Where The Truth Lies by Pat Conrad MD

There are different ways to lie.  The most direct of course, is just an absolute falsehood, easily disproven.  The more dangerous are the indirect lies, suppositions and insinuations along the lines of “Now I’m not saying my political opponent would actually beat his wife…”  The indirect approach has been turned into a very profitable art form by the ABMS.

The American Board of Medical Specialties was given a huge cash cow by that damned Institute of Medicine study in 1999, and has been milking us ever since.  Richard Hawkins, president and CEO of the ABMS, assures us the ABMS-enforced Maintenance of Certification is both an objective measure of physician worth, and that it improves patient care.  Hawkins states that “physicians do not always accurately self-assess the areas of practice in which they may need improvement.”  Hmm, sounds reasonable, even if earlier generations of doctors did a great job of keeping up all on their own.  The non-profit Joint Commission on Accreditation of Healthcare Organizations was created to do good through standardization, and became a hugely expensive, punitive, self-serving body that now cannot be excised from hospitals no matter how idiotic or deleterious (remember to lock up that sterile water).  The ABMS has provided a similar model, arguing for reasonable-sounding standardizations that rapidly became an extortion racket, backed up by self-serving proponents anxious to preserve their power and lucrative salaries gained off real doctors’ efforts (Hand washing module, anyone?).

“There is a substantial amount of evidence indicating that participation in a continuing certification process improves patient care.”  Actually, the best you can argue is that the MOC is pushing more docs to practice the way they are told.

The ABMS touts a study of “improved asthma action plans” and a decline in exacerbations as a result of the MOC.  They do NOT show that any decline in exacerbations is statistically significant against the larger population of physicians with pediatric asthma patients, only that those “participating” did better.  No, I’m not against quality improvement.  But when the CEO of the ABMS pushes a study that from their subordinate American Board of Family Medicine, I’m already more than skeptical.  The federal government wants to mandate the Physician Quality Reporting System for all docs; the ABFM gins up a study that shows better blood sugar control when combining their Performance in Practice Modules with the government PQRS.  So the ABFM forces doctors to pay for a PPM to measure quality; the government forces doctors to report “quality.”  This measuring and reporting is combined in a study to satisfy both parties, then is pushed by the ABMS as purporting to improve health care.  All of this is done to satisfy external organizations that can threaten the physician’s livelihood.  None of it is done with any input from the individual patient, an afterthought whose best use is as the raw material for all of this quality.  Argue with any of this and you hate quality.

And then the lies start slithering in.

“There is no evidence that the cost of participating in MOC is raising consumer health care costs…”  Even if that is true, what about raising MY additional costs that I cannot pass along to the customer?  Whether $5 or $5,000, it’s MY money – what gives you the right to pick my pocket?  You imply that no one’s costs went up, and it took a fair amount of pricier, extra-hoppy IPA to wash out the taste of that last re-cert exam.

Hawkins claims that MOC doctors cost Medicare less per patient.  The MOC requirement showed no statistical significance in the growth of the annual hospitalization rates, but claims an improved per beneficiary cost of $167/year, “a small reduction in the growth differences of costs for a cohort of Medicare beneficiaries.”  Not the “total cost” as claimed by Hawkins, but he’s hoping you will read it that way.  The study referenced here states:  “Ambulatory care–sensitive hospitalizations are hospitalizations triggered by conditions thought to be potentially preventable through better access to and quality of outpatient care.”  “Thought to be”…’potentially preventable”…”better access to and quality of”…these aren’t even objective terms, they are first-year med student slogans.  Hawkins’ claim that this proves that MOC represents $5 billion in annual savings is as dumb and dishonest as the average statement from the average U.S. senator.

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“ABMS and its Member Boards rely on a highly trained and specialized workforce including psychometricians, assessment professionals, and medical educators to develop, evaluate, validate, and administer Board Certification programs…”  Yes you fatuous ass, I remember that highly trained professional literally checking my pockets, and running a metal detector over be EVERY TIME I came back from taking a leak during the middle of that pointless re-cert exam.  You want to use this MOC extortion to engender more public trust in physicians, when you can’t even trust them to go to the bathroom without cheating during a test so long and fast as to render cheating impossible even if it were open-Google.

Hawkins:   “ABMS has a longstanding policy that Board Certification and MOC should not be a requirement for licensure…Board Certification is voluntary and physicians have alternatives to ABMS Board Certification.”  Here again, he may not be telling a directly factual lie, but Hawkins you are lying your ass off by implication.  The vast, vast majority of physicians take the MOC because they are forced to by the hospitals and insurance companies, that will not allow them to work in their facilities, or pay them without your extorted recertification.  MOC may not be required for licensure, but letting it lapse means loss of employment, and you damn well know it.  In fact, you rely on it for your extorted cushy income

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“It stands to reason that the greatest expenditure is in staff compensation, and its executive compensation is aligned with like non-profit organizations.”  Just like the ABFM’s Dr. Puffer, who makes $800K/year without having to see patients?

Hawkins, I challenge you:  if the MOC is really as beneficial and necessary as you claim, then physicians would WANT to take it and wouldn’t need to be forced.  So have your lapdog subordinates like the ABIM and ABFM make MOC voluntary, and free.  Make all board certifications lifelong, and you all truly work not for profit, but for the satisfaction of making us all better.  Then have your subsidiary groups run some more studies on the MOC, participation rates, quality improvements, and money saved.  If you need to make up the personal income, I hear there is a doctor shortage that is worsening.  Maybe you could see some patients.

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115240cookie-checkWhere The Truth Lies by Pat Conrad MD