Shhh. I think this is supposed to be a secret, but this Wednesday at the super-elite AMA House of Delegates meeting in Chicago, where only the mostly highly connected and AMA devoted doctors get to attend, they actually stood up for us. It is now AMA policy that the AMA opposes mandatory ABMS recertification exams.
Crazy, right? News of this random act of fortitude trickled out to us on Twitter by the small handful of delegates who very helpfully tweet updates for those of us on the outside. But other than those little tweets, no word from the AMA on this incredibly good news. This is HUGE folks! The AMA opposes ABMS recertification exams! It’s time for celebration, and press releases, and emails asking us to rejoin the AMA. And yet, no word from the AMA.
It’s not listed in the Top 10 Stories from the AMA 2016 Meeting. It’s not mentioned in the coverage of the MOC resolutions that passed. By looking at the AMA website and news coverage, the only MOC resolutions that passed were the typical mushy kind. Here’s how the AMA reported their “newsworthy” MOC resolutions. Hold on to your knickers, these are some groundbreaking resolutions.
“Delegates adopted policy to further these efforts, including:
- Examining the activities that medical specialty organizations have underway to review alternative pathways for board recertification
- Determining whether there is a need to establish criteria and construct a tool to evaluate whether alternative methods for board recertification are equivalent to established pathways
- Asking the American Board of Medical Specialties to encourage its member boards to review their MOC policies regarding the requirements for maintaining underlying primary or initial specialty board certification in addition to subspecialty board certification to allow physicians the option to focus on MOC activities most relevant to their practice.”
Whoa Nelly. And the AMA wonders why they’re bleeding membership. Nearly every doctor in the real world is saying “STOP MOC”. And the AMA flitters about asking for more studies and playing footsie with the ABMS. In defense of the authors, these resolutions probably started out strong. But once the board-member packed committees hacked them to impotent pieces, there’s no meat left.
So what about that resolution opposing ABMS testing? Well, if you go to the AMA website and create a secure login and scroll through the hundreds of pages of amended resolutions from the nine reference committees, you’ll find…. Resolution 309 presented by Florida, California, Georgia, Pennsylvania, Washington, New York, & Virginia hidden in Reference Committee C. The language is strong:
RESOLVED, That our American Medical Association call for the immediate end of any mandatory, recertifying examination by the American Board of Medical Specialties (ABMS) or other certifying organizations as part of the recertification process (Directive to Take Action);
and be it further
RESOLVED, That our AMA support a recertification process based on high quality, appropriate CME material directed by the AMA recognized specialty societies covering the physician’s practice area, in cooperation with other willing stakeholders, that would be completed on a regular basis as determined by the individual medical specialty, to ensure lifelong learning
(Directive to Take Action); and be it further
RESOLVED, That our AMA reaffirm Policies H-275.924 and D-275.954 (Reaffirm HOD Policy);
and be it further
RESOLVED, That the AMA voice this policy directly to the ABMS and other certifying organizations (Directive to Take Action); and be it further
RESOLVED, That there be a report back to the AMA HOD by the 2017 Annual Meeting. (Directive to Take Action)
Awesome, right? Well, as soon as the committee got ahold of it, they butchered into
RESOLVED, That our American Medical Association call for the immediate end of any mandatory, recertifying examination by continue to work with the American Board of Medical Specialties (ABMS) to encourage the development by and the sharing between specialty boards of alternative ways to assess medical knowledge other than by a secure exam or other certifying organizations as part of the recertification process (Directive to Take Action);
and be it further
RESOLVED, That our AMA support a recertification process based on high quality, appropriate CME material directed by the AMA recognized specialty societies covering the physician’s practice area, in cooperation with other willing stakeholders, that would be completed on a regular basis as determined by the individual medical specialty, to ensure lifelong learning
(Directive to Take Action); and be it further
RESOLVED, That our AMA reaffirm Policies H-275.924 and D-275.954 (Reaffirm HOD Policy);
and be it further
RESOLVED, That the AMA voice this policy directly to the ABMS and other certifying organizations (Directive to Take Action); and be it further
RESOLVED, That there be a report back to the AMA HOD by the 2017 Annual Meeting. (Directive to Take Action)
Funny how that works. The resolution was dead. Gutted.
