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:

The American Board of Family Medicine

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.
Yup.  They someone want to be our friends.  In fact, they are even offering up their counsel of lawyers to help you if you get in trouble. I wonder if they will help a doctor who loses his privileges because he refuses to take the MOC?
I welcome your opinion on the ABFM Hail Mary Letter of Desperation.

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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] 

  9 comments for “Hail Mary Pass from the ABFM

  1. July 23, 2017 at 9:55 pm

    Guys and gals-

    Join PPA (http://practicingphysician.org). We’re working to end the extortion through exposure of fraud, legislation, and if necessary, legal action.

    Enough is enough.

    The ABIM defined “professionalism:” and it involves the ABIM Foundation that purchased a $2.3 million condo complete with Mercedes S class town car for themselves. Give me a break.

  2. Theresa
    July 23, 2017 at 12:18 am

    I LOVE this post … I just read my letter today (a bit behind on my mail) and thought “WTF?” All I know when I feel this way is something disingenuous is happening. Who has time for this political bullshit? I am definitely too busy and getting too old to tolerate these “authorities.” Ugh. Wish I could be free of their nonsense. I pay my near grand ransom yearly and just wish they would go away.

  3. flaminis turnday
    July 22, 2017 at 5:24 pm

    I just completed the re-certification exam. How ridiculous. Nothing relevant to my practice – nuance driven ‘gotcha questions’. Then I receive another THREAT – a subtle message that should I have a medical board issue, then CERTIFICATION might be revoked. After supporting this
    SCAM for many years and taking the time to PASS their ridiculous exams, all I receive is threats to my livelihood. To add insult to injury, they insinuate that they have the right to make a CERTIFICATION decision on the basis of perceived physician burnout or mental duress I believe that we are witnessing a progressive alignment – collusion between the FSMBs and ABMS. This will only grow more onerous as parameters of QUALITY – regardless of statistical validity – play into who will be granted the privilege of practicing and who will be denied that privilege in the near future. There is only one way to stop this nonsense – educate the participants about the ongoing SCAM and STOP FUNDING SELF DESTRUCTION. Unfortunately, this will never happen as the physician sheep will go along with anything – even if it is to their detriment. Meanwhile simply look around at the ABUSES, MALPRACTICE, POOR WORK ETHNIC, ETC ON FULL DISPLAY THROUGHOUT THE HEALTHCARE SYSTEM SINCE ACA came into existence.

  4. sp
    July 22, 2017 at 12:42 pm

    despicable. I like how they acknowledge that stress causes burnout but don’t in any way take responsibility for their contribution to the doctor’s stress.
    IRONY

  5. Randy
    July 22, 2017 at 9:45 am

    I got the same letter and e-mail. Overall it was confusing. One part seemed to be vaguely threatening and another made it sound like they want to be your friend.

    It’s no secret that many state boards are on the warpath against opioid prescribing. It’s a little disheartening that your board certification would be in danger because you agree to a settlement with an overzealous board.

    • Hal Koiman
      July 22, 2017 at 8:36 pm

      This is EXACTLY why no physician in their right mind would be licensed through the Interstate Medical Licensure Compact.

  6. Bill Ameen MD
    July 22, 2017 at 8:56 am

    Hi Dr. Doug,
    I got an invitation to take the recert exam in an email just yesterday. My boards expired Dec. 31, 2014! I guess if they’d been feeling the heat in 2014 or 2015 I’d have gotten my Hail Mary letter! Judging by a cover story in Medical Economics last week, I’d wager it’s just a year or two before the Board changes its approach on MOC. Or maybe not. Hell, at my age I don’t even want to take a driver’s test ever again, let alone questions about tropical sprue and Fanconi syndrome.

  7. July 22, 2017 at 7:21 am

    I’m certified by the ABIM. My take on this letter is that it likely went out to all diplomats not just someone who has lapsed (not personal).

    It would appear from a national level they are pointing out they are observing trends that are harmful to their constituents and wish to inform that giving in to what may appear as not such a big concession affects credentials. They appear to be encouraging doctors to understand they may have given up more than they thought. I see this as helpful but I can see how it might be perceived as you have

    • Just me
      July 31, 2017 at 10:47 am

      Dr. K: that is exactly my take on the letter also. each of the scenarios covered makes ‘sense’ from a limited perspective dealing with only that one given issue. however, overall, it apparently jeopardizes certification in all states, and they want the ‘diplomate’ to be fully aware of that. offering legal assistance is, imho, rather welcome in this instance, unless of course, your personal legal assistant is the typical ‘bottom feeder’ who feels they and they alone have all the answers, and you should never listen to any other ‘legal assistants’ advice. as for continuing and continued certification, I leave that to one’s discretion. again imho, that ‘looks’ good on your office letterhead listing, and indicates a level of ‘wants to keep up with current practice guidelines’. however, I know an equal number of those with updated ‘credentials’ who should have never made it out of medical school at all, and those with no or lapsed credentials whose word I trust no matter what…. guess there is good and bad every where you look…..

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