Meg Edison

Medicine

My MOC Failure

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Today one of my favorite families came for a visit.  The kids were behind on their check-ups, but this wasn’t too surprising. Their young mom was recently diagnosed with stage 3 cancer and was working her way through surgeries and chemo.  The length of time since our last visit made me worry that mom’s health kept the kids from their routine visits,  but upon entering the room she looked well. We chatted for a bit and caught up on her health before moving to talk about the kids.

“Sorry we’re behind. Our insurance company sent a letter saying you were no longer a provider, so we had to transfer out.  I couldn’t find a doctor soon enough, so we just went to the ER and Urgent Care for sick visits and the care wasn’t as good.  When I called your office to get our records transferred, it turned out that letter was false.  I’m glad they asked why we were transferring, we almost left you based on that letter.”

I sat in stunned silence and blinked back tears of frustration and anger as the full weight of her statement hit me.  In the middle of cancer treatment, this family was forced to leave and seek care in the ER for one reason and one reason only: MOC.

I’ve hesitated to share the outcome of my failed MOC battle for many months now, but this visit today reminded me why we must fight against the monopoly of forced MOC. MOC doesn’t just harm doctors. It doesn’t just cost money. It harms our patients and it nearly cost me the right to care for one of my very favorite families in their most vulnerable time.

I’ve passed the American Board of Pediatrics board exam twice, I’ve completed countless hours of their proprietary online tests, I’ve completed three of their research projects on my patients. But when the ABP demanded another $1300 or they’d revoke my certification, I had enough. In protest of the shake down, I didn’t pay. The ABP and ABMS advertise their MOC product as “voluntary”, so I took them at their word.

It turns out MOC isn’t voluntary at all. Within weeks of not paying, I received a letter from BCBS of Michigan telling me to buy my board certification by December 31, 2016 or risk being decredentialed. I am board certified through National Board of Physicians and Surgeons, and asked if that was acceptable, and was rejected. Only ABMS boards allowed.

The date came and went, I didn’t pay, and I prepared to defend my case in front of their medical directors at the two appeal hearings guaranteed in my contract. Certainly the medical directors would understand this was a money grab by the boards, that I had passed every academic requirement due until 2023?  Certainly the medical directors would see how discriminatory it is to require me to pay and jump hoops unceasingly, while exempting grandfathered doctors from MOC altogether? Certainly the medical directors would see I had fulfilled more board requirements than a grandfathered physician, resident, or medical student but was treated as less qualified?

The date for my hearing was set, and I felt confident the logic of my argument would prevail.

And then the phone calls from panicked patients started.

A full month before my hearing, BCBS started sending letters to my patients telling them I was already a non-participating doctor. Patients started to transfer out, my billers and partners started to panic. I called BCBS, and asked them to stop the letters until my hearings were completed. They refused. I contacted my state attorney general, he couldn’t help. I contacted the state insurance commission, they couldn’t help. I contacted the AMA, and they said to contact my state medical society. I contacted my state medical society and their lawyers for help. Their advice: just pay.

Tired, trapped, and under coercion, I paid $1300 plus a $200 late fee. Within seconds, I had my American Board of Pediatrics certificate in hand, within hours BCBS reinstated me, and never sent out another letter to my patients.  It was clearly, all about the money.

I am a diplomate of the American Board of Pediatrics against my will. I find it morally reprehensible to financially support an organization that harms fellow physicians.  I find it demoralizing to know my money supports their lobbying efforts against our state MOC legislation. Yet I paid in order to see my patients. I paid so I could still be a doctor. The American Board of Pediatrics could ask for another $1500 next year, and I’d have to pay again. There is no choice.

Is it possible I was targeted for being so outspoken on MOC? Possibly. My initial letter to the ABP has over 100,000 views. My medical society has used me on the cover of their magazine and their website dedicated to fighting forced MOC. The ABMS Senior Vice President knows me by sight, and has watched me testify against forced MOC in our state capitol on multiple occasions.

But I’ve been contacted by countless quiet Michigan physicians threatened and decredentialed for simply refusing to pay for MOC. It doesn’t matter who you are, an outspoken physician with a state medical society behind you…or a solo practitioner quietly trying to stay afloat…you must comply.

I don’t know the solution to this problem. It seems like every legal, logical, and ethical boundary that should prevent a certifying company from gaining such absolute unchecked power has been ignored, and every professional organization that should help us is impotent.