But between testimony in Reference Committee C on Sunday, and final voting on Wednesday, the Pennsylvania Medical Society melted the meeting down with a blistering two hour exposé on the abuses of the ABIM and the boards in general. It was standing room only, with Dr. Wesby Fisher and Charles Kroll presenting their financial data, Dr. Bonnie Weiner discussing NBPAS, and Dr. Scott Shapiro announcing the PA Medical Society’s vote of “no confidence” in the ABIM and plans to pursue legal action against the boards. Full report on the meeting and PowerPoint presentations can be found here.
With a much needed boost in morale and the data to support strong action, the full house convened on Wednesday and the delegates soundly rejected the Committee’s butchering of the resolution, extracted it to a full vote on the house floor, and restored the strong language of the first resolved. It passed easily.
RESOLVED,That our American Medical Association call for the immediate end of any mandatory, secured recertifying examination by the American Board of Medical Specialties (ABMS) or other certifying organizations as part of the recertification process for all those specialties that still require a secure, high-stakes recertification examination.
Boom. This is amazing! So why isn’t the AMA announcing this from the rooftops? Why is this hiding in hundreds of pages of resolution verbiage, only accessible via secure login?
Because they’re hoping you don’t know. If you don’t know, then they can ignore this policy exists and they won’t have to fight their friends at the ABMS on your behalf. But now you do know. You know that your colleagues from Florida, California, Georgia, Pennsylvania, Washington, New York, & Virginia wrote a strong resolution and fought it to the end. Now their resolution is policy. Bravo to Texas and Michigan standing strong as well.
Obviously, I’m not good at keeping secrets, and I hope the rest of my physician colleagues spread this secret policy far and wide. While I’m not yet ready to jump on the AMA bandwagon, I am warming to the realization that the AMA is made up of individual doctors. If we fill the AMA with the right physician delegates who will fight for us, we might actually win a few battles.
UPDATE: 6/17/16 ABMS Responds to AMA MOC Resolution. Still no mention of the MOC resolution from the AMA.
Full annotated report of Ref Com C, along with members of the committee here.
Link to the AMA HOD Reports here, AMA membership not required, just create a login.
Photo by (cup)cake_eater 
Finally, after 22 years, I MAY rejoin the AMA again…
Could this be the “Trump” effect?
Not so fast.
The AMA hasn’t done anything yet. Their attempts to gut the Resolution speak louder than their later backtracking and restoration of the original strong language– which occurred ONLY AFTER being shamed into it in the face of damning evidence against the whole MOC scheme (thanks to the Fantastic Five who had the courage to present on Monday). And even now they aren’t taking up the mantle; instead they choose to look for cover and limit any damage to themselves, while waiting to see which direction the wind will blow to take up with the presumptive ‘winner’.
The fact that they know we can’t be ignored anymore is notable and I hope represents a turning of the tide. But we’re not there yet.
The “AMA” didn’t attempt to gut the resolution, the amended language is what came out of reference committee, based on testimony provided there and the weight of the testimony for or against something. The process is democratic and is based on voting, not on “shame” or etc. Education staff may want to bring this to CME for a report back in 2017, and likely that is when the real debate will start.
Finally! More docs growing a pair:-) Here is hoping more of our brethren join those of us who engaged in “civil disobedience” and just stopped playing the game.
I’ve believed for a long time that AMA is a reflection of the physicians who are engaged in its activities and governance. If dedicated independent physicians are part of the House of Delegates, those are the kinds of policies which will be adopted. Kudos to PAMED for standing strong and proving that when physicians work together to support their profession and their patients, GOOD things can happen!
I agree Donna. Some are going to characterize me as “anti-organized medicine”. That couldn’t be farther from the truth. I’m on the board of directors for our county medical society, I’ve sat on reference committees at our last 3 house of delegates and chaired the committee this year. I care about medicine, I care about organized medicine. That’s why I am so upset at their leadership and so proud of the delegates. I’m not lobbing grenades from the sidelines. I’m very invested in the process and will continue encourage others to get involved.
