The REAL Purpose of the MOC by Pat Conrad MD

puffer1  abfm

Last August on this blog, a fellow traveler posted a comment on this blog about James C. Puffer, MD: “…the President of the ABFM, received salary and retirement compensation of $742,000 in 2011. If you want someone willing to stab their fellow physicians in the back, you have to pay well.”

I was curious, and wrote to Dr. Puffer with that exact quote, and asked, “Is the figure quoted accurate, and are there any extenuating circumstances? I am contacting a major network regarding this as part of a larger piece on the declining interest in primary care, and I would like to present my facts, and all sides accurately.”

I never got any response from my emails to TV networks (insert your favorite Brian Williams jab now), but I did get this actual response from Dr. Puffer:

“Dr. Conrad,

Our Support Center has forwarded your email to me for review and a response. I am happy to do so.

As a not for profit entity recognized by the IRS under code section 501(C)(6), our tax returns are available to the public for review. These tax returns, like those of all other not for profit entities, are posted on the GuideStar web site ( GuideStar obtains the tax returns from the IRS as they are filed. You may review our returns by registering for free with Guide Star. The returns for the most recent three years are available for viewing. Included in Form 990 in Part VII is a detail of the compensation of officers, directors, trustees, and the highest compensated employees.

If you review the Form 990 for 2012 (submitted in November of last year), the most recent available, you will see in Part VII that my reportable compensation for tax year 2012 was $608,796 and estimated other compensation was $133,793 for a total of $742,589. This total includes salary, benefits and retirement contributions. My compensation package was established by our Board of Directors using data from a salary survey of comparable positions within the industry – a corporate best practice. If you review the compensation paid to other executives of ABMS member boards or major medical organizations (such as the AAFP or ACP), I believe that you will find the salary consistent with that paid to other executives in positions similar to mine.


James C. Puffer, M.D.

President and Chief Executive Officer

American Board of Family Medicine”

Doug recently posted a piece called “Mercy Killing the MOC”, which made me recall this exchange. I was board certified in family medicine in 1999. I was proud of that accomplishment, and thought it meant something; since then, I have had to constantly prove my board certification in order to stay employed. Moreover, I have for years had to contribute to Dr. Puffer’s considerably larger salary by jumping through his little hoops in order to prove my fitness to pay even more money to take an exam to prove to lay people that I know my job. Like most of you, I can use my spare time and cash to fulfill what Dr. Puffer thinks up while he’s on the clock.

Dr. Puffer and his ilk have been put in very lucrative positions by a combination of government and quasi-governmental lapdog groups, lauded by academia and the media. To them has been given the power to force the rest of us to comply with the directives of those whose livelihoods do not rely on direct patient care. The ABFM and its MOC have added nothing to my skill as a doctor, and has added not a single dime to my income. I am forced to do something that has only harmed, not helped me. So what is the real purpose of the MOC?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  13 comments for “The REAL Purpose of the MOC by Pat Conrad MD

  1. Steve O'
    February 20, 2015 at 9:00 pm

    But be grateful – how else would Washington form an opinion of the lowly family practitioner but for Dr. Puffer, to hob with the nobs and knowingly chat at the country club about the exorbitant prices of private jets and private islands.
    Imagine if they knew what it was like behind the Potemkin curtain – that most of us neither own a private polo grounds, not even a brace of polo ponies; that we buy our cars on payments and houses on payments, that we will never be seen skiing Aspen or Jackson Hole. They can sniff out our type there within a few seconds, anyway.
    Thank goodness we have puppets at the top of the Boards and Institutions that can mingle with the beautiful folks and summer Martha’s Vineyard or the Hamptons.
    No wonder doctors poll so poorly in the public image! Draped with at $15,000 suit and $2,000 shoes, what would you expect but envy and resentment? That is the illusion that these folks put forth of the American Doctor.
    In reality, my child does not want to go to college, and I am somewhat relieved, for I can retire at some time before I die. That is the mundane and venal world of medicine behind the mask. The pretty people don’t want to see that, of course!
    So make your donations when our own species of Televangelists pass the collection plate.