My state medical society has held clear policy opposing board certification, let alone MOC, for insurance plan participation for 20 years. They’ve been negotiating for 20 years, yet aggressive MOC discrimination continues.  The AMA has strong policy opposing MOC abuse, but refuses to do anything.  The FTC should see this monopoly as a clear anti-trust violation. They are waking up, but still not acting.   I am baffled the IRS doesn’t question the million dollar salaries raked in by these “non-profit” organizations. It seems like this would be a slam-dunk class action lawsuit for some smart law firm, but no one is interested in the case.  State legislation is likely our best bet, but the lobbying power of insurers, hospitals, the billion dollar ABMS certification industry and their codependent specialty societies is nearly impossible to fight.

If nothing is done, ABMS will win, because their entire coercive business model relies upon our professionalism. As physicians, we take an Oath to “Do No Harm”. We promise this to our patients.

My first emotion when I heard my patients were forced to receive care in the ER was not anger at ABMS. It was gut-wrenching guilt. I dared to speak. I dared to fight.  I underestimated their power. I was stupid enough to think MOC was a physician issue. It never crossed my mind that my patients would be harmed. I know better now. The next time they ask for another check, I will comply, and they know that. I just hope something is done before then. Primum non nocere.

Learning from MOC Reform Failures in Tennessee, Florida, & Oklahoma

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bicycle race crash photo

It’s been a rough few weeks for physicians in this year’s first state battles against forced Maintenance of Certification. The good news is that 13 states now have pending legislation to limit the power of the ABMS over physicians. These bills are coming up in red states and blue states, sponsored by democrats and republicans alike. Maryland even has bipartisan sponsorship of their bill. The bad news is we physicians have a steep learning curve, as we’re finding out that hospitals, insurance companies, and the ABMS are incredibly powerful and organized in their lobbying efforts.

The past few weeks have produced disappointing but instructive failures in Oklahoma, Tennessee, and Florida. While heartbreaking to watch, there’s much to learn from these states as we all move forward. As testimony to the true grass-roots nature of the MOC battle, each of the 11 states are trying different legislative angles. There is no “template” being used. This is both exciting to see, and a bit nerve-wracking. The states are a “laboratory of democracy”, and this MOC battle demonstrates this, as each state tackles the issue in different ways that best suit their legislative climate.

Oklahoma stunned everyone last year when they passed the first Right to Care legislation protecting patients and their doctors from MOC red tape, in bipartisan fashion, without a hitch. Unfortunately, the language was not as tight as first thought, and hospitals found wiggle room to continue forcing MOC on some doctors while exempting “grandfathered” doctors. Oklahoma HB 1710 was introduced this year to clarify the language for hospitals.

The bill looked like a slam dunk. The hospitals didn’t seem to oppose it, the medical society didn’t even make it a priority for physicians to call prior to the vote. In the final 24 hours before the vote, the ABMS and the hospitals went on a lobbying and misinformation tirade, pouring incredible amounts of lobbying pressure and money upon the legislature. (ABMS and Hospital Talking Points Found Here.)

Physicians were caught off guard (because we work), and were completely flatfooted to respond to such an outpouring of lobbying power and misleading information. In the end, HB 1710 failed miserably 71-22. Oklahoma’s MOC law from last summer still stands, but in legal limbo, likely needing an Attorney General’s guidance on what the law means.

The takeaway point here is that the ABMS will spare no expense to stop state legislation. The ABMS will ignore the rights of physician diplomates and will instead work together with hospitals and insurers and lobby for the “rights” of hospitals and insurers to force doctors to buy their MOC product. This is stunning mission creep on the part of ABMS and violates their claims upon the “voluntary” nature of MOC, but is not surprising given the money involved.

ABMS plus the 24 subspecialty boards currently have $1 billion in assets. This is a high-stakes game, and the lobbying effort in Oklahoma shows they will outspend us at every turn. They know we have real jobs, and can’t abandon patients and cancel surgery on short notice, so they will lobby last minute in ways we cannot. This means we need to start personal conversations with our lawmakers early and often about MOC. We can’t rely on medical society lobbyists, we need to make the calls ourselves and get our colleagues to call as well.

