MOL linked to MOC?

I am rarely stunned by events. Things have to be out of the rare. Things have to ring out past the six-sigma or essentially be confident outliers. You know stuff like the 9/11, shuttle Columbia disaster or the black hole discovery. And then there is this, which caught my eye and raised my eyebrow and a convective invective that echoed in the entire house and possibly hurt the neighbor ears too. This…this veiled atrocity seems to climb the same ladder of incredulity as descending down the stairway to hell.

MOC and the AMA;

Let me preface, before I unveil this declaration in its birthday suit, that the “well-meaning” attendants who hold the keys to our futures are the very people who stand to gain from it. The term Maintenance of Certification or (MOC) must come as no big surprise to the doctors but it is largely ignored by the patients and the very “observant” nitpicking media. Just like the ICD Coding is a multi-million dollar contractual windfall for the American Medical Association or the AMA that has only 16% of physicians as its devoted members. AMA has a loud voice because its executives stand in front of the microphone often and collaborate with their counterparts that serve in the government. But now... now, there is a new movement afoot by the AMA to obtain a fresh stream of dollars from policymakers and a fresh “new blood” of members, via the fiat served on the beleaguered physicians to oversee this bogus certificate maintenance. You see, it is and always has been all about money!

MOC and physician knowledge:

Certification in a Specialty is an accepted event, even though it matters little to the patients at-large and further more matters even littler to actual patient care. I have known absolutely brilliant physicians who have never been certified and likewise, I have known others with multiple certificates who are as “dumb as they come.” (Sorry, I am in the judgment seat on this one). Dr. Stream, president of the American Academy of Family Physicians to his credit, said. "It's a fairly rare patient who really deciphers this information."  Yes Dr. Stream you are correct! The only way it becomes an issue with the public is by “making it an issue” as the ivory-towers are wont to do; splash an anecdote and create a junk-science study to prove the cause-celebre. 

The next question that follows is: does MOC have any bearing on the quality of a physician’s ability?

Answer: Read on...

You shake your head. Let me explain…

Does not the practice of medicine have any meaning that doctors have to take patient-centered time and hard-earned money in the pursuit of satisfying the bureaucracy? Do engineers, lawyers and professors take this form of MOC? Answer: No! Well if esoterica is the wisdom in science then we are all dumb. MOC is nothing more than a chosen format to learn the esoterica with no application to the real-world patient care. Ask any physician. But, not one involved in the system.

ABMS piped in for MOC:

Dr. Kevin Weiss MD MPH, ABMS (American Board of Medical Specialties) President and CEO, states,  "The public can be confident that physicians who are meeting the requirements of the ABMS MOC program are committed to lifelong learning and ongoing self-evaluation," The vice of this “virtuous” statement does not take into account the Continuing Medical Education or 50 hours of annual CMEs the physician currently has to undertake to keep his or her license valid. So, the question that begs an answer is why the MOC then? Here, then is the argument about which mode of learning is the best form for learning. I say, practical experience on a patient-by-patient basis is the ultimate version. In this version, one has to open the books, read through the current science in the journals and engage fellow physicians for their understanding before undertaking any action on any patient’s behalf for any complex care management. I know of several physicians who open up their surgical books and journals before they go into the operating rooms just to refresh and confirm their thought process. I know of several Oncologist who are constantly fighting the battle of keeping up with the daily barrage of newer cancer discoveries so as to provide the best care to their patients. And I know several physicians with many certificates decorating the walls who stand knock-kneed when a difficult case presents itself.

I say...Follow the Money:

The ABMS lists their nebulous reasons for the MOC on their website: “However, in 2006, ABMS’ 24 Member Boards adopted a new gold standard for re-certification with a continuous ABMS Maintenance of Certification (MOC) program for all specialties. MOC uses evidence-based guidelines and national standards and best practices in combination with customized continuing education so physicians demonstrate their leadership in the national movement for healthcare quality. MOC also requires proof of continuing education and experience in between testing for re-certification.” The gobbledy-gook is well written and anyone challenging this would be considered a truant. But look inside this and you will find that the MOC is nothing more than a continuous stream of extraction of hard-earned wealth in the name of excellence. To grow, every company must find new sources of revenue and don’t for an instance think that the ABMS is not a company/business. In this case as fewer and fewer physicians decide to go for certification the need for finding additional heads to bolster the income of an enterprise becomes great, thus the advent of the MOC. As can be easily noted initially the Certification was a one time event to challenge the physician’s knowledge and then soon thereafter as the dollars rolled in, the drumbeat for a continuum was established and now this! By the way here is the Tax Form 990 filed by ABIM (American Board of Internal Medicine) in 2010:

Revenue Amount	$2,643,505
Asset Amount	$62,368,044
Asset Range	$50,000,000 or Greater
Income Amount	$6,132,648
Income Range	$5,000,000 to $9,999,999

While we are on the subject of money, dare I say that the president of the ABIM received over $1 million in compensation in 2009 and over $800,000 in 2010. Nice reimbursements for bureaucracy, don’t you think?