  2. Bill Ameen, MD
    February 18, 2015 at 9:01 pm

    I note the motto of the ABFM, “Palmam qui meruit ferat”. My Latin’s a little rusty…does that have something to do with greasing the palms??

    • Steve O'
      February 21, 2015 at 9:38 am

      It’s one of those pretentious Latin phrases that assumes you have read Cicero and Livius and Julius Caesar – elsewise you are an illiterate germ.
      It is perfectly good Latin to translate it as “A slapdown on those who be askin’ for one.” (I have friends who know this stuff.) Hmmmm. Is that referring to us, campers?

  3. MACF
    February 18, 2015 at 7:01 pm

    OK, here is a question for you ABIM people:

    I am 52, ABIM/BC doing EM medicine because I can’t stand all the crap that you allowed to happen related to primary care.

    So now it comes the time to recertify on stuff I have not use/need/seen/required in 10 f…ing years.

    My options are:

    a) Commit suicide
    b) Shut the f.. up and comply with all the MOC requirements
    c) Give up my gun rights and move to Canada,
    d) Ask my handyman if he would take me as a partner.
    e) Wait for one of my kids to do something worth to invest money on.

    • Sir Lance-a-lot
      February 18, 2015 at 8:33 pm

      Holy cow, I had the same experience last year!

      I’m ABFM/BC, but do urgent care. All of that BS chased me right out of “real” medicine.
      I don’t use even a small fraction of that FP stuff – Ever – Especially the OB.

      My list of options was almost identical to yours, except the partnership was with the auto mechanic.
      I even have a friend in Canada who periodically tells me how great it is to practice up there and asks me to come.

      And since I recertified, they’ve instituted a whole new raft of BS things I have to do.


      • Pat
        February 18, 2015 at 11:24 pm

        Yep, that’s why I went full-time ER eleven years ago, and never looked back.

      • macf
        February 21, 2015 at 9:28 am

        Congrats with the recert.

        I am goin with option “B”, put my life on hold for a year and hope for the best.

        Needless to say that I did not make the mark to “grandfather” for EMBC.


  4. Doug Given MD
    February 18, 2015 at 5:59 pm

    Good money comes from screwing other docs with ridiculous fees to do the moc and retest on boards and all the other crap we have to do.

  5. Kurt
    February 18, 2015 at 3:48 pm

    Thank you very much for answering my question as I was wondering what this Puffer guy makes.
    I believe making 4.5 times more than I as someone actually trying to take care of patients as opposed to blood sucking off of the rank and file is a travesty. Boards should be a service group for the members and the heads shouldn’t make more than an average member.

    What I said in the IOM blog (if Doug didn’t censor me) pertains to this jerk too. Kurt

  6. Bill Ameen, MD
    February 14, 2015 at 12:36 am

    Dr. Doug,
    I grit my teeth with anger when I read about a shark like Puffer sucking working doctors dry with this MOC bull. Effective immediately, the ABFM should commute every Boarded doctor to a life sentence…Board-certified for life. Let the states mandate CME for licensure. Of course, it won’t affect me…my boards and fellowship expired at the stroke of midnight on Dec. 31 and I resigned from my hospital staff because they require certification…but it still doesn’t matter, because I freakin’ RETIRED June 30!!! Life is good again (and I’m still getting rent from the hospital!)!

  7. Dr Bonz
    February 13, 2015 at 2:46 pm

    “….So what is the real purpose of the MOC?”

    I can answer that question in 6 figures: $742,589

  8. Sir Lance-a-Lot
    February 13, 2015 at 10:55 am

    Interestingly, a quick search of the AAFP and Florida state web sites turns up no licensed physicians or AAFP diplomates with the last name Puffer, so I guess that “Dr.” Puffer doesn’t need to worry about fulfilling his own MOC requirements.

    • Sir Lance-a-lot
      February 13, 2015 at 11:12 am

      I am mistaken.

      Dr. Puffer does not practice in Florida, where the ABFM is located.

      He is licensed and listed as a current ABFM diplomate, with an oak leaf cluster for Sports Medicine, in Kentucky.

      Must be a rough commute.

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