Tennessee started out very strong this session with an elegant MOC bill SB 298, sponsored by Senator Richard Briggs. If you don’t know who this guy is, just Google him. This is the guy you want sponsoring your MOC bill: Cardiothoracic surgeon, army trauma surgeon, Bronze star, the physician that treated ABC anchor Bob Woodruff when he was injured in a bomb blast in Iraq, —on and on, just a class act. The hospitals and insurers had such a fit and lobbied so hard against the bill, pushing delay upon delay, that the senate committee had to strip any mention of hospitals and insurers from the bill for it to move forward. The sad, impotent Tennessee bill now simply says that MOC can’t be required for a medical license. Which…it never has been required. In fact, MOC isn’t required for a medical license anywhere in the country. So Tennessee wrote a bill outlawing something imaginary.

The takeaway point here is that hospitals and insurers desperately want to force MOC on “their” doctors. I have no idea why, but they do. Perhaps it’s a way to control doctors, perhaps it’s just a marketing ploy, i.e. “all our doctors are board certified”. Perhaps it has something to do with NCQA making ABMS board certification a HEDIS measure (funny how that happens, when the president and founder of NCQA is also on the board of ABMS). But for true reform, we have to take on the hospitals and insurers. What good is a medical license if we can’t practice in a hospital or participate with insurance companies without being coerced to participate in ABMS MOC?

Comprehensive MOC legislation must have three components if it is to ensure MOC as a voluntary program: it must prohibit MOC from being required for a medical license as a preventive measure, but must also prohibit MOC from being required for hospital privileges and insurance reimbursement because this type of coercion, discrimination, and harm is happening now. If any of these three components are missing, physicians can still be forced to participate and pay in order to work: they will not be free.

For states that have to settle with legislation that only prohibits requiring MOC for a medical license, don’t settle for long. Keep pushing. Kentucky, Missouri, and North Carolina passed this type of limited legislation last year. Maryland, Rhode Island and now Tennessee are likely to pass this type of weak legislation this year. Don’t settle, keep pushing for more next year.

Florida. Oh Florida. I don’t even know what to say. The story of Florida’s MOC legislation is just plain bizarre, not quite Florida Man bizarre, but still…close. Florida had fantastic MOC legislation with SB 1354, it was comprehensive and beautiful. Then it went to committee and everything went sideways.

The health policy committee “amended” the legislation, by erasing every single word of the bill and replacing it with their own language directing the state to regulate the subspecialty boards, with a plan to control MOC rather than ensure its voluntary nature. The language now allows doctors to be forced to do MOC, so long as the board registers with the state, is a 501c3, has a brick and mortar building with full-time employees, requires ongoing “practice improvement modules”, charges no more than $500 every other year, and doesn’t require additional testing, plus whatever extra regulations the state wants to add at a later date. If a board does not comply with these requirements and get certified through the state of Florida, Florida doctors can no longer call themselves board certified in that specialty.

This tactic is so out of left field, I can’t make heads or tails of it. On one hand, I chuckle at the idea of the certifying boards having to comply with certification themselves. On the other hand, for boards that spend a little extra money complying, they will have the legitimacy of the state behind them. Like all forms of regulation, it always favors the “big dogs”. Despite public protests to the contrary, big corporations like regulation and often lobby for more regulation to stifle competition, knowing start-ups don’t have the funds to wade through the red tape. A situation like this with open-ended regulations will favor the well-funded boards under ABMS and their lobbying prowess and harm competition like NBPAS.

I don’t even know what the takeaway is from Florida, other than a need to stay vigilant. I’ll sit by with popcorn and watch what happens, but certainly wouldn’t encourage this method for other states until we see how the Florida experiment shakes out. The Florida legislation does not make doctors more free, it does not decrease the cost of healthcare, it does not increase access for patients, it does not decrease the regulatory power of the state. It takes a budget-neutral bill and creates new regulatory authority for the state with the expected budgetary bloat involved. But, it’s fascinating to watch from the outside.

My only piece of advice for doctors in Florida faced with this bill of uncertain impact…ask for one last amendment: the approved boards must provide peer reviewed data showing improved patient outcomes from their programs. As there is not a shred of evidence behind MOC, this simple amendment will stop this nonsense cold.

Going forward, I have most hope for Texas, Alaska, and Georgia to lead the way this year in real reform. Georgia has already passed their bill through the legislature and are only waiting for the governor to sign. Texas and Alaska have comprehensive MOC bills, and have similar personalities in their physicians and their legislature: they don’t like outsiders telling them what to do. I expect they will pass their bills this session without difficulty.

