have grown from an average of $146,000 per year before Maintenance of Certification was introduced to over $1 million per year after Maintenance of Certification was introduced for its defense against physician lawsuits. Ironically, we pay those fees as well. Anti-trust suits and class action law suits are pending against the ABMS and American Osteopathic Association. Rest assured anyone speaking in opposition to House Bill 273 somehow has a financial interest in the program or the data they sell. Keep that in mind in the weeks ahead.

Physician shortages and burnout are real problems today and affect every state in the union. How does Maintenance of Certification affect this? No one has bothered to conduct a study examining the psychological, economic, or employment outcomes of highly experienced physicians who fail a re-certification examination of which there are many. Nor has there been a study on the impact that Maintenance of Certification testing has on a doctor’s loyal patients. Hundreds of tweets and emails I receive each year speak to the reality of the tremendous negative effect on decent, highly-respected colleagues too embarrassed to go public with their failure, many of whom quietly leave medicine. The Maintenance of Certification profit-making machine is creating a physician brain drain and a shameful exodus of too many good people.

This is why 23,000 US physicians signed an online petition to end Maintenance of Certification monopoly. That is why the Pennsylvania Medical Society issued a formal “Vote of No Confidence” against the American Board of Internal Medicine in June of 2016. That is why the AMA House of Delegates (including the Ohio delegation) voted to end Maintenance of Certification at the same meeting. This is why a new, competing board called the National Board of Physicians and Surgeons led by unpaid board members to independently verify a physician’s participation in Continuing Medical Education was created and a growing number of hospitals accept as an alternative to participation in Maintenance of Certification. And that is why the Ohio State Medical Association has voted to support this bill. Physicians across the country are not blind to the corruption, and the burden to practicing physicians and their patients is not trivial. Twenty three states have introduced similar bills to this one, and 8 have enacted those laws.

Despite all of this, I am sure that opposition to House Bill 273 will remain strong. When one considers the numerous subspecialty board review courses that exist, and the gauntlet of tests a physician must endure to become licensed, certification of physicians is a $2 billion dollar-a-year enterprise. Our opposition will tout the duration, breadth, and scope of training required by ABMS member boards as the best validation of physician knowledge, while ignoring a physician’s clinical experience entirely. But as Dr. William Osler famously said, “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” The fact that this shameful bureaucratic continuous re-credentialing system has wrapped itself in a blanket of highly respected, well-meaning physician contributors should surprise no one, but it does not change the facts. In other states, opponents to similar bills as Ohio’s House Bill 273 have been strangely silent about the corruption, preferring instead to focus on the public’s “need to know” talking points as a way to spin away from the ugly truth. Why is that? Do they believe corruption is inevitable? Do they assume practicing physicians will just shrug and write another check?

Winston Churchill once said, “Criticism might not be agreeable, but it is necessary. It fulfills the same function as pain in the human body. It calls attention to an unhealthy state of things.” Maintenance of Certification is very unhealthy for our profession. The time we take away to defend our profession in this very sad chapter of our profession is time we take away from our patients, including your constituents. That is why we need your help and your attention to this uncomfortable matter.

In closing, of course initial board certification is important but this has nothing to do with repetitive re-Board certification known as MOC. Of course physicians want to self regulate and want to participate in CME, but they should not have to prop up coercive program based on threats to our integrity and civil liberties for their profit. Scare tactics about patient safety and physician self-regulation are just that; last ditch efforts of intimidation to prop up the gravy train.

Thank you for having the courage to vote against the status quo, against the multimillion dollar lobbyists, and thank you for protecting Ohio physicians and their patient’s access to them by voting in favor of House Bill 273.
-Wes

Wednesday, September 20, 2017

Ohio and the Embarrassment of MOC

Today Ohio legislators will be introduced to the concept of "Maintenance of Certification" or "MOC" when House Bill 273 is introduced by Representative Theresa Gavarone (R) to the Ohio Health Committee. Most of the Committee members won't have a clue what MOC is or why they should care.

Lobbyists from the American Board of Medical Specialties (ABMS) and the American Hospital Association (AHA) will claim "the legislation puts patients at risk" and that "patients deserve to know their physicians are up to date" even though this statement flies in the face of the ABMS's own data and that of independent researchers. They even have the nerve to make statements like this: "Faced with a physician who was certified after residency who has not kept the certificate current, patients will be in the dark."

Like the members of these corporations ever set foot in a patient exam room...

Here's ABMS's ACTUAL history of promoting patient "safety" and knowing what patients think.

Recall that in 1969, Dr. Thomas Brem, former Chair of the ABIM and President of the "Advisory Board of Medical Specialties" (our current ABMS) testified before the House Committee on Interstate and Foreign Commerce, stumped for Big Tobacco by testifying "neither can offer unequivocal scientific proof that smoking does or does not cause cancer of the lung." Dr. Brem conveniently failed to mention he was receiving payments from "Special Account No. 4" that was maintained by tobacco company lobbyists. How many lives were affected by this testimony?

