Starting in the 1970s, specialty boards began issuing time-limited certifications, at first good for 10 years
When it comes to legal liability, doctors may still be the “captain of the ship.” But increasingly, government, hospitals, and third-party payers are demanding that doctors constantly have overseers. In living memory, a medical school diploma and perhaps a year of internship could gain one a medical license. And board certification—showing successful completion of rigorous extra specialty training —was good for life.
Starting in the 1970s, specialty boards began issuing time-limited certifications, at first good for 10 years. Now even “grandfathered” physicians will be stigmatized online for “not meeting requirements” for maintenance of certification (MOC).
After 40 years of pushing MOC, the American Board of Internal Medicine (ABIM) is unable to demonstrate any value for patient care, writes Paul Kempen, M.D. Yet, doctors may have to go through the process to keep their hospital privileges or to remain on an insurance panel, no matter how stellar their record of patient care. But recertification is still claimed to be “voluntary.”
The process keeps getting more expensive and onerous. Examinations may be required every 5 years, or still more often, along with nearly continuous participation in newly added demands such as practice improvement modules (PIMs).
The failure rate on the 2013 ABIM exam was 29%!
So one day a highly trained, experienced physician may be board certified—and the next day, after examination results are revealed or a deadline for MOC compliance passes, he may be decertified and unemployable. In that one day, could he have become demented, or fallen behind in keeping up with his field?
For some physicians, it may be literally impossible to meet the requirements, say if they miss a deadline owing to illness or family emergency, and are ineligible to try again without taking a whole new residency program—which likely doesn’t exist.
Making a MOCkery of Medicine
David Mann, M.D., recounts his experience in being recertified in cardiac electrophysiology. He had to do an Approved Quality Improvement Pathway:
“Some of the more understandable options had to do with collecting data from patients to send to the ABIM. What they wanted this data for or what they would do with it I had no idea. The striking thing though was that NONE of the options had anything to do with the subspecialty I was certifying in.”
After laboriously collecting data on 50-100 patients for the Hypertension Module, he was informed that too many of his patients failed to meet goals for—lowering serum cholesterol. He needed to show “improvement” in meeting goals (that have since been withdrawn), even though lipid management is the jealously guarded prerogative of family physicians in his area. “After several months of effort that completely distracted me from my real job as an electrophysiologist, the answer to the question of Life, the Universe and Everything was a faulty cholesterol level.”
Conflicts of Interest
The pay of executives heading “nonprofit” specialty boards is justified by the amount of revenue, which depends on number of physicians paying fees and the amount of the fees. Might this be compared with paying prosecutors by length of prison sentences?
The “educational testing” industry, worth billions, is permeated with cozy financial relationships like that between NEJM, ABIM, McGraw Hill, and Area9 Labs (which produces the Knowledge+ website of NEJM Group, a division of the Massachusetts Medical Society). NEJM Group exhaustively markets its costly version of ABIM’s MOC. By supplying access to NEJM for staff members, asks Westby Fisher, M.D., “are our hospitals supporting the ABIM’s proprietary, self-mandated and scientifically unproven educational process that ties passing a test to the maintenance of hospital privileges?”
MOC is tied to “quality”—providing the proper care and avoiding “inappropriate” care. Endorsement by the self-appointed National Quality Forum (NQF) is considered the gold standard for best practices. Recently, the cochairman of one of its patient safety committees, Charles Denham, M.D., was accused of taking a $11.6 million bribe from CareFusion to get NQF to endorse one of its products.
NQF CEO Christine Cassel, M.D., former CEO of ABIM, treated the Denham scandal as a mortal threat. Then, to “avoid distraction,” she resigned her directorships with Premier ($235,000/y) and Kaiser Foundation Health Plans and Hospitals ($203,500 in 2012). Because she is “well compensated” by NQF ($516,000/y), it is, however, “unreasonable to suggest she would be influenced by money.”
NQF is funded by Medicare/Medicaid, which could refuse payment for services that are not compliant with the Choosing Wisely campaign of ABIM and the ABIM Foundation. The current president of ABIMF, Richard Baron, M.D., came through the revolving door from CMS. ABIMF president emeritus, John Benson, Jr., M.D., clearly wants CMS to enforce CW. He writes: “The prospect of health care consuming 20% of the GDP by 2020 is unconscionable so corrective actions have enormous urgency.” CW could also be tied to MOC (NEJM 2/13/14).
What better way to reduce medical costs than to remove non-cooperative physicians in mid career?© Copyright 2014 Tanna K, All rights Reserved. Written For: Tinytown Unleashed