The ABMS, hospitals, and insurance companies have shown their hand. It’s our turn to take a good look at what has happened in Oklahoma, Tennessee, and Florida, do our M & M conference, and move forward smarter and more effective as a result of these pioneering states.

Right to Care legislation is right for patients and their physicians. We may not have the lobbying money or the power, but we are on the right side here. It sometimes feels like we’re a small disconnected group of physicians hashing this out in our own states, but we don’t have to fight alone. We can work together and learn from each other. Physicians in states that succeed can mentor physicians in states that are aspiring.

The AMA has been woefully silent on this issue, but Right to Care legislation is exactly AMA MOC policy put into state legislative form. This is not fringe, this is supported by the vast majority of physicians, our state medical societies and the AMA. Knowing this keeps me confident we will succeed.

Photo by SWoo

Update: Now 12 STATES! Maine has a bill heading to testimony on Tuesday, April 11!

Happy National Women Physicians Day

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It’s now 10pm and like many working moms, dinner is finished but dishes need to be done, the kids are in bed but I still hear cackles of laughter from my older girls’ room as they are talking before sleep, I’m finally sitting down but I have a lot yet to do. Tomorrow is the 2nd annual “National Women Physicians Day” and I’m thinking about what that means. 

I’ll admit it, last year when the 1st National Women Physicians Day was announced, I may have rolled my eyes just a little and wondered why we needed a day to celebrate women only.  Either by luck, sheer optimism, or choice of specialty, I’m fortunate enough to say I’ve never once felt held back by my gender. To the contrary, as a pediatrician, being a woman and a mom is actually an asset rather than a liability. 

But when February 3rd arrived, and I watched social media light up with new profile pictures of my fellow women physicians celebrating the day, along with photos at work in scrubs, performing surgery, giving lectures, in rescue helicopters, in military uniforms,  I was moved.  The face of medicine has changed and it is beautiful.  In that moment, I was truly proud to be part of the sisterhood and was thankful for a day to remind each other of all we have in common and all we have accomplished. 

Celebrating National Women Physicians Day on the birthday of Elizabeth Blackwell, the first woman to receive a medical degree in the United States, puts our careers and successes in context.  We stand on the shoulders of giants. From Elizabeth Blackwell, to Rebecca Lee Crumpler, Mildred Jefferson to Linda Brodsky—countless women physicians not only broke through barriers, they paved the way and mentored others.  They left medicine better than they found it.  This commitment to the future of our profession has never been more pressing. 

As it stands, nine out of ten physicians do not recommend medical careers to their children. Those that do, do not recommend primary care.  This is a tragedy.  Our world needs good doctors, and who better than the children of healers to carry on this calling?  There are many things we do for our children to prepare their future, from teaching them to read to saving for college.  We need to take a hard look at the problems in medicine with them in mind. What can we do to make medicine a better career for them, how can we ease their way?

Before my girls went to bed tonight, I asked if they’d ever consider being doctors. My oldest, who is genetically wired to be an engineer, gamely said she’d think about it only after making a complete list of the pros and cons. I think the engineer mind is strong with that one!  My younger daughter said she’d be interested, but wasn’t sure about “that blue cross stuff”. My heart sank as I realized my frustrations with bureaucracy, MOC, and third party payers were far more transparent than I’d realized. “But if I can fix those things, what would you think about being a doctor, like mom?” Her eyes brightened and she responded, “Spending the day around babies? Sign me up!”

On this 196th anniversary of Elizabeth Blackwell’s birth, it is interesting to note that despite all her hardships and challenges as the only female medical student among 150 men and subsequently the only female doctor in the country, she loved medicine and recommended the career to other women. Just five years after Elizabeth graduated from medical school, her sister Emily became the third woman in the United States to receive a medical degree, one sister paving the way for the other. 

This is what being a woman physician means to me now. It’s no longer about passing the next test, proving myself, and advancing in my career. I am happy and fulfilled where I am. Having reached my goals, I can look beyond myself to the next generation of physicians. Within the next 6-8 years, my girls will be making their career choices.  If I do my job and “fix those things”, medicine will be better than I found it.  I truly hope one, or both, of my daughters will look at this wonderful profession with bright eyes and say, “Sign me up”. 

Who Is Seema Verma?