Mostly it is staff who decide what goes up on the web page, and CME staff are a fan of MOC, even if the membership is not. So… you have to force their hands.
NOW THIS NEEDS TO BE MADE INTO A BILL AND PASSED AS A LAW IN ALL THE STATES , AS OKLAHOMA HAS DONE.
Meg-
Why are they not sharing this from the rooftops? I believe they’re in damage control. The AMA realizes that as a member of the ACGME, the AMA, AHA, ABMS, NBME, JCAHO, CCMS, AOA, AAMC are all in this together. Better to try to wall themselves off from the tsunami of legal action that’s about to befall the ABIM, ABIM Foundation, and ABMS before things get really messy. Trouble is, there’s still that pesky antitrust case out there against the ABMS. And who’s lawyers are defending the ABMS? The AMA’s. And note there’s no press release. No main stream media coverage of this story. “Let them eat cake” for a while and leak the story, but don’t publicize it, says the AMA. *Shhhh*, as you say.
I’m a cynic. I fear that things aren’t so pristine as “MOC is dead.” At least not yet.
Realize that many of our specialty societies have colluded with the MOC program because it benefits them so well financially. Realize that the quality, safety, and public reporting industries have numerous COI’s with MOC, too. For instance, our MOC and that “program improvement module” data gets processed by CECity (that was purchased by Chris Cassel’s Premier, Inc for a cool $400M after she helped prop up its valuation by having the ABIM contract with CECity for $5.5M of our testing fees for four years) for their services with the data they collect sold to other credential verification companies. Credentialing physicians, you see, is a $400M/yr business, about a third or half of which is from MOC. That’s right. One Wall Street business deal with more than all of MOC put together, courtesy of Dr. Cassel. These folks LOVE MOC and will lay down on the street to defend it.
Only with strong legal action, a Congressional investigation, and indictments from the DOJ, IRS, or FTC will things really change. Heads must roll. Baron, Cassel, Wachter, Wolfson, Holmboe, Langdon, Lipner, and their accounting firm and other board members – the whole unelected and unaccountable lot – need to be investigated and prosecuted where appropriate. And let’s not forget the violation of physicians’ privacy when a two-time convicted felon “Director of Investigations” has access to our addresses and emails and has access to the FBI and Postmaster Inspector’s hotline. Jesus!
Little AMA resolutions that promise to end MOC are just window dressing, especially given the degree of cover-up, tax fraud, financial malfeasance, egregious salary distributions, fiscal mismanagement, and violations of non-profit organizational law that has occurred since at LEAST 1986. Time to end it with a thorough investigation, jail time, and heads rolling, not some quaint AMA resolution.
-Wes Fisher, MD of the “Dr. Wes” blog
We can end MOC any time we want to. If physicians as a group simply stop participating in MOC the whole thing will collapse. Are hospitals going to replace us if we are not board certified? Are insurers going to remove us from their panels? Are your patients going to stop coming in to your office? Lets just stop the madness and put MOC paperwork in the recycle bin.
I like it. All the busy work is designed to keep us busy and distracted. This s the old trick in the book….
Just to add to Dr DiZio’s comments we have successfully eliminated recertification requirements completely from our hospitals med staff bylaws.
One victory at a time next state if Arizona.
