The American Board of Medical Specialties says “board certification is a voluntary process, and one that is very different from medical licensure.” This is echoed by my board, the American Board of Pediatrics, who says “Board certification is a voluntary process that goes above and beyond state licensing requirements for practicing medicine.”
Over the past few years, the definition of “board certified” has changed from a one-time test to an ongoing series of tests, hoops, and fees to maintain certification through the MOC program. Not participating in any portion of the convoluted and expensive MOC program results in loss of board certification, but so what? Board certification, either as initial certification or 20 years into maintaining certification is voluntary, so what’s the big deal?
Well, it turns out, not complying with MOC is a big deal. Not only has the definition of “board certified” changed, apparently so has the definition of “voluntary”.
On December 17, with the blessing of my partners, I decided to test how “voluntary” board certification is. Over the past 13 years, I’ve passed my board examination twice, completed multiple proprietary online tests, and completed three ABP research projects on my patients. But when the American Board of Pediatrics threatened to revoke my certification and nullify 13 years of testing and research projects if I didn’t pay $1300 to “maintain certification”, I had enough. I didn’t pay, and voluntarily gave up my board certification.
I wrote a letter explaining why, so there wouldn’t be any confusion. To date, that letter has been read 100,000 times. Clearly, I hit a nerve among my colleagues. But what would happen to me professionally? What happens to doctors who stop doing MOC?
First off, after many threatening emails, the American Board of Pediatrics erases the name of any doctor who fails to complete any of the four parts of MOC from their website. Erases.
December 17, there I am.
And now, I don’t exist.
Grandfathered doctors, like ABP president David Nichols, are listed as “Board certified, not participating in MOC”, but those of us who have passed multiple board exams and a decade of MOC? Erased.
Obviously, they have the technical ability to list us as “Board certified, not participating in MOC”, but they don’t. They erase our names, as if we’d never passed our boards to begin with. The only way to find out that I’ve passed two board exams is to write the ABP and pay $40 for a release of information. Why would they do such a thing, why make this so difficult for us? Because their website has the power to destroy our careers, that’s why.
Four weeks after my Open Letter to the American Board of Pediatrics was published, my name was erased from the ABP website and the threats began. On an insanely busy Friday afternoon in February, I was called by Blue Cross Blue Shield of Michigan/Blue Care Network, and informed that I had to immediately cease from seeing any of my BCBS/BCN patients. Immediately. They checked the ABP website, my name was no longer listed and I was therefore no longer allowed to see my patients.
I asked if I could have a colleague co-sign my notes, and that was not allowed. I asked it I could see my patients and not be paid. They said I was forbidden from seeing my patients. I submitted my board certification through the National Board of Physicians and Surgeons, and was told only ABMS boards were allowed. I asked if I asked if I could see the credentialing policy I was being held to, and was told “it was proprietary”. All this stress and harassment in Michigan, because I didn’t pay $1300 to the American Board of Pediatrics, a multi-million certification corporation out of North Carolina. Unbelievable.
I pushed back and asked for a departicipation notice in writing, and they backed off. I now have until December 31, 2016 to comply and pay the American Board of Pediatrics $1500 (with the added $200 late fee, of course), or I will be banned from seeing my patients at that point.
Next up were the hospitals. My hospital privileges were due for renewal this month, and imagine my surprise when I had to sign a contract confirming that I would enroll in ABP MOC! This was nowhere to be found in my med staff requirements, which only requires me to have initial board certification. When I asked the hospital credentialers, they assured me this was a glitch. No one knew how this language made its way on to the computer-generated contract or how to change it. After much anxiety, I signed the contract as there was no alternate way to get my privileges renewed. Time will tell if I lose my hospital privileges over a computer “glitch”.
So far, six months after dropping my board certification, I’m still standing, but not without a ridiculous amount of harassment and bullying. My scenario repeats itself thousands and thousands of times across the country. Usually, most doctors back down and pay the money, they stop doing CME of their own choosing and complete the education modules decreed by the boards, they stop doing their own novel medical research and instead complete the busywork research for the boards, they give up family time to travel to review courses, they shut down their offices to take secure examinations. Doctors do this out of fear. The ABMS has long banked on fear and intimidation as a business model.