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Seema VermaI opened up Twitter yesterday morning to the best hashtag I’ve seen in a long time: #SeemaVerma. I yelped and jumped out of my seat in excitement. Seema Verma! Seema Verma! I took to the socials and posted my excitement at President-elect Trump nominating her to take over for Andy Slavitt as head of the Centers for Medicare & Medicaid Services. And all my friends said…who?

As I looked around the web, I realized the rest of the country was asking the same thing. At the risk of sounding like a fangirl, Seema Verma is just plain awesome. I met her 3 years ago when a small group of doctors (like, 3) were frustrated with being frustrated in a post-ACA world and wanted to find solutions.

We scoured the web for innovators, called them up, and asked if they’d come to Michigan to talk to some doctors.  For those who don’t know already, Seema Verma was one of the principle architects of the “Healthy Indiana Plan”, an innovative program that piloted the concept of using an HSA for Medicaid-eligible individuals.  Because of this, she was tops on our list of “dream speakers”. As it turned out, she was the first person to sign up to speak! In addition to cutting short her vacation in the middle of a beautiful summer so she could come talk to us, she did it for free. She’s that awesome.

I searched my archives and was able to find the video recording of her talk, and it’s as good as I remember. The ideas of the Healthy Indiana Plan rocked my world, and that of the doctors and lawmakers in attendance. Seeing alternatives like this transforms the way you look at Medicaid. Listening to her again, I am just thrilled that a woman like this, who really gets what physicians and patients are dealing with, is going to run CMS.

Watching this video again is also very humbling to me.  The conference was a bare-bones, fly-by-the-seat of our pants event. It was put together by three doctors, none of the speakers asked for speaking fees, we begged and borrowed meeting space and AV supplies. Yet the hunger to learn about innovative healthcare policy was so strong, we had physicians flying across the country to attend.

Most exciting in retrospect, if you look closely, you’ll see some of the Giants in healthcare policy and innovation in the audience. Three years ago, we were just a ragtag bunch, bouncing ideas off each other, trying to find a way. Now these presenters and folks in the audience are national policy leaders. This speaks to the importance of physicians engaging in the process, taking risks, being a little rebellious, meeting face to face, and championing new ideas.

So, who is Seema Verma? Well, watch the video and see for yourself.

Addendum: For those curious about my handmade sign on the podium. Docs4PatientCare donated the AV team and AAPS sponsored a much-needed cocktail party after the conference. The conference was truly the work of 3 Michigan physicians, from arranging speakers, venue, caterers, flights, hotels, drivers, CME accreditation, graphic design, webdesign, print media, email lists, invitations, social media….you name it…all while working full time jobs. I have 3 days of post-event migraine to prove it was our conference, while at the same time,  I will be ever grateful to D4PC and AAPS for believing in us, our vision, and our ability to pull it off. Even I didn’t believe in us at the time!

American Board of Pediatrics Directly Markets to Parents

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askyourpeds

Well, it’s official. The American Board of Pediatrics has officially jumped the shark. Faced with the reality of thousands of pediatricians refusing to buy the American Board of Pediatrics MOC program, they’ve taken a page from Big Pharma: direct-to-patient advertising. When Big Pharma can’t convince doctors to prescribe an expensive or useless product, they create a flashy, heart-tugging, and often deceptive advertising campaign directing patients to “ask your doctor about X, Y, or Z”. It works pretty well for the pharmaceutical industry and their bottom line, so I can see the appeal to the board certification industry.

This week, the ABP unveiled its new website MyCertifiedPediatrician.org. The website targets parents, directing them to “ask your pediatrician if he or she is board certified today”. It directs parents to the ABP database to check if their doctor is board certified. Mind you, this is a discriminatory and deceptive database that allows older doctors who have only passed one test to remain active and searchable even if they don’t do MOC or pay more money,  but deletes the names of completely qualified younger doctors who have passed multiple board examinations if they do the same.  Most disturbing are the 14 videos that use chronically ill children and their parents to market the ABP Board Certification product directly to other parents and young patients.

They’ve developed marketing tools targeting patients, such as cute digital “I Am Certified” widgets you can place on your office website (with threats of legal action if you use it and then fall behind on your MOC, so I won’t tempt lawyers and post a copy here).  If you want hard goods, they’ll provide “I Am Certified” window clings, pamphlets, and buttons for your white coat.

