On February 25, 2015 the American Board of Pediatrics published their “long-awaited” response to the growing physician outcry against the “Maintenance of Certification” scheme. I started writing a full response to their blog article, but I can’t even get past the graphic posted at the top of the page. Read their graphic carefully.
Bottom Line: The ABP believes that accountability to the public, continuous improvement of our operations, and transparency are important core values for the board.
Yeah, I know. Not a single mention of actual pediatricians, their diplomates, who are working daily in the care of children.
There are currently over 200 moderated comments allowed on the blog, I’ve read every one. 100% are negative, not a single comment in support of MOC. But it doesn’t matter what pediatricians think, because board president David Nichols started out with their Bottom Line: They don’t care about pediatricians.
They are accountable, not to pediatricians, but to the “public”. I honestly have no idea who the public is, because patients are not demanding board certification, let alone MOC. I’ve never, ever, had a family ask if I was board certified. My guess is that “the public” is pure imagination.
They are not focused on continuous improvement of MOC for pediatricians, they are focused on continuous improvement of their operations for themselves. MOC is an incredible revenue source. All the physician opposition to MOC revolves around three main concerns: Useless Part 4 “Performance in Practice” modules, never-ending and irrelevant secure examinations, and exorbitant costs. But because their focus is on their operations, ie. revenue, there’s no way they can respond and improve MOC for pediatricians when their revenue depends upon those issues opposed by their diplomates.
They claim transparency, but refuse to be transparent. They post silly grade school graphics of their budget and projected revenue, but refuse to release real numbers. They post data that makes it look like they’re $1/2 million in the red, poor guys, just barely making ends meet on $28 million dollars in revenue! Maybe posting data on board member salaries would help explain the $1/2 million shortfall. Previous ABP president James Stockman took home a cool $1.3 million annual salary, but David Nichols refuses to post his and other board member’s salaries. That’s the real transparency we want. But then again, they’re not accountable to us, remember?
But there is a way out of this mess, and I thank David Nichols for advertising it to my fellow pediatricians:
In the midst of debate around MOC, a different model has emerged. The National Board of Physicians and Surgeons (NBPAS) now offers a certificate for individuals with a valid license, a history of initial board certification, and evidence of at least 50 hours of CME credit. The reliance on CME for maintaining certification mirrors the requirements for renewal of licensure.
The National Board of Physician and Surgeons (NBPAS) is a new certification board open to pediatricians, recently created by practicing physicians in direct response to the failure of our boards to listen and adapt to diplomate concerns about MOC. The pediatric board member of NBPAS is none other than David John Driscoll, M.D., Professor of Pediatrics, Mayo Clinic College of Medicine. Take a look down the list of board members, it’s a veritable who’s who of medicine. No wonder the ABP is worried.
NBPAS certification standards are straightforward, egalitarian, inexpensive, and physician-focused: Pass a board examination once, hold an active unrestricted state medical license, demonstrate commitment to ongoing education through 50 hours of CME every 2 years. Seeing how the ABP has made it abundantly clear in their “Bottom Line” that they do not care about practicing pediatricians, it’s time we stop supporting a corporation that doesn’t support us and pursue certification through a physician-minded organization that does.
The ever-changing ABP rules say my certification expires December 2015, at which point I’ll breathe easy knowing my certification will no longer be at the whim of a board that doesn’t care about me. Instead, I’ll be a proud diplomate of the National Board of Physicians and Surgeons only.
Timothy Bill, MD says
Having just completed my first 10 years of MOC culminated by a ridiculous exam that has absolutely no practical importance, I hope that this new board is open to other specialties. The time commitment and expense for the traditional path is exorbitant. Moreover, I do not think that I can go through this process again. It is nice to see that the bureaucrats make over 10 times what I earn as a solo-practice hand surgeon. I’m not sure that I want to know what the MOC board members in my specialty make for their services.
TheresaWillett MDPhD (@drtwillett) says
Preach on, Dr. E 🙂 A few will hopefully become the many who actually stand up for rational practice rather than status quo.
TheresaWillett MDPhD (@drtwillett) says
By the way, I DID let my ABP status ‘lapse’ in 12/2014, but only technically. You see, I completed more than the minimum CME with self-assessment, and I completed 2 modules for QI (based on provided data, though, as I have moved and am not currently practicing). Thus, I have complied with my MOC in every way EXCEPT paying the fee for the exam due in 3 years. They sent me a lovely letter essentially threatening public shaming if I do not pay the fee. I took an informal poll of other practicing Peds if they would hire me with lapsed status, and the answer was a resounding NOPE. Until the majority of Peds can work without fear that specific certification will be a requirement for employment, we have not won the battle against this parasitic entity that we created.
Katherine Frederick Galarza says
I could not agree more. It is time to stop being lemmings and take a stand because this does matter. We have been the frogs in the pot of every increasing temperature water and it is time to hop out! It is the last time that I, a respected, honest, well educated professional will lift my pant legs, evert my pockets, lift my sleeves and be wanded to take a test. If the ABP thinks that I am so untrustworthy after years of training and sacrifice and 17 years of practice then I certainly shouldn’t be trusted with children’s lives.time to vote with our feet and our $1230.
Dr. Wes says
You missed the EKG finding on that graphic, too. The wide complex multiform QRS is reminiscent of pre-morbid hyperkalemia. Perhaps a subtle indication of their prognosis?
Kathy Murray Leisure MD says
Excellent note, Rebel MD (Dr Meg Edison)! All good comments. Fifteen years of MOC tyranny is enough (1990 – 2015). End MOC, stop MOC, no MOC. We are preaching to our own choirs. We must become physician activists. 1 Hospital Med staff bylaws: I am uncertain if unions for hospital employed physicians might be needed to get hospital CEOs to listen. Meanwhile, let’s work to get MOC requirements off your hospital medical staff bylaws. Enroll in the National Boards instead, if necessary. 2 The Interstate Compact and other Federation regulations coming to you: Wake up! Be sure to BLOCK the Interstate Medical Licensure Compact from passing in your state, marketed by the Federation of State Medical Boards for “licensure portability”. The Interstate Compact has a nasty Trojan horse which requires MOC for physician eligibility! The Compact also eliminates physician and state medical board civil rights and due process against vast and broad powers of their national Compact Commission. No guarantees that physicians will be leading the practice of medicine anymore. Too late for Wyoming and Utah! WY and UT physicians in these states adopted the 2015 Compact this winter. Woe to you, my prayers go with you. 3 Organized medicine: All physicians, if not yet done, must work towards passing a state society Resolution in OPPOSITION to MOC. Then use that state medical society statement to slam more Trojan Horses like MOC which come from the Federation of State Medical Boards, Obamacare, and other federal regulators as the regulators fleece doctors w absurd MOC requirements. On all three fronts, say again and again how MOC is morally, ethically, scientifically, and economically wrong for US patients, physicians, and our health care system. “We’ re sorry” patch apologies (like ABIM’s reform promises Feb 2 2015) are not enough. Stop the cancer now. See ChangeBoardRecert site for our Feb 12 Emancipation Proclamation to the ABIM CEO. End MOC entirely. Please become active w hospital staffs and legislators to end 15 yrs tyranny, bad policy, oppressive and wrongful practices.