That model is coming into question as more and more doctors fight back. Rather than fear, I’m banking on the strength of my fellow physicians to return board certification to its rightful place as a voluntary process: one that is not tied to licensure, hospital privileges, insurance participation. Oklahoma has shown us this is possible.
This morning, Michigan will take the first step towards freeing our doctors from overreach of the ABMS, as House Bills 5090 and 5091 finally go to testimony before the House Health Policy Committee. I will be there testifying, alongside an incredibly diverse group of physicians finding common ground on this issue. The powerful insurance and hospital lobbies will oppose us, as anticipated. Maybe the ABMS will send someone to plead their case.
I remain optimistic that Michigan lawmakers will see MOC for the money-making sham it is, and act on behalf of Michigan doctors and our right to care for our patients without interference by these unaccountable outside board certifying corporations. My hope is that this will be the beginning for other states to follow in our footsteps and return board certification and MOC to a voluntary process, free of fear and intimidation.
Steve Karp MD says
” No one knew how this language made its way on to the computer-generated contract or how to change it.” However if the hospital is sued and those computer records are subpoenaed you will find out. Anything generated by a computer leaves a fingerprint of at least a time and date stamp. Hospital computers will require users to log in and then you’ll know who was responsible. “Oh, you didn’t enter that. But they used your password. So do you want to take the fall for someone else. Name names now!” The mere mention of these factoids will make the hospital attorney’s head explode because they will know that they are not dealing with a fool. Don’t let these life-suckers make you play their game. Make them play your game. And always try to stay two steps ahead. Good luck.
Keep up the good work. Don’t back down. We need to get organized in California next! Thank you for your voice and your strength.
Hal Koiman says
Hang in there, Meg. Also, you should start a contributions page, similar to Dr. Rushford’s. (http://www.doctorsjustice.com/#!donate/c1ghi)
We will all send you a bit of money so that you can fight on a while longer. Lawyers are expensive, and organizations with deep pockets will plan on dragging things out until you run out of money. It’s the only way they can win, because they know they are in the wrong. It’s a classic legal strategy. Let us help you a bit, and keep fighting!
Meg Edison MD says
Thankfully, I haven’t needed lawyers yet. I’m getting by on good looks and charm…well mostly just blind luck. I am partial to Barolo and good bourbon…so feel free 🙂
Rebekah Bernard says
Thank you Megan. I’m with you fully, pushing for Oklahoma’s model in FL. I dropped MOC and my ABMS will expire at the end of 2016, so I am watching carefully.
As the wife of a med/peds physician, I just wanted to say thank you for your fight against MOC.
Clay Watson says
Hi Meg. Thank you so much for your courage and your ACTIONS. Please submit this to kevinmd as well at firstname.lastname@example.org. This is another website with a large readership. Every doctor needs to hear about your story. I also mentioned it to the American Association for Physicians and Surgeons. Check them out. We need to get organized as a profession. We must use power. If enough of us say “NO”, then they have to do it our way.
Michael Garrett, MD says
Thanks for standing up, Meg. I’m with you 100%. Michael Garrett, MD. Owner, Direct MD Austin.
You just need a few cases of affected doctors to file an extortion complaint with the feds, FTC and take the case to court as individual cases NOT class action!
Steve Karp MD says
Your point is quite valid. Look at what happened to the law student, Anna Allaburda. “Ms. Alaburda, 37, is the first former law student whose case against a law school, charging that it inflated the employment data for its graduates as a way to lure students to enroll, will go to trial.” [(NY Times 3/6/16). She lost as reported on 3/24.] The jury trial was in part due to the fact that others have tried the class action approach and the courts had tossed them out.
The problem with the judiciary is that it’s a rigged system against the citizen due in part to many being appointed by politicians. They use ‘standing’ inappropriately, they create ‘precedent’ when it’s expedient, and they recognize ‘administrative law when they fear for their jobs’ (administrative law being an offshoot of the Executive branch). No judge wants to remain in traffic court so rocking the boat at an early stage in one’s career is not advisable. As for juries, they are penned into determining cases based on the presumed justness of the law, into which they must fit the facts of the case, rather than having a trial of law and fact. As for facts, they too are somewhat arbitrary, based upon what the judge determines to be admissible.