But what does that mean??

Clamor for Policy-making:

So what happens when this enterprise fails to catch the policymaker eyes? Well. Create the magic of diversion. State that patient care is suffering because the physicians are not up to date with their knowledge. Publish the information so it gets a media play. “The American Board of Pediatrics has posted members' maintenance of certification online since January 2010.”  This by virtue of its statement suggests that those not participating are somehow deficient. To further the argument, state that this is in the best interest of the larger public good and then do what the bureaucrats do best, ensnare a few up-worldly mobile, self ingratiating and self-serving individuals to create the chutes and ladder game for the physicians who will be bound to this form of indentured behavior. "ABMS has always made available the knowledge of physicians' certification. Now that physicians are engaged in maintenance of certification, it is a very natural next step for that information to be made available to the public,"

Now then, having established a few steps towards this “nirvana” how does one force all the physicians to comply with this “eagerly accepted and anticipated” mandate?

Federation of State Medical Boards (FSMB):

The Board of Medical Examiners of different states are now coalescing behind the Federation of State Board of Medical Examiners who have decided how to enable the validity of the MOC concept by making it a sine qua non to the medical licensure of a practicing physician. “The Federation of State Medical Boards and individual medical and osteopathic boards nationwide are developing new maintenance of licensure requirements, and the FSMB has said those rules will take certification standards into consideration.” The collaborating parties in this joint strike task force will also serve the AMA for its legitimacy. The following statement implies a mountain of evidence between the lines: “The AMA should serve as a central repository of information and resources for physicians about maintenance of certification,” said Colin Edgerton, MD, a Georgia rheumatologist and alternate delegate with the Young Physicians Section. Having such a resource would be a valuable benefit for AMA members, he added.”

The Battle Beyond:

This will be fought hard and long and might end up on some dockets too. The self-serving proponents will vilify the physicians for opposing it and start demonizing them in public by saying these detractors want to practice sub-par medicine and endanger the lives of the vulnerable patients. When they make their case, their information will be provided in a straightforward format with the physician's name, certifying board and "yes" or "no" to whether the physician is meeting MOC standards, said ABMS President and CEO Kevin B. Weiss, MD, MPH. Their motives will be no different then those of any political opponents ~ humiliation and rhetoric. “Starting next year, patients, insurers, credentialing organizations and others will be able to go to an ABMS website to see if a physician is keeping up with maintenance of certification.”

So now as the temperature rises and things burn to a red hot, the power-brokers are collectively signing-up to use the MOC and morph its needs as mandatory towards keeping the privilege of holding a license to practice medicine. The battle Royal is about to begin. All sensors are recording data. Yes movement is afoot. "Something wicked this way comes." We shall see.

When the battle begins, the physicians will only have to show the facts that MOC has no known benefits in patient-care. Yet it will be a long hard fought battle. Invectives will fly and the bruising will hurt the physicians cause some more. The demonizing will capture the eyes and the ears of the public. Even if the physicians win, medicine and medical care will lose some more luster. So what to do? Should we fight this at all? The answer is, as in any case of injustice, a resounding YES!

There are intelligent thoughtful voices out there: Washington State Medical Assn. President Doug Myers, MD, said during reference committee testimony on June 17.

“We don’t want [physicians] to lose their license because they don’t have maintenance of certification,” But, I am sure Dr. Myers knows that the drumbeat in the distance is getting louder.

The nobility will be tarnished some more until nothing but a rusty flagpole will stand where once a gleaming beacon of truth held sway.

We must keep that nobility.

We must, for the sake of the future generation of patients and physicians.

We must for everyone’s sake.

If you don’t believe me, live on!

References:

 http://www.ama-assn.org/amednews/2011/11/14/prsc1114.htm

AMA advised to monitor maintenance of certification and licensure requirements

http://www.ama-assn.org/amednews/site/house-more.htm