Hail Mary Pass from the ABFM

I came home to a letter from the American Board of Family Medicine.  They have been threatening to pull my certification every month (I have not paid their extortion money this year) so I thought it was another “reminder”. Instead it was some bizarre and generic warning letter about professionalism.  I found the same letter later in my email box with the subject line “help”.  Here is what it says:

July 21, 2017

Dear Fellow Family Physician,

An important component of maintaining board certification is the demonstration of professionalism. This allows your patients and the public to know that, as a board-certified family physician, you have fulfilled the standards of professionalism, licensure and personal conduct outlined in ABFM Guidelines. Specifically, these guidelines state that a family physician must continuously hold a currently valid and full medical license that is not subject to practice privilege limitations in any state or territory in which s/he has a medical license, regardless of whether or not they are currently practicing within that state. We provide this communication to assist you if you encounter a situation that suggests that a limitation to your medical license is warranted.

The ABFM Board of Directors has recently noted several illustrative cases of state medical licensure limitations of family physicians that can impact license limitations, and thus, board certification:

1. Dr. M fails to timely report adequate CME documentation after a medical board audit of his attestation with state CME requirements for a state in which he’s never actually practiced (he has several state medical licenses). He signs a Voluntarily Surrender of Physician License, reported to the Federation of State Medical Boards (FSMB) as a disciplinary action against his license.
2. A state medical board review determines that Dr. A failed to meet quality medical standards of care in eight of her patients with chronic pain (i.e. excessively prescribing opioid medications without adequate evaluation, monitoring or follow-up). Dr. A also prescribed controlled substances to patients without obtaining and/or documenting that she accessed state medical board-required reports from that state’s online prescription reporting system. Her license is limited by precluding Dr. A from treating any patient for chronic pain and, except in emergency cases of acute pain, from prescribing opioid medications. The FSMB reports this disciplinary action against her medical license.
3. Due to some health issues exacerbated by overwork, Dr. P’s state medical license has a limitation placed through a consent agreement that he may not see patients in an emergency department setting between the hours of midnight and 7 am. This license limitation is reported to the FSMB.
4. Dr. Y practices maternity care. Based on allegations of negligence in her delivery of a newborn involving the use of a vacuum assisted delivery device that resulted in the infant’s death, she signed a settlement agreement with the state medical board, accepting a formal disciplinary action and stating she agreed to immediately cease “operative” vaginal deliveries.
5. Dr. L, in a small practice with limited staffing, is accused by a patient of inappropriate behavior during a gynecological exam; rather than risking additional publicity that may come with litigation and desiring to put the matter behind him, he accepts a license limitation from his state medical board requiring all female patients have a chaperone present.

Additionally, the ABFM Credentials Committee has observed three major trends, with increasing frequency:

1. medical licensure limitations being imposed for the improper prescribing of opioid medications, often seemingly due to inadequate knowledge and/or training;
2. the impression that some diplomates or residency program directors do not fully comprehend the consequences that any state medical license limitation has on board certification status. We are concerned that diplomates may not be fully knowledgeable of ABFM policies when involved with state medical licensing board proceedings, especially at times in which they are asked to sign consent agreements, and that their legal advisors may not understand that any limitation to a medical license constitutes a violation of the ABFM Professionalism standard when advising their clients.
3. an apparent rise in physician impairment. Historically, impairment was thought to be primarily due to substance misuse, but physician burnout and mental distress may also cause impairment. State licensure application questions asking whether the physician has a history of counseling or mental health issues may inadvertently contribute to this impairment by dissuading physicians from getting needed mental health care and/or counseling.

The American Board of Medical Specialties (ABMS) and representatives from state licensing agencies are working together to better understand the various processes within state licensing agencies and medical boards, and to improve state medical boards’ awareness of the implications of decisions on board certification. Professionalism policies across all 24 ABMS Member Boards are consistent in how they apply these principles.

While the ABFM has previously disseminated policies related to revocation of board certification and eligibility on the ABFM website, the Phoenix newsletter, and periodic emails and meeting presentations, we want to use this communication to reference the Guidelines for Professionalism, Licensure, and Personal Conduct of The American Board of Family Medicine (ABFM), asking that you read these carefully for full comprehension and understanding. We invite any diplomates involved in state licensing board proceedings that may lead to a license limitation or other negative finding, to strongly consider having their counsel communicate with ABFM’s legal counsel early in the process so as to seek guidance on the possible avoidance of unnecessary negative effects on ABFM certification status. This is a service readily available to all diplomates that ABFM hopes will be utilized frequently.

For residency program directors, we recommend that you carefully review these guidelines at an educational session, as most residents are not aware of these potentially career-altering circumstances. We will continue other educational efforts as well. The Board of Directors of the ABFM is committed to doing what we can to help diplomates avoid loss of board certification while still maintaining standards that make board certification valuable to diplomates and to the public.

Sincerely,

Elizabeth G. Baxley, MD Chair, ABFM Board of Directors

Joseph W. Gravel, Jr., MD Chair, ABFM Credentials Committee

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Right off the bat they try to tell me how great it is to maintain my board certification. My bulls%t detector starting whaling immediately. Then they go on to list some weird cases of inappropriate care.  Where were they going with this? Then it ends with how they want to be there for me.

 Many others have since sent me the same email asking why they got this.  The answer is nobody knows.  One of my readers had this to say:

My take:

They’re feeling the heat from the exposures and the dawning understanding of their thieving and scumbaggery, and like a cornered animal, they’re showing their teeth.

A large enough pack of dogs could finish them off.