Unfortunately most lawyers will tell you what you can’t do and that’s why the best lawyers cost so much. They know that money talks and you’re paying for their creativity. They know that the words by themselves are not the law but can be used in such a way that the loopholes within law can be exploited. Now legal loopholes either exist due to ignorance, purposeful acts, or unintended consequences. In any event, when it comes to counsel, you get what you pay for.
Alan McKendree says
Just curious, Dr Edison…do you support the abolishment of licensing laws as such? The current licensing system could be replaced by a COMPLETELY voluntary system of certification. Anyone who wanted to go through the exact same education as M.D.’s do now could do so, and receive a certificate at the end. Anyone who wanted to do half of it could receive a certificate to that effect, etc.
Patients would have a vastly wider range of expertise from which to choose, and practitioners could treat those who selected them.
I believe abolishing licensing laws would solve your MOC problem and allow you to keep practicing as you wish. What do you think?
Steve Karp MD says
In a way licensing laws are being abolished. In Pennsylvania, SB 717, to be voted on today, seeks to grant NP’s independent medical practice in the commonwealth. So essentially NP’s will be considered as MD/DO’s at least when it comes to the practice of Internal Medicine, despite the fact that on paper none would be able to even qualify to take the IM board exam, nor I don’t hesitate to say, have the knowledge base to pass it. I believe that physician training should not be altered but MOC and reboarding should be abandoned and if physicians were smart they would abandon the NP’s by the roadside i.e. don’t take their elective referrals.
I’ve passed the test and cranked out a handful of useless activities. I am due for payment this year and I cannot stand the thought of giving another dime to the ABP and Virginia Moyer VP, MOC and quality. In her own words “Diplomates who choose our modules (PIM’s) or other modules (e.g., EQIPP) often do so just to get a project done, at the last minute, to get credit. They, of course, then say the activity was “useless”, and they’re probably right”
Wanda Abreu says
I wrote to the ABP after my recertification….I let them know that I felt it was PRIMARILY a way to get money…the fees are absurd. I would say MOC is 70-80% is NOT HELPFUL when you compare the amount of time needed to complete. I could do a whole week CME and get 10X more benefit to patient care than MOC which takes a lot longer. It is inefficient and just stole quality time both personally and professionally. In addition they have contract with one specific testing center that meant I had to drive 3 hours to their approved site instead of to another testing center we have in my local town. I wouldn’t mind if I actually benefitted or if my patients benefitted from this test…it’s just a hoop to jump through. My opinion is that we should certify once and then fulfill a certain number of specialty specific CME every 5 to 10 years. ABP MOC is a joke..
You are my hero! Thanks for all your work and passion. I am with you 100%. I pledged today to Right2Care. This MOC process deprived me of my family, personal time, and several clinics. Absolutely useless and ridiculous process.
I hate what happened to you, I hate that the practice of Medicine has become certifications,certifications and certifications and still patients are not happy, law suit cases still happening, malpractice insurances are up to the sky… So why we need all those certifications if nothing changes despite all the time and effort investeed in those ? We have to remember that practicing medicine is an art, that everybody handles differently and as soon your patients are healthy and happy, that is what matters the most. Thank you for your efforts, I hope we can stop this non sense one day… But mean while the society sees Doctors as a way to make money, they always are going to create a new law, a new certification, a new rule that we are going to have to follow (and pay, of course) in order to keep
And so it begins…the litigation the ABMS ABP and the ABIM will face will crush them. Under no legal of medical definition is an otherwise competent doctor suddenly “de-certified” or “un-qualified” or “not a doctor” because they choose to craft their post-graduate education independent of these fees. If your career is altered by the ABP, you have a right to sue the ABP for triple damages and it will be a matter of time before there will be a Class Action Lawsuit. ABMS, ABP and ABIM: who will blink first?
steven rosenberg says
maybe ABMS needs to review the English language. Board Certified is past tense. The doctor was certified and therefore should be listed as certified, though could be listed as not maintaining certification. Similar with letter from BCBS as the state attain certification. He clearly had attained certification but elected not to be extorted by a money making Board.