The whole propo campaign is both nauseating and hilarious.  Because I’m a glutton for punishment, I slogged through all 14 videos. It was physically painful to watch chronically ill children and their parents used in this campaign. In watching the patients, it’s very clear none of the children used have any idea what board certification is. It sounds like the children had good caring doctors, but I couldn’t help but harbor anger toward their doctors for exploiting their young patients in this way.

Not surprisingly, none of the parents in the videos understood board certification either. Even mother “Breck” admitted she hadn’t heard of board certification until she had to make the video.  Mother “Kate” praised the excellent care she received by a doctor just 6 weeks into her fellowship…she praised the care given by a doctor that wasn’t board certified!

This change in tack can only mean one thing: the ABP is in trouble. The data doesn’t show board certification makes for better doctors, so now they’re trying to claim that board certification is a “commitment” and “gift” to our patients. They don’t have the data to support MOC as a quality measure, so they’re going to shame us into participating.  My fellow pediatricians need to think twice before downloading that “I Am Certified” logo, because supporting this organization is not something to be proud of.

This is an organization with $107 million in total assets, earned on the backs of hard-working pediatricians. They award themselves million dollar salaries, fly first class to “board meetings”, rake in a $17 million retirement plan while pushing practicing pediatricians into early retirement, taking us away from our families for testing and hoops with zero evidence to support their claims of quality.  For those who do download this logo and use it lavishly, stop and think about what it really means.

The “I Am Certified” logo serves as a notice to parents that their pediatrician is beholden to the ABP, the ABP educational programs, the ABP research projects, and may actually not be a very good doctor. A pediatrician that displays the “I Am Certified” logo is no longer choosing her own education tailored to her patient population, she’s learning what the ABP says she should learn.

A pediatrician that displays the “I Am Certified” logo may be performing Part 4 research projects on patients without consent, and sending that data to the ABP or publishing it in the AAP journal (http://www.ncbi.nlm.nih.gov/pubmed/24935994 and http://pediatrics.aappublications.org/content/early/2016/02/01/peds.2015-0675 ).

A pediatrician that displays the “I Am Certified” logo is not a free thinker, doesn’t question authority, and is happy to comply with whatever new requirements are forced upon them and their patients without regard to evidence.

And lastly, you have to question the quality of a pediatrician who would use the desperate “I Am Certified” logo to market themselves.  Being board certified in pediatrics comes down to paying $1300 to a 501c3 non-profit in North Carolina.  It’s on the level of paying to be included in those scammy “Who’s Who” directories. Any doctor who would wear an “I Am Certified” button on their white coat, hand out “I Am Certified” fliers in their waiting rooms, or issue the stock ABP press release when they “complete MOC” is a little suspect in my mind. A good doctor doesn’t need to puff themselves up with pretend quality credentials to get patients.

The ABP should be ashamed of themselves for this advertising campaign and the way they are using chronically ill children and their parents to sell the MOC product and the way they are directly marketing this to young families. Perhaps the American Board of Pediatrics needs to watch their own videos, specifically of mother “Carole”, who in an attempt to sell board certification gives an eloquent argument against board certification. Here’s what she has to say:

“In healthcare we typically want our physicians to be very knowledgeable, which is important, but it’s more than just the science, it’s the human element that is so important to patients and families. It’s being able to communicate with us, but also with our children–having that bond when you come in the room. There’s that knowledge of the science and the medicine, but there’s the interpersonal aspect of it–it’s the human, it’s the communication, it’s the compassion, and above all it’s empathy when needed.”

That right there, all the stuff that matters to parents, has nothing to do with board certification or MOC. In fact, throughout the video testimonials, everything the patients and families valued about their pediatricians–compassion, communication, rapport, coming in on their days off, going above the call of duty–those are qualities that have nothing to do with the ABP. They can’t be tested, quantified, or data collected and the ABP certainly cannot take credit for those skills.  Yet that’s exactly what the ABP is trying to do. They are trying to take credit for the excellent care, late nights, and compassion we demonstrate every day.

Don’t let the American Board of Pediatrics take any credit, docs. It is your hard work, your commitment to continuing education, and your compassion that is saving and improving the lives of children every day. The ABP is just trying to come in a steal the glory on your dime.  This all reinforces my very conscious decision nine months ago that “I Am NOT Certified”, a decision I haven’t regretted for an instant.