While we'd like to think this is just an isolated event, it was not. In fact, such corporate collusion has been the hallmark of the ABMS and their member boards as they shower themselves with lavish salaries and perks at the expense of vulnerable work-a-day physicians.

For her entire career as President and CEO of the American Board of Internal Medicine, Christine Cassel, MD served on the board of directors of the Greenwall Foundation, Kaiser Permanente, Premier Inc and other organizations with quality health care agendas at diplomates' expense while never disclosing these conflicts of interest. It was only after she joined the National Quality Forum (that receives the majority of its funds from government contracts), that these financial relationships were exposed. Citing the "distraction" of it all, she quickly resigned her affilitation with Kaiser and Premier, but not before bilking her unsuspecting ABIM colleagues for over $8.9 million and free travel for her spouse and helping to facilitate the $400 million purchase of CECity, Inc. by Premier (in which she held stock).

Robert Wachter, MD, the golden-boy of corporate medicine and promoter of hospitalist medicine, was also former chairman of the board of the ABIM for a time. He, too, would rather not discuss his "love agenda" for medicine once his relationship with IPC The Hospitalist Company was exposed by the Department of Justice for overbilling patients. It is no wonder he brought down his industry-sponsored blog, Wachter's World.

Nothing to see here, folks.

Other ABMS member boards and their corporate partners would also not like legislators to examine the American Board of Pediatrics, who saw no problem giving James Stockman, III, MD a $2.4 million golden parachute to help fund his car collection and retaining him to work eight hours a week for a $793,438 annual salary. Who funds such largess?

Working pediatricians.

James Puffer, MD of the American Board of Family Medicine and their directors have also enjoyed high salaries while quietly funding his organizations' Foundation's purchase of corporate office buildings and running for-profit real estate management companies. I'm not sure I've ever seen a clearer quality and patient safety initiative funded by diplomates.

The truth be told, MOC is a horrible embarrassment to our profession. We are doctors, for goodness sake. We are not funding vehicles for political and corporate agendas. It is sickening to me that we continue to see medical specialty societies joining the ranks of these highly-conflicted organizations so they can dovetail their lucrative data registries with maintenance of certification as their next sure-fire business model. Is spending time, energy and money lobbying on Capital Hill to keep such registries funded on the backs of working physicians more important than supporting doctors' effort to remain at the patient's bedside rather than at the keyboard?

It seems so.

MOC is coercive, hopelessly financially conflicted, and corrupt. Working physicians need Ohio representatives (and all state representatives) to examine the facts, not cave to the hospital and insurance company lobbies. Working doctors know the score now. Many any are quitting rather than subjecting themselves to MOC again and again just to keep money flowing to the ABMS and their member boards so they can keep working. Patients, particularly those in rural areas, lose when this happens.

From it's inception, MOC was created from lifetime board certification, not for patient care quality or safety, but rather so ABMS officers and directors could pay themselves handsomely. It continuation is fueled by deception, political agendas, and cronyism. MOC also requires coercion and strongman tactics to keep the money flowing. No matter how our own bureaucratic colleagues might sugarcoat MOC on the pipedream of assuring patient care quality and safety, critical examination of the evidence clearly demonstates what an embarrassement the program has been to the integrity of US medicine.

It's time to end it.

-Wes

Monday, September 11, 2017

The American College of Cardiology and ABIM

I wonder how many American College of Cardiology (ACC) members are aware that the ACC entered into a "Memorandum of Understanding" with the American Board of Internal Medicine (ABIM), (along side the American College of Physicians and American Society of Clinical Oncology) "to explore development of collaborative pathways through which physicians can maintain board certification:"
“The ACC is pleased to join ASCO and ACP on exploring these additional pathways for cardiologists, oncologists and internists to maintain their certification. For cardiology, the ACC would provide clinicians with learning material and assessments modeled after its lifelong learning self-assessment program (ACCSAP). Helping our collective members in the provision of professional and compassionate care, while also keeping up with current knowledge, is a shared goal. We appreciate ABIM’s willingness to continue to listen to and engage with stakeholders in order to achieve this goal in a more effective manner.”

Mary Norine Walsh, MD, FACC
President, American College of Cardiology
What is not mentioned is the exchange of funds that will occur between organizations. How much will ABIM's inter-organization "certification" cost? Might this be one more financial bail-out strategy for the ABIM, given their long history of financial impropriety and rapidly depleting consolidated net assets? Why does the ACC insist on perpetuating MOC when the AMA House of Delegates voted to end the program? Might these organizations' own financial and political aspirations supercede the needs of their members? How much more money will practicing cardiologists have to spend to remain employed at their hospital systems now that MOC is increasingly tied to our credentials and insurance payments?

MOC has become one of the largest single causes of burnout and distrust in our professional societies that increasingly ignore their members' concerns in the name of political correctness and personal gain. This professional society collaboration is anything but helpful to resolving the MOC impass and only serves to strengthen our resolve to end it.

