American Board of Family Medicine

No one thinks that doctors shouldn’t initially sit for a board certification.  We just think the MOC or Maintenance of Certification is a sham and a money grab.  The American Board of Internal Medicine has been getting hit hard by its members to stop this travesty but to my knowledge no one has really pushed back against the American Board of Family Medicine enough.  If the AAFP was truly representing us then why aren’t they doing anything?  Could they be benefiting from their relationship with the ABFM?  There is a lot of money at stake and family doctors need to know where it is going  This is from Dr. Westby Fisher’s blog six months ago:

For instance, while the public only has access to the ABFM’s tax forms to disclose the financial dealings of the organization, we quickly see that MOC continues to be a windfall for the ABFM. In fact, in 2014 MC-FM fees (the ABFM’s MOC program equivalent) contributed 46.4% ($12,776,905) of their $27,525,430 annual haul from ABFM diplomates. These fees helped support Dr. Puffer’s $803,687 annual compensation and the organizations’ $3,521,629 “donations” made to their “ABFM Foundation” and “Pisacano Leadership Foundation.”  (In 2012 and 2013 these “donations” were even larger: $6,147,376 and $7,878,535 respectively). MOC also helped fund the ABFM Executive’s first class and companion air travel and their Directors’ first class air travel and a  $1,449,525 retirement package with $435,000 in post-retirement medical benefits. No wonder MOC is such a great deal and needs to continue!

The ABFM is a tax-exempt 501(c)(6) tax-exempt organization that has accumulated a remarkable $130,082,516 in assets on the backs of working physicians that is offset by “liabilities” that fund the salaries of 75 people and other “projects” in the amount of $45,838,832 yeilding a net asset balance of $84,243,684 at the end of 2014. Rather than offset the fees that diplomates have to pay the ABFM for MOC, these fund transfers show the ABFM would rather continue to plow this money into itself (rather than defraying costs to its members) by growing its supporting “Foundations.”

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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] 

  12 comments for “American Board of Family Medicine

  1. Julie
    June 14, 2017 at 7:33 am

    Thank you Doug for posting this. The AAFP needs to lobby for the FM docs who care for patients.

    • Kurt
      June 14, 2017 at 2:04 pm

      Juile, The AAFP isn’t going to do sh** for you nor anyone else. They’re in bed with the ABFM.
      Academic Ba****rds and F***ing Morons. The Academic “Service” organizations have become
      certifiers because the rank and file got too used to feeding off the government teat! Now we suffer for it.
      I am not going to say what should be done with them because I do not want Doug to censor me but I agree they should be involved with initial certification, they can offer CME to cover the 50 hours per year requirement and that’s it! There is ABSOLUTELY no proof MOC is doing anything to improve the health of this country PERIOD!! Many in FP do not do the full range of practice. I do geriatrics and most of my women have had hysterectomies so I don’t do gyne and I gave up kids ’cause it takes too long to figure out just what the specialty doctors have my older patients on these days with EHR!! No time to do the other stuff. CME should be left up to subjects the practitioner feels benefits THEIR practice not what some ivory tower idiot think.

    • Pat
      June 14, 2017 at 4:48 pm

      Julie, Kurt has it exactly right. The AAFP has established a long, irreversible culture of putting more burdens and restrictions on their members every time some gov’t subsidized jerk has a “good” idea, like MOC. The head of the ABFM makes over $800K per year NOT seeing patients, while telling the rest of us how to. How do you honestly think he will lobby?

      Last year I passed my family medicine board for the third (and final) time, and I’ve never felt more personally humiliated, or ashamed of FP at large. I could repeat all of residency and not have known the answers to a large chunk of bizarre, fanciful questions (asking me what kind of coronary stent I, a non-cardiologist, would recommend, or moronic questions about quality studies and social services). The pat-down I got every time I went to the bathroom before I was allowed to renter the test booth was literally the envy of TSA. I blew a couple grand, weeks of studying, and two days I could have had off in order to take a test required by insurance companies and hospitals so I can still work and pay my bills. I got NOTHING in return, and it did not alter my practice in the least. The systems put in place that required me to undergo this self-punishment might be government-driven, but they were easily supported by the AAFP, et al, and by needy, greedy patients – voters – who empowered that government and its organized lapdogs.

      Family medicine as a discipline is wonderful knowledge, which cannot itself be good or evil. But like other knowledge, this discipline has been masterfully flipped on its practi-, sorry, providers in order to exploit them (ditto internal medicine, it appears). No medical student with a brain or any pride should go anywhere near this posinous culture, all of which has been fostered by the damned AAFP.

