The Man Behind the MOC


If you ever want to lose weight via vomiting then I recommend you read this pitiful article in Medical Economics.  Richard Baron MD is the President and CEO of the American Board of Internal Medicine and ABIM Foundation and he offered to be interviewed in order the defend the program.  You can read the whole thing here but here are just some of the highlights:

  • “Putting out a credential that speaks to whether doctors are staying current in knowledge and practice, I think overwhelming numbers of doctors want to have a way to reassure themselves that they’re doing that.”
  • “The second thing is everyone agrees CME varies enormously in quality and effectiveness. Everyone knows about courses you can go to on the cruise or at the ski resort and may or may not be getting any knowledge. And it’s important not just that your seat was in the seat, but that you actually know what you need to know to do what we do. And what we do is pretty important and it changes pretty rapidly and people are not good at assessing what they don’t know.”
  • It used to be that lifetime certification was a great way to do that. But with knowledge changing as fast as it does, it becomes pretty important to know who’s staying current.
  • ME: Is there any evidence that certification, or lack of certification matters to patients?RB: “Absolutely. I think patients are desperate for high-quality information about doctors and who they’re seeing. Lots of doctors say to me, ‘no patient has ever asked me whether I’m board-certified.’ Well first of all, lots of patients I talk to say ‘I go on the internet or I look at the directory, and if that doctor’s not board-certified I don’t go.’ Lots of people tell me that. They’re not asking the doctor because they already know before they came. So yeah, I think patients do care about it. I think patients don’t look too deeply the way doctors do at what’s behind the credential. But I think they respect it a lot more deeply than they do Yelp reviews.”
  • ME: So you’re not concerned that what NBPAS does may make what ABIM does irrelevant?RB: “I’m not concerned at all, I think if anything they make it more relevant, because they highlight the fact that we actually have a performance standard in the middle of our program.”
  • ME: Another big concern we hear is how ABIM spends its money. And today’s announcement didn’t really touch on finances at all. Are you concerned about the anger that’s out there about ABIM’s finances?RB: “A lot of people have raised issues about that. We are fully transparent about that. Go to our website, and you’ll see a graphic that shows you where we spend our money and how we spend our money. You’ll see an audited financial statement posted on our website, which very few nonprofits do.People have raised questions about compensation practices. We have a compensation committee that follows best practice standards, gets comparable figures on what people in senior executive positions get paid, which is how nonprofits set salaries.

    To put it more bluntly, if I were trying to hire a cardiologist, and I said I’m going to pay you a general internist’s salary, I couldn’t hire a cardiologist on a general internist’s salary. And you can’t hire a chief operating officer of a $56 million-a-year company on the salary that you hire somebody to manage a one-doctor medical practice.

    So we’re in a competitive market for talent. Our salaries are competitive, they are reviewed by an executive compensation committee, there’s an independent consultant that provides competitive data in the marketplace. So we have nothing to apologize for in our finances, That’s why we put it all out there.

    We understand that every dollar we get we need to spend carefully. And we understand that doctors are concerned about the fees. And as we think about re-creating the program we will be looking at ways to restructure fees. But what I pay in fees to ABIM is less than what I pay the Commonwealth of Pennsylvania for being licensed, less than what I’m paying the federal government for having privileges to prescribe narcotics.”

So as you can see, the ABIM and their leaders are overall good guys.  They are there for you. Without their seal of approval you are NOT current in your knowledge. They have deemed that your CME, without them, sucks.  They feel that certification is critical to patients because they can look it up on the internet but, interestingly enough, Baron never discusses recertification.  Isn’t that what the whole controversy is about?  And the crack team at Medical Economics doesn’t even ask about it or the fact that they can remove all evidence that you ever certified in the past if you don’t pay up. Overall, Dr. Baron isn’t worried at all about the alternative board NBPAS because not enough docs have joined them yet.  He then finishes off with some complete bulls&t about the absurd amount of money they are being paid.

As we physicians continue to try and take back healthcare it sure would be nice if we could also shut these jokers down. Dr. Wes, how about it? Your thoughts on this?

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]

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6 Responses

  1. Pat says:

    This crap will only be stopped by physician boycotts of board recert’s, and strikes.

  2. John Kelly, MD says:

    Along with embracing the vaporware of Information Technology in hopes of running medicine like the automobile industry, we also bought into a meritocracy, and the many ways computer programmers can measure us. Now, practicing physicians know that a number is only meaningful if the machine measuring it has the correct estimate of reality, but in an expanding industry of people who justify their power and mighty salary (the way our culture measures power) these experts on the judgement of others expand their invasive influence and feel who is going to disagree with making sure their loved ones are protected by the most scrutinized doctors in history? The pharmacies question my choice of meds and downplay the worth of my work as they are now investors rather than a service and want to save as much of that bottom line as possible, and they have huge salaries, too (how our culture measures bioavailable testosterone). They are invested in our being found wanting. Why should they pay us what we’re worth? So medicine is the one job where you do the work, and someone then decides what they will pay you, while our professional organizations try to prove they should pay us more rather than their stockholders, by constantly extending their mighty influence to measure us and have data which says we’re “alright.” They think this will sway insurance who wants to keep the money, but really, these organizations are businesses, too. They are far more powerful than practitioners, and if they can make more money by charging us to pass their many MOC demands, they will. To think that they represent our interests is just folly. Feels better to think so, but show me anywhere they’ve been successful in getting us paid more on the front lines.

  3. HJR says:

    What a weaselly little POS. He wouldn’t last a week on the front lines. People like him have been in charge of the asylum that is modern medicine for too long, and now that the lunatics are turning on them, they don’t know what to do. He looks like a deer in the headlights.

  4. Steve O' says:

    There are many assumptions handed to the individual doctor by these boards. The first is that a board is not an aggregate of the various practitioners, each bringing their own experience and understanding to a common forum. Such processes lead to a messy and democratic institution which acts as though it is a college of practitioners striving, under the conflict inherent in individuals, to define and advance a profession.
    Each specialty is a property of a corporation, which duly copyrights and regulates the trademark, and is aggressively trying to push members out of its guild, for the sake of blackmailing those remaining into obedience. Do not dissent, or you will be segregated.
    As such systems cost remarkably little to operate, but acquire vast revenue from their unconsenting hostages, there is no need to use the money to advance the specialty. Rather, it is to richly reward those who have scrambled to the top of the pack. Medical status has long thrived on fear and competitiveness – surely these people are conditioned to obey.
    The body of scientific research is riven through with corruption, and the “Best Practices” are frequently the consensus of the insiders who hold the “top positions,” self-defined, in the field. “Best Practices” is not a consensus, but a diktat.
    The myth must be marketed that these memberships have meaning and relevance, which they do not. The insiders try to prop up their status; they can’t. When a country freely prints bogus money, the value of money in circulation falls; it’s hyperinflation. If the value of a board certification is propped up with unearned respect for the organization, it must be enforced by law. That is why board certification is being touted for medical licensure.
    Surely, any small collection of the learned within the executive counsel of the board can see that this con is unsustainable – it will blow out, sooner or later, like a Ponzi scheme. Their individual goals is to grab the goodies with both hands, and screw what happens by 2020. That is the summit of the medical specialty collegium at the end of 2016 – grab the loot and scoot. Leave the wreckage to the locals. Why have we arrived at this consensus? How is this fair to the patient or the public?

  5. Thomas D Guastavino says:

    Show me the evidence that grandfathered physicians with lifetime certificates were any worse or better then physicains being tortured by the constantly changing requirements for MOC.

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