Steve Karp MD says
Good point. I believe another issue is whether as a physician who had a “time limed” certificate, it is legal for the ABMS to prevent you from acknowledging or advertising that. I believe the ABMS claims that they do have that right. Keep in mind that after initial certification it really is just a matter of whether you choose to belong to the club. If this is really all about “quality” perhaps the onus should be on the residency programs to not let you go until you pass, a sort of exit exam of a minimum standard achieved.
Meg Edison MD says
ABP sends all non-compliant docs an email telling us how we are allowed to “advertise” ourselves, with threats to sue us if anyone lists us as board certified in pediatrics and we aren’t. The main reason I got certified through NBPAS a year ago, was because of this. I have no idea what websites out there list me as “board certified”, and didn’t want a lawsuit over it.
Do u really think that blue cross and blue shield looked u up and saw that your name dropped off? I doubt it. I suspect that your board proactively published bulletins on who is nasty and delinquent, specifically to encourage this type of harassment.
Meg Edison MD says
Yipes. I never thought about that. Crazy how quickly they came after me.
I agree with above poster…because I allowed my certification to expire as well by refusing to do MOC. And I haven’t heard any complaints from BCBS /BCN michigan
Meg Edison MD says
BCBSM says they only verify board certification every 3 years. I guess it’s just plain old coincidence that I was checked 4 weeks after publishing my Open Letter to the American Board of Pediatrics and 3 weeks after MSMS put me on the cover of their magazine to announce the Right2Care campaign. Excellent.
Phenomenal. Thanks for taking a stand. I always wonder how being “board certified” turned into a forced financial gutting of physicians.
I am not a doctor but your story is an inspiration. I am from Canada where the practice of medicine is under almost complete government control. Centrally planning heath care is a prescription for disaster and as proof, observe Canada’s declining heath care system. Don’t believe what you read about the benefits of socialized medicine. Patients are literally dying in line. Doctors must remain independent and free so they can exercise their own judgement for the benefit of their patients.
well Michaeln55m, I am ER physician, people are also dying here in the US because of a declining healthcare system too! I agree with Dr. Edison, the MOC is strictly driven by money and politics!
Celia Entwistle says
Wonder if you could use crowdsourcing to fund lawsuit for harassment. You might not beat BCBS but if the hospital caves, then they can take on BC and the other insurance bullies. I once worked in an urgent care. In 2009 I took my second recert early (paranoid I wouldn’t pass–I did), but this locked me out of ER LLSA yearly testing for that year. BCBS would not pay the urgent care for me to see patients because I “had not kept up with my certification”. No one else working there was board certified EM. It was stupid and bullying behavior. Who made BCBS Boss of all Doctors?
Steve Karp MD says
Funny how the insurance is called the ‘Blues’ whereas it’s we who really have it.
Midwest Hospitalist, Not Otherwise Specified says
Let’s not forget to support the NPBAS, which I’m sure the majority of readers here know is an organization offering an alternative board certification status dependent on a much more appropriate indicator of “MOC,” CME participation. I’ve personally been intended to join but haven’t as yet–I now will do so without delay.
We physicians also need to press our hospital leadership to embrace the group and expand its recognition. I’m impacted by the equally onerous ABIM. Their recent monthly tweaks to their absurdly complicated and clinically irrelevant MOCK (no typo) process indicates their sanctum has been breached quite effectively–but they’ve got a long way to go.
Physicians have enough stress and interference in fulfilling our purpose in providing patient care as it is. We don’t need to permit this cabal of physicians across many specialties who have found a way to profit profoundly off our suffering. It’s time they focus on the challenges practicing physicians face perhaps for the first time in their existence.