Leaving Medicine Better Than We Found It

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Like many of my fellow pediatricians, today I read the three page letter written by American Board of Pediatrics CEO David Nichols.  It was a full day seeing patients and it took me nearly three hours to finish it. The letter was so upsetting I couldn’t handle reading it straight through. I’d start reading and my stomach would turn, I’d start to despair about the future of medicine, and I’d put the letter aside. Thankfully, it was a busy day and I was always rescued from this sadness with a patient. It’s summer, so that means sports physicals.  Today I saw lots of 14 year old girls, the same age as my oldest daughter, and it was fun. But between patients, I’d try to slog through more of the letter and the sadness would return…only to be rescued by a patient.

The emotional swing of my day is just one illustration of the stunning disconnect between the joy we find in being doctors and the soul-crushing work done to us by those in power. After carefully reading the letter, I had planned on writing a witty article making fun of the imaginary bell shaped curve and debunking Nichols’ whole straw man set-up. Now I realize it’s not worth it. Nichols’ letter is just one man’s desperate attempt to justify his million dollar salary. My sadness today was not with Nichols and the ABP, indeed I’m not even board certified through the ABP anymore, so what they say does not really impact me.

The real issue here is leaving medicine better than we found it. I can safely say the generations before me dropped the ball.  I’ve talked to many retired doctors and after chuckling “man I’m glad I got out”, there is a soft sadness and recognition of failure when they see the look on my face at those words.  They failed us.

Those in power now, like Nichols, are continuing to fail us.  At a certain point, even the $1.3 million dollar salary fades away late at night, and Nichols knows he’s made medicine worse for his fellow pediatricians. He’s taken our money, he’s driven good doctors into early retirement, he’s cost us jobs, promotions and pay.  He’s torn nursing physician mothers from their newborn babies, he’s forced physicians from the bedside of their own sick children and parents, he’s made physician cancer victims choose between taking a test to keep their job or taking care of their own health.  This is what the ABP Maintenance of Certification program and never-ending hoops are doing to us.

Nichols and the ABP are the perfect case study in how to ruin medicine and your fellow physicians.  From Nichols’ letter, it’s clear the ABP is not listening. Instead, the letter attempts to divert our attention and divide us.  Those of us who believe MOC is discriminatory, unjust, and an intrusion into the professional joy of the doctor-patient relationship are not just a “faction”, we are the majority.

The beauty of the MOC  fight is that it is also a perfect case study in how to make medicine better.  We are the majority, and we need to act that way.  We need to reject the whole premises and imaginary power of these boards.  We have to stop participating and let the program die away. This new generation of pediatricians graduating should be taking their boards for the first and last time. MOC stops with us.

As it stands, nine out of ten doctors do not recommend medical careers to their children. Those that do, do not recommend primary care.  This is a tragedy.  This world needs good doctors, and who better than the children of healers to carry on this calling?  There are so many things we do for our children to prepare their future, from teaching them to read to saving for college.  We need to take a hard look at the problems in medicine with them in mind. What can we do to make medicine a better career for them, how can we ease their way?

I can think of many toxic aspects of medicine, MOC is just one. I fight it because it’s an easy win. The tough ones on reimbursement and regulation are yet to come, but already we are seeing strong wins for those brave enough to challenge the whole system.  There are some bright spots, some really exciting bright spots in medicine.

Direct primary care, be still my heart!  The disruptors and innovators out there are almost too many to mention, Lee Gross of Epiphany Health, Josh Umbehr of Atlas MD, Zubin Damania of Turntable Health, Ryan Neuhofel of Neucare,  I could go on and on. These docs are doing the impossible: after generations of rapidly deteriorating satisfaction in medicine as a career, they’ve actually created models that are better than the “golden age” of medicine. By meshing old school primary care with technology, they’re providing better quality care, better patient satisfaction, better physician satisfaction and decreased cost. It’s stunning. And it’s happening now.

When I see what these amazing docs are doing, how they are making medicine better for physicians and patients, when I step away and just spend time with my patients, all the babbling by Nichols and the ABP just looks pathetic, archaic, and irrelevant. Tonight, as I was thinking through all these issues and how I can improve my little corner of medicine, Zubin Damania posted this video, and I’m crying. This is exactly what I’m talking about. There is no question. I know where the real revolution in medicine is taking place and where our future lies. Let’s get to work building it.

 

Photo by Alex E. Proimos