-Wes

Monday, September 04, 2017

Our Unsustainable Fear-based ABMS Physician Credentialing System

"... diplomats would be asked, but not required, to renew the validity of the certificates at periodic intervals or face the uncertain consequences of loss of their status as certified internists, subspecialists or holders of certificates of added qualifications."
(Glassock, R. J., Benson, J. A., Copeland, R. B., Godwin, H. A., Johanson, W. G., Point, W., Popp, R. L., Scherr, L., Stein, J. H., & Tounton, O. D. (1991). Time-limited certification and recertification: the program of the American Board of Internal Medicine. Annals of Internal Medicine, 114(1), 59–62.)
* * *
"Candidates for Board Certification and Maintenance of Certification agree that their professional qualifications, including their moral and ethical standing in the medical profession and their competence in clinical skills, will be evaluated by ABIM, and ABIM's good faith judgment concerning such matters will be final.

ABIM may make inquiry of persons named in candidates' applications and of other persons, such as authorities of licensing bodies, hospitals or other institutions as ABIM may deem appropriate with respect to such matters. Candidates agree that ABIM may provide information it has concerning them to others whom ABIM judges to have a legitimate need for it.

ABIM makes academic and scientific judgments in its evaluations of the results of its examinations. Situations may occur, even through no fault of the candidates, that render examination results unreliable in the judgment of ABIM. Candidates agree that if ABIM determines that, in its judgment, the results of their examination are unreliable, ABIM may require the candidates to retake an examination at its next administration or other time designated by ABIM.

ABIM also may evaluate candidates' or diplomates' fitness for Board Certification – including their professionalism, ethics and integrity – in disciplinary matters, and ABIM's good faith judgment concerning such matters will be final."
(ABIM Online Maintenance of Certification Policies. Available at http://www.abim.org/maintenance-of-certification/enrollment-cost/policies.aspx . Accessed 3 Sep 2017).
* * *
"ABIM's review of evidence seized from the Arora Board Review reveals you were a course attendee. As part of your Examination, you and all other examinees signed a Pledge of Honesty, agreeing among other things that you would not give or receive aid in your examination. The Pledge of Honesty also prohibits Examinees from disclosing, copying, or reproducing any portion of the material contained in the Examination. You were also provided with contact information for ABIM's Exam Integrity Hotline to report inappropriate behavior that occurred with the Arora Board Review course.

ABIM has ethical and professional concerns from arising from your conduct described above. As a result, ABIM is placing a copy of this letter in your file."
(Lynn O. Langdon, MS, Chief Operation Officer, ABIM "Letter of Concern" dated 8 June 2010)
* * *
"The American Board of Internal Medicine is moving against nearly 140 doctors who it says cheated on the organization's certification exams by seeking out, sharing and in some cases purchasing actual test questions from a board-review company.

Board certification isn't required to practice medicine, but is commonly needed for doctors of all stripes to secure hospital privileges or participate in insurance plans.

In suits filed Friday in U.S. District Court for the Eastern District of Pennsylvania, the ABIM alleges that five physicians infringed the organization's copyright on test questions. The suits also accuse them of misappropriating trade secrets and breach of contract."
(Hobson, K. "Medical Board Says Doctors Cheated" Wall Street Journal 9 June 2010.)
* * *
"I must say, candidly, that with over 50 years of law practice I have never before seen the likes of the repeated attempts by Dr. Westby G. Fisher to malign a person based upon an 11-year old “blip” in his long and successful career of public trust. It is, to be sure, unconscionable, to be using invective to shame the ABIM and, along the way, destroying the career and good name of a very honest, competent person, I know that if a member physician were similarly treated you would be mounting the ramparts to obviate its harm to his/her career."
(Letter from Sidney Baumgarten, Esq., Attorney at Law, to Alan J. Miceli, Editor, Philadelphia Medicine Magazine dated 27 Dec 2016)
How much money does the trademarked time-limited ABMS MOC® program generate annually for the ABMS and its member boards?

$392 million. Per. Year.

(This amount does not include the revenue generated by board review courses and study materials sold by colluding state medical societies and medical subspecialty societies.)

Fear and intimidation might sell MOC® for a while, but when the US medical education and credentialing system in the United States relies on fear for little more than its bloated bureaucratic and political purposes, it is non-sustainable. Practicing physicians like myself will not be ruled by fear-based policies and politics, especially when those imposing the mandate are completely unaccountable to our patients and our families.

I would encourage all of my readers to boycott the ABMS MOC® program (irrespective of the "kinder and gentler" model MOC® pivots toward), remain board-certified with the National Board of Physicians and Surgeons, and to consider joining Practicing Physicians of America, to protect our civil liberties of free speech and Fourth Amendment protections against illegal search and seizure.

Our ability to care for patients without such intimidation demands nothing less.

-Wes