This recertification system is a bunch of crap that does nothing to show how good or bad is a physician. It is a bully system that only makes money for the recertification company/business. I initially did not recertify. Board certification was the only requirement ; I needed the $500 as a solo practitioner. ACOG threatened to take away their cute FACOG letters, and I told them they could keep their cute letters, but I was forced to cooperate with ABOG as most insurance companies and hospitals have bought into the notion of recertification to cover their a**. My feeling was, i jumped through the appropriate hoops in training and passed my boards. These were the requirements until our fellow colleagues became business savy and invented recertification; subsequently gaining a financial benefit at the cost of their fellow physicians. At our hospital, some of the older physicians making decisions for other physicians are not even board certified; how freaking ironic is that.
TOTAL CRAP. UNTIL WE GROUP TOGETHER AND END THIS ABUSIVE HEALTHCARE SYSTEM TOWARDS PHYSICIANS, THEY WILL PICK US OFF ONE AT A TIME. UNTIMATELY, WE HAVE THE POTENTIAL TO BE IN CONTROL.
Dr. Jimmy says
How “Boards” are imposing themselves is with all our money !! Read my story, see how far a “Board” will go http://www.doctorsjustice.com
Steve Karp MD says
As a profession we physicians are being attacked on many fronts. We can argue all we want about the uselessness of MOC, and I wholeheartedly support the effort, however we are being sold down the river by those we supposedly represent us in their tepid, if extant at all, attempt to stop the independent practice of Nurse Practitioners throughout the U.S. Two days ago the Pennsylvania Senate (12 Yay, 1 Nay) changed the requirement that NP’s “collaborate” with Physicians to what will now be independent practice. The following is what I’ve submitted to the Pennsylvania Medical Society on their website.
“I faxed a strongly worded letter to (Senator) Gordner earlier in the week so perhaps it did some good regarding his (nay) vote. However my policy will be to not accept referrals from Nurse Practitioners (I am a radiation oncologist). Their organization has claimed for years that NP’s are not practicing medicine but rather “advanced care nursing.” My policy will be consistent with not accepting referrals from Chiropractors, Dentists and Podiatrists all of whom do not practice medicine or surgery in the same sense as a Doctor of Medicine/Osteopathy. Keep in mind that the #1 cause of litigation against Physicians is the claim of a delay in diagnosis. I will not allow myself to be placed in a position for having to defend my care because of lesser trained, lesser knowledgeable and lesser liable practitioners of ‘advanced nursing care”. Insurers are not in the business to purposely lose money. Any objective analysis will reveal the greater liability of patient’s cared for by a NP. Given that, why Med-Mal insurers will not demand a premium to insure them, only the government knows. Finally, will NP’s also be ‘credentialed’ to perform minor surgery? Perhaps we should just go back to the old days and have the barber remove our inflamed appendix, rather than a general surgeon.”
Unfortunately people have become quite docile despite the much greater availability of information available to us compared to any time in human history. One of the most powerful ways to expose the stupidity of people is through the use of ridicule. It’s what makes others’ ears perk up. It is the sophisticated people’s use of the F word. And it works if used appropriately. Where am I going with this you ask? Look ahead. How many former nurses are there in America. Probably 1-2 million. Is it farfetched to think that the states boards of nursing aren’t looking at that potential labor supply? By reactivating those nursing licenses, within several years you can train a boat load of NP’s to set loose upon society. Then what happens? Primary care represents about 50% of those undergoing medical training. Why should the government continue to spend millions each year training doctors in primary care if much cheaper NP’s are available? And I’m back to ridicule. Only by exposing the sheer stupidity of such ideas, and those who present them, do we have any chance of preserving quality of life and medical care in society.
To make a website or blog it’s very easy without any knowledge , just follow some videos on youtube and one hour at least you can build your blog…for your advices i took them seriously and must do some changes on my blogs they all related with adsense , and a syou say i make 10 $ minimum per day. ? the most important thing it’s TAKE ACTION.
The letter from BCBS is simply affirming that they require ABMS certification for credentialing. You don’t NEED to be credentialed by BCBS to see patients covered by BCBS. If you are not credentialed you would be considered “Out-of-network” like many other providers. You would most certainly be able to continue caring for those patients but you may not be reimbursed as well since you would no longer have your contracted fee schedule. The insurance companies require the PATIENTS to know who is and who is not “In-Network.” Physicians are not mandated to walk into a room and list their network affiliations. You need to read that letter carefully… they don’t ban you from seeing their patients… they simply state that you would no longer be affiliated…. in other words, you’d lose your free schedule. This may result in a loss of new patients to other affiliated physicians but BCBS cannot tell you to stop seeing patients… they can only remove you from their Network physicians….. do others agree with this?