Wes, the AMA’s web of malfeasance is so tangled that it would take years of full-time work for us to dissect it. Just one small example, the AMA develops a policy that telemedicine doctors should be licensed not in the state where they practice, but in the state where the patient is calling from. Does this make any sense? It’s just semantics…does the care occur in my office or in the patient’s living room? They could have easily proposed a much more common-sense policy that the care occurs in the office of the telemedicine provider, and leave it at that. No additional licensure required. But wait…then all of a sudden we find out that the AMA supports the FSMB’s interstate licensure compact, a law that would be totally unnecessary unless a large number of physicians all of a sudden need to be licensed in other states! How could this possibly be necessary?? Oh wait…telemedicine providers will have to be licensed IN EVERY STATE if they want to have a thriving business. And then the FSMB says, “you know what, we’ll give you a 2-fer. Since the ABMS senses a groundswell of revolution against MOC, we’ll add mandatory MOC to the interstate licensure bill.” So now, the AMA is in the extremely awkward position of supporting the nationwide adoption of a law enshrining the process that their House of Delegates overwhelmingly smacked down this week. It’s going to take them a long time to sort out all of these conflicts, but as in all things, their allegiances will be the strongest where the money comes from. So we need to keep up the pressure and should have no illusions that the AMA will act in the best interests of working doctors.
Another story about MOC and job search in Florida
I am looking to join a Pediatric group. I am a solo Pediatrician. MOC will expire 2016. I am boarded by NBPAS.
I was told by a future employer I have to be board by ABP(ABMS), due to insurance reimbursement.
It is time FLorida pass a bill like Oklahoma !!!!!
Hi Dr Corey Howard here. I am the Chair of the Florida Delegation and main author as well as the lead on this issue at the AMA. Let me explain the process and help others understand how we can all be helpful with regard to the issue of recertification. There is an excellent article in MEDPAGE TODAY that outlines most of what happened.
The original resolution called for an immediate end to the high stakes recertification exam. The resolution was sent to a reference committee for debate. Most of what was heard was against recertification and for the resolution. The chair of CME requested that we continue to work together with the ABMS in an effort to improve the process. The resolution committee took that language and disregarded the rest of the testimony and offered a substitution that eliminated all of the original language.
After working with many other states and individuals (most are against the high stakes exam) an alternate new substitute was offered (written by Pennsylvania) by me to the house of delegates that was inserted instead of what the reference committee wrote:
“Resolved that our AMA call for the immediate end of any mandatory, secured recertifying examination by the ABMS or other certifying organizations as part of the recertification process for all those specialities that still require a secure, hight stakes recertification examination”.
That resolution passed by a 2/3 majority. It was a fair democratic process that showed how important this issue really is. A few additional resolves were added:
“”RESOLVED, That our AMA continue to work with the American Board of Medical
Specialties (ABMS) to encourage the development by and the sharing between specialty
boards of alternative ways to assess medical knowledge other than by a secure exam.”
“RESOLVED, That our AMA continue to support the requirement of Continuing Medical
Education (CME) and ongoing, quality assessments of physicians, where such CME is
proven to be cost-effective and shown by evidence.”
The resolution then passed with an overwhelming majority. While not perfect, it is a very good start.
This is an example of the process to have one person with an idea create a resolution, have input from many others and work through the process to have a desirable outcome. It was very fair and one that I suggest all physicians become involved with.
I also recommend that everyone join their state or speciality medical association as well as the AMA because together we really are stronger.
There is more work to be done and we need everyone’s help. We need to address alternative boards as well as individual state legislation to ensure that we (physicians) are not subject to a single test, as part of our ongoing continuing education, that can limit one’s ability to practice medicine. I believe that the time has come for us to choose the type of continuing education we want and need rather than learning something just for a test that has not been proven to have any validity.
Join your state or speciality society AND the AMA and let’s make a difference together.
Corey
The development of the MOC process was so misguided, forcing dedicated providers to use precious time and money to go through the arduous process of recertifying through activities that add no value to medical practice. Sorry, but I’m not ready to pretend to work together when change only came about from a prolonged massive outcry by practicing physicians. In my mind, this relationship ended a long time ago.
Where has the AMA and AAP been since 2010? And if anyone is truly wondering “whether alternative methods for board recertification are equivalent to established pathways” then I can honestly answer no. The other methods can’t be compared to the MOC’s shameless extortion of physicians and betrayal of the public by diverting our focus onto their nonsense activities.
To quote Virginia Moyer, VP and chair of ABP MOC:
“Diplomates who choose our modules (PIM’s) or other modules (e.g., EQIPP) often do so just to get a project done to get credit. They, of course, then say the activity was “useless”, and they’re probably right.”
