I’m chuckling at this stupid study I just read in the Journal of the American Board of Family Medicine.
Let me say off the bat, the study is load of crap and was a load of crap from the very beginnings of its deeply-biased inception. But we’ll play the game anyway. Never mind the first crazy assumption that health disparities between rural and urban areas are due to “stupid” rural doctors. Never mind the second crazy assumption that THE ONLY TRUE WAY to judge sufficient medical knowledge is the MOC exam.
Ignoring those two insane assumptions, let’s commence a study. And pray and cross our fingers that we can show how stupid the hick rural docs are compared to our slick urban docs. Please. Please.We want to be famous and publish in the Journal of the American Board of Family Medicine. Please let it be true!!
And oopsie daisies. What did the study show? It showed that rural doctors, with their worse patient health outcomes, were more likely to pass the MOC exam. Or…if you’d prefer the most generous possibility…poor health outcomes have nothing to do with MOC. But of course, the propagandists…oops, sorry…”researchers” didn’t say that. They twisted the study outcome to fit their crazy assumptions, once again.
Objective: Health disparities exist between rural and urban areas. Rural physicians may lack sufficient medical knowledge, which may lead to poor quality of care. Therefore, we sought to determine whether medical knowledge differed between family physicians (FPs) practicing in rural areas compared with those practicing in metropolitan areas.
METHODS: We studied 8361 FPs who took the American Board of Family Medicine maintenance of certification (MOC) examination in 2009. Data sources were examination results and data from a demographic survey of practice structure and activities, completed as part of the examination application process. FPs’ location of practice was categorized as either rural or metropolitan using a moderate and conservative definition based on reported community size. Univariate statistics assessed differences in FP characteristics between rural and metropolitan areas. Logistic regression analyses determined the adjusted relationship between rural status and the odds of passing the MOC examination.
RESULTS: Metropolitan FPs were less likely than their rural counterparts to pass the MOC examination using both the moderate (odds ratio, 0.67; 95% confidence interval, 0.54-0.83) and conservative (odds ratio, 0.56; 95% confidence interval, 0.42-0.74) definitions. Physicians in solo practice were less likely to pass the examination than physicians in group practice.
CONCLUSION: Rural physicians were more likely to pass the MOC examination, suggesting that rural health disparities do not result from a lack of provider knowledge.
If this study had shown what the researchers were hoping and praying, that passing the MOC exam is tied to better patient health, you bet your booties that would’ve been headline ABMS news today. Instead of reporting the obvious alternative, that passing the MOC exam is tied to worse patient health, they decided to change course.
Their conclusions, again through the filter of those two insane assumptions: Rural physicians were more likely to pass the MOC examination, suggesting that rural health disparities do not result from a lack of provider knowledge.
Again, no, but thanks for playing. The one and only conclusion this study can tout is this: Rural physicians were more likely to pass the MOC examination. Period. That’s it. There can and should be no assumptions made that tie quality of care, health outcomes or sufficient medical knowledge to passing the MOC exam. But who wants to question the validity of a multi-million dollar extortion scheme? Apparently not these dudes. Which obviously make you wonder about how honest the “researchers” were in disclosing their conflicts of interest. I mean, in addition to the obvious conflict of interest… this is IN the Journal of the American Board of Family Medicine.
I will give them credit for actually reporting the data. You can expect to see many many more of these “studies” to come out soon. It’s a high stakes game, and millions of dollars are riding on finding some shred of evidence linking MOC to better patient outcomes. The reason? Doctors are rebelling against MOC.
Board certification used to be a life-long certification, kind of like lawyers passing the Bar. It was a one-time examination, meant to voluntarily demonstrate a fund of knowledge when graduating from a residency or fellowship. Our commitment to life-long learning was then demonstrated by completing the CME requirements as dictated by our state boards of medicine. But the national boards got greedy, and unilaterally decided to rescind life-long status, shaking doctors down for more money, requiring more tests, requiring doctors to collect patient data for the boards…all under the guise that this “continuous maintenance of certification” would protect patients and produce better physicians without any evidence to support the shake down.
So does complying with MOC lead to worse health outcomes? Well, no. I was just being a bit facetious and tweaking the authors of this silly study. But could it? Absolutely. MOC has completely monopolized the CME industry via regulatory capture. As a pediatrician, I spend $1230 on MOC, for which the American Board of Pediatrics is so kind as to award me CME credits as well. Am I going to go out and pay for another CME course, one that better applies to my patients and not the dictates of the American Board of Pediatrics? Not likely. So yes, the heavy-handed top down monopoly of CME will lead to less choice in what continuing education I may pursue and will be likely to pursue.
And I haven’t even started on the poor health outcomes from worsening access, when docs decide to quit medicine early, rather than subject themselves to another pointless, expensive and demeaning round of MOC. You can take that one to the bank right now, because docs are fed up.
Meg Edison MD is a pediatrician in private practice. You can follow Dr. Edison on Twitter at @megedison
Photo by Night Owl City