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Thank You Burtt

March 18, 2019 1 Comment

As I was building this new site, moving content over from Rebel.MD, I heard about the death of my friend and mentor Dr. Burtt Richardson. He got a kick out of my adventures, many opinions and ambitions, and I am sad not to be able to share this site with him. He would have laughed.

I met Burtt and his wife Gladys during my pediatric residency in Maine. Burtt was a rural pediatrician, and my program sent interns out to rural sites for one month rotations. Burtt was entirely committed to my full education on rural pediatrics.

My rural month landed in the winter. Winthrop, Maine is only an hour away from Portland, but nearly impossible to drive daily during the winter months. This didn’t deter Burtt, he just gave me his home.

During my month, he and Gladys moved out of their home next door to the practice, and lived in their “camp” a few miles away. Let that sink in for a minute, because it’s only now that I’m an attending that I realize how remarkable this was. He was so committed to the pediatric education of a complete stranger, that he moved out of his own home to make it happen.

He taught me how to use his woodstove, reminding me during the workday to run over and put a log in the fire so the house would be warm when we finished seeing patients. Every morning, he, his lawyer friend and the lawyer’s blind dog would meet me for an early run. It was dark in the mornings, so he brought me reflective gear. We talked a lot during those runs. I also got terribly frostbit on my ears and nose, so busy chatting I didn’t realize how cold it was.

On the issue of politics, Burtt and I were as opposite as you could imagine. I’m incredibly grateful we met in a time when that was okay. We’d run and talk and learn. Burtt chuckled that we were such political opposites that we’d both end out with our own FBI files, depending on the political whims of the day and what ideas were deemed dangerous at the time.

Burtt didn’t have an “after-hours” service answering calls, the calls came right to his home. His home phone would ring through to his camp, but for night calls he let me answer the phone first…and then I’d hear him pick up and listen in on the advice I gave. Remarkably, I only answered a handful of after-hours calls that whole month. He shrugged, “I start educating families from the beginning, and they nearly never need to call me at night.”

Once, he took Ryan and I out to a community play, grinning as he showed me The Cell Phone, housed in a briefcase. “If we’re really lucky, you’ll get a page and have to leave the play to call back on The Cell Phone!”. Again, he was fully committed to giving me the full experience of a rural pediatrician.

Despite all I learned about pediatrics and being a pediatrician during that month, my favorite and most lasting memory came the following summer when Burtt took us to climb Katahdin. Ryan and I had hiked and kayaked the coast of Maine extensively my intern year in Maine, and as Midwesterners, were in love with the ocean. We couldn’t grasp why Burtt was so keen on Katahdin. Why go inland to hike a trail when the ocean was so gorgeous? But Burtt kept insisting. He made all the campground reservations and trail plans, so we went.

And he was right. Katahdin was amazing. It’s a 6 mile hike up, gaining nearly a mile in elevation. The dizzying heights, precipitous climbs aided by iron pegs driven into sheer rock, and uncertain weather…the whole experience was mind-boggling. Ryan and I got within 1/2 mile of the peak, and had to turn back as snow and high winds made the trek too dangerous.

That night, Burtt made us a dinner to soothe our disappointment at not making the peak, a dinner that very likely changed the course of our lives and planted the Airstreaming seed. To put Burtt’s dinner in perspective, Ryan and I made dinner the night before as we set up camp, a very Midwest camping dinner of chicken chili, cornbread, and Coke. That night inside the tent, in one of the most remote places in America, as the wind whipped and the rain beat down, Burtt pulled out white wine, caviar, and crackers…followed by linguini with white clam sauce…finished with Maine wild blueberries and fresh cream. And he did it like it was completely normal.

Now Ryan and I had camped our entire marriage. Our honeymoon after my first year of med school was 10 weeks on the road out West with a tent and $3,000. Over the years, we’d camped from Maine to Alaska. We camped the first month of pediatric internship waiting to move into our home. Eating Burtt’s dinner, I realized we’d been doing it all wrong. There was no going back to chicken chili.

The next morning, we woke to break camp and the sun was shining. Because we were in our twenties, Ryan and I HAD to try climbing it again. Burtt, at 67, hiked halfway with us and sat at Chimney Pond with his O’Douls. (He was incredulous that Ryan and I packed Cokes to drink on the hike, and predicted that soda companies would be sued for causing obesity and other health issues. We laughed at the time, but turns out he was right. Instead, he chose beer, a drink that…in his words…had stood the test of time for thousands of years). That morning, we beat the weather and made it to the peak.

The next year, our daughter was born, and it was 15 years until we could attempt Katahdin again. If possible, it was even more breathtaking the next time around.

It was so epic, that we returned to climb it again 3 years later, this past summer, and I determined that I’m officially old. The kids went on ahead and beat me to the peak. I have no idea how Burtt climbed it in his 60s, but I’m forever thankful he did.

He introduced us to a hike that is now part of my kids’ life narrative and accomplishments. He taught us to up our food game to the point of hilarity, especially when camping. My parents can thank Burtt for inspiring our Leelanau camping weekends. And for better or worse, we now choose beer over pop.

Cheers Burtt. Thanks for your friendship and legacy in our lives.

Filed Under: Uncategorized

My MOC Failure

December 3, 2017 29 Comments

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 de-credentialed 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.

Filed Under: Medicine, Uncategorized

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WillowBeWellWillowbe DPC@WillowBeWell·
15 Nov 2019

I love seeing so many strong female physician leaders at Nuts&Bolts! Nary a man-el in sight. #DPC #nomanels #WomenInMedicine @D4PC @D4PCFDN @kksheld @McknightmdEllen @megedison Dr Eliana George

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megedisonMeg Edison MD@megedison·
14 Nov 2019

Compression socks activated! Looking forward to speaking @D4PCFDN DPC Nuts & Bolts 2.0...hopefully without puffy ankles. 😊

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megedisonMeg Edison MD@megedison·
14 Nov 2019

Unbelievable. #heartofadoctor #brainofadoctor #trainingmatters

PGHobgyn@PGHobgyn

Some days... life is crazy.

#oblife #medtwitter #obtwitter

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Retweet on TwitterMeg Edison MD Retweeted
ExitABRExit ABR@ExitABR·
14 Nov 2019

Huge win!!!

Our biggest hospital MedExec approved new bylaws that recognize non-ABMS boards. They found the recent DOJ opinion letter very convincing. Hey, @NBRradiology, when are y'all going to go live so I can say goodbye to @ABR_Radiology? 1/2

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