Huge news, and kudos to all of you who have worked so tirelessly to make this happen. I am curious… were the performance improvement modules (part 4 of the pediatric MOC) discussed?
The ABMS has issued an official response to the AMA MOC Resolution. So far, no public comment from the AMA on this “phantom resolution”.
Response to the American Medical Association Policy on Secure Recertification Exam
The American Board of Medical Specialties (ABMS) is opposed to the American Medical Association’s (AMA) call for the immediate end to any mandatory, secure recertifying examination by ABMS or other certifying organizations as part of the recertification process for those specialties that still require a secure, high-stakes recertification examination.
Consumers, patients, hospitals and other users of the Board Certification credential expect board certified physicians to be up-to-date with the knowledge, judgment and skills of their specialty—both at the point of initial certification and along the physician’s career path – and to verify it through an external assessment. The privilege to self-regulate which physicians enjoy demands that we meet that expectation with more than just continuing medical education.
Continuing medical education is an important component of a physician’s continuous learning and an important part of Maintenance of Certification (MOC), but by itself is not sufficient to verify that a physician is up to date. The other components of MOC—professionalism, external assessment of knowledge, judgement and skills, and improvement in medical practice—are also important.
National certifying and recertifying examinations evaluate certified physicians against an objective, national standard in a given specialty, which is important both to patients and to providers who are making credentialing and privileging decisions. It is a critical component of our profession’s commitment to self-regulation and to the public trust.
ABMS Member Boards and the AMA Council on Medical Education have been working together to modernize the Boards’ recertifying examination processes and more than half of the ABMS Member Boards are in the process of developing and piloting alternative assessment models. ABMS Member Boards are working to make MOC more relevant and customized to individual practices, and are adopting changes to their assessments to make them less burdensome, more formative and more relevant to practice.
ABMS urges the AMA leadership and House of Delegates to reevaluate this policy, which places the established system of professional self-regulation at risk and erodes the public’s trust that board certified physicians will hold themselves to the highest standards
– See more at: http://www.abms.org/news-events/response-to-the-american-medical-association-policy-on-secure-recertification-exam/#sthash.AJ66eweS.dpuf
Very interesting comments by Meg Edison above. Someone named Megan M. Edison wrote an open letter to the ABP (http://rebel.md/open-letter-the-american-board-of-pediatrics/) in January 2016 advocating to do away with MOC and supporting “alternatives”. I wonder if this can be the same person?
I received an email from the new chairman of the American Family Practice Board telling me all about himself…Dr Keith Stelter. I congratulated him but told him that part of the problem is that he was a life long bureaucrat in academic medicine and he has no idea what private practice was all about. I then received an email from a Robert Cattoi, director of communications…telling me how the Board has not changed all that much since 1969 and this is not a membership organization but his constituents are the public.
Long story….after many emails and telling him that the requirements have changed…ie MOC….it went on deaf ears. These people are so out of tune ….it is only for the money in the name of quality and public safety. After 25 years I finally have had enough and will not be renewing my re certification. THEY NEED US MORE THAN WE NEED THEM. I hope the AMA finally will do something useful.
Dr R
Merit Badge Medicine BS
Mid levels have one exam of 110 questions and are certified for life. They go to school or through correspondence school get their degree in less than sixteen months. They now have independent practice of medicine in many states. That said, why have I taken three boards and a clinical exam board plus residency exams and then another certification exam that has to be repeated? Money and it has not changed my practice that is the standard of care in my area.
I had to reschedule my re-certification test few times, as I did not have enough time to prepare with busy schedule. I was threatened by my employer that I might lose the job if don’t get re-certification immediately !! You would n’t believe, I had to take time off from my work, prepared for the test and passed the test to save my job. Am I a better doctor now, because I passed the test? The whole MOC modules and tests are such a joke!! ABIM was getting more and more greedy to grasp money from all doctors’ pocket and they are still planning by different other ways to do it, when thousands of doctor’s opposed against MOC.