Steve Karp MD says
I’d say that you’re correct. Ideally all of Meg’s Peds co-specialists should drop BCBS in order to make a statement. But they won’t because…
Thank you for fighting and risking so much for the rest of us! I am joining the fight inspired by people like you!
Steven Newman says
Articulate, succinct, focused, and well balanced. Is this the ‘Bernie’ of pediatrics?
Your perception of the cudgel of the ABMS requirements for MOC VOLUNTARY certification, however, will only be modified by participating activist physicians that may take several years. As the large number of both primary care, and surgical specialists who are grandfathered retire in today’s ACA mandates, and the graduating newly hospital employed physicians mature and for fiscal reasons age out of the employed environment with a desire to diminish residual high education debt, and family obligations – they will ultimately turn to existing medical advocate societies. So, state medical societies will evolve into such, if they are to continue. Your state medical society is poised to do so. The first step is to demonstrate credibility with legislative action. Although grandfathered in my specialty, I hope to see, and support your leadership in this evolution.
Get Cash For Surveys Review says
Great stuffs! Thanks for sharing this
We are consecious enough about giving good care to the patient. MOC is not needed . It is more stressful then helpful.
I fully agree with you and commend you on taking that step towords fighting the MOC. I feel encouraged enough by your actions to proceed with the same. I am due to be recertified 2018 and I’m not doing any of the MOC’s. I will wait and see how that works for me too
Chris Owens says
Thank you for this
In my field (pathology) the MOC is only 200 dollars every two years so while useless at least it isn’t as costly. I think recertification exams are even worse. The American board of Pathology recently released pass rates of the recertification exam. Since 2015 with nearly 900 test takers 0 have failed for a 100% pass rate!? What is the point. Either we are all perfectly competent or we are not but the test is not good enough to identify incompetent providers. Either way a 100% pass rates essentially is mathematical proof of how silly the process is
ranjan paul says
its great to see some of us have a backbone and fighting back to wrest control of our lives and profession back from these charlatans who have no moral except to have power and money and profess that they are doing this to maintain the safety and meanwhile transferring money out of country on offshore accounts and buying condos taking multi-million dollar salaries.kudos to do u Dr. Megan i wish we had lot more like you.I am an internist
What’s a little board certification test every two years. It makes you re-study all the stuff you’ll never see. I’m an anesthesiologist…no -one ever dies as a result of an anesthetic I administered. But guess what…I still don’t really understand what the F— “heat of vaporization” has to do with my daily practice. All I do is crank up or down that bitch vaporizor – and everybody is happy.
Just take your freakin salary and run…life is too short. Give a F— about NP’s – 50 % of them are headed for divorce anyway because they are a miserable bunch of jealous people who resent your M.D., compared to their R.N. Ignore them.
Why don’t you all [ ladies included ] “man up” and tell regulators to kiss your a–! If everybody did it they’d be out of business. You guys need to do some jail time so you can teach people how to mind their manners.
Until that happens…you’ll continue to be fodder for HMO’s Medical Boards, Medicare investigators, cops, administrators, and insurance companies.
Ari Kostadaras says
Physicians have all the power to change the system but as always we’re not grouped for the same goal. This is a multi million business Cartel. When physicians walk out from hospitals, or insurances their bylaws will chance very fast. Remember. No institution or insurance can survive without physicians.
I don’t know how I came to your site but clicked on to it because when I recertified the first time I thought to myself resentfully, I’ve already done this the first time. Why am I subjecting myself to this cruel and expensive punishment every 10 years? What’s the point in CME and recertification? It’s redundant and someone behind the scenes is gaining from this. I still have MOC fees from 3 years ago accruing interest every year. I don’t plan on recertifying again or paying these ridiculous MOC fees and missing out on more time from my family life. It is insanity.