  2. June 12, 2017 at 1:52 pm

    I let my credential as a ‘Board Certified’ sports and family doctor pass after 1 certification (right after training was over). If I weren’t a concierge medicine doctor, it’s unlikely I would be able to do that because I would have to employed by a large group/hospital who would likely require it. Shrugging off the bureaucracy feels as good as taking care of the patients.

  3. Perry
    June 12, 2017 at 9:40 am

    Funny, family docs in practice make about 1/4 or less of what Dr. Puffer makes, and probably do 10 times the work. We should all be MoC gurus.

    • Julie
      June 14, 2017 at 7:27 am

      Amen Perry.

    • Julie
      June 14, 2017 at 7:31 am

      Amen Perry. I totally agree that the current MOC process is essentially extortion. I love my career and my patients. I hate the system which has been created. I’m a capitalist and I don’t believe anyone should work for free, but what does Dr Puffer do that merits that pay.

  4. Pat
    June 11, 2017 at 10:02 am

    It is depressing to have my livelihood tied to such a corrupt organization. Going into family medicine means being someone’s bitch as long as hospital priviledges and insurance accreditation require current board certification. The modules push unproven or at best arguable disease approaches; having a FM board question asking me what type of coronary stent I would recommend is ludicrous. Dr. Puffer is less principled than Tony Soprano, and provides far less value to his protectorate.

    I’m happy to have escaped to the ER, and I cheer those who with the courage to go DPC. But every time I have to renew hospital priviledges, or do another MOC module, I’m reminded of what a poor specialty choice I made, how exploited I am, and how rotten it makes me feel.

    • Steve O'
      June 11, 2017 at 10:37 am

      I object strongly on your behalf to the first phrase, “what a poor specialty choice I made, how exploited I am, and how rotten it makes me feel.” You will note that doctoring has been systematically controlled, exploited and deliberately sucked dry over the last 50some years.

      I attribute it to nothing but envy. There is something about the 20’th century that wound up making most people’s jobs SUCK. Look at the promises of “increased free time,” then at the amount of liquor, drugs, food and gambling – and television – needed to keep the workplace from suiciding. Most people’s jobs SUCK.

      Except for the doctors in the old days. The work was meaningful, the productivity was obvious, the “customer” was direct in feedback, and the hours weren’t bad. Look at how the modern populace “perceives” the careless lazy doctor, and see how much of your misery is from propaganda.

      The slave-maker come and take us away, and it ain’t our fault. The feeling of rottenness is the obvious consequence. “By the rivers of Babylon we sat and wept when we remembered Zion.” (Psalm 137) Except that the generations that remembered Zion are almost all past, and in ten years, medicine will be understood as a slave’s job.

      Where else do you see a desperate shortage of labor, and so many restrictions and pressures on the worker to qualify to keep working? It is a scam. When they bring in the next wave of green-card doctors, when they change all staffing models to contract and locum (that’s nearly been completed), when they allow PA’s to independently practice (like California and the VA), when they allow EMT’s to prescribe (it’s coming,) when they allow antibiotics over-the-counter, will that convince anyone? No the propaganda will just get louder and louder.

      The duty and the calling is wonderful. Ain’t your fault that the slavecatcher done got you.

      • Pat
        June 11, 2017 at 12:55 pm

        I’ll stand on my statement. It’s not envy, it’s a recognition of poor foresight on my part. I do plead guilty for not seeing this for what it already was years before I jumped in. When people think they have a right to my efforts, “calling” is a defunct term.

        • Randy
          June 11, 2017 at 2:44 pm

          Whenever we talk about our decision to go into FP I’m reminded of this line from the movie Stripes: “So we’re all dogfaces, we’re all very, very different, but there is one thing that we all have in common: we were all stupid enough to enlist in the Army. We’re mutants. There’s something wrong with us, something very, very wrong with us.”

          Because although I often complain about all the external forces making my profession worse, ultimately I was the guy that decided to go into it. I had friends going into GI or anesthesiology or derma-holiday (sorry you derms out there) but I liked the idea of FP and still do. I’ve done a good amount of ER work and much prefer office FP. And as you say the signs were there of what FP would become, I just didn’t recognize them.

  5. Randy
    June 11, 2017 at 9:49 am

    It’s really the problem with many credentialing or regulatory organizations – the tendency to subjugate their initial reason for formation to focus on self-preservation and enrichment. Since many of them are what amounts to monopolies there aren’t any quick fixes.

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