Hey, AAFP, Why Can’t You Hear Us? Get Rid of the MOC!

In typical administrative fashion, the AAFP President Elect, John Cullin, MD, tried to calm its members down about the MOC (maintenance of certification) issue.  You can read it all here but it is all political speak.   Let me break down the salient points with my opinion in parenthesis:

  • This is an extremely complex topic dealing with the nature of medical professionalism, the historical development of our specialty societies and boards, the constitutional basis of medical licensure and protection of the public, as well as changes in technology that are fundamentally changing how we practice medicine. Further complicating matters is the increasing stress that our members are experiencing due to excessive administrative burden, changes in payment and meeting documentation requirements with poorly functioning electronic health record systems. (It’s not complicated.  Just get rid of the MOC)
  • The AAFP has been involved in intense conversations with the ABFM to address our member’s concerns. Remember that the AAFP and the ABFM are separate organizations and do not have shared governance or an overlying umbrella organization. (But you both financially benefit from the MOC though, right? That’s a major conflict of interest.  If you get rid of the MOC then the AAFP stands to lose a ton of money. Hmmm.)
  • The task force thought that much of the recent anger about continuing board certification can be traced to the perceived value of certification. Value is benefit divided by cost. It can be improved either by increasing the benefit or decreasing the cost. In this case, the costs are more than just fees; they include the significant administrative burden of continuing board certification processes. We look to the ABFM to be mindful about decreasing this unnecessary burden. (Yes, get rid of the MOC.)
  • In addition, a major issue of concern to the AAFP is that board certification is often being used inappropriately as an absolute or sole requirement for credentialing and privileging, and sometimes for employment and payment. (So, get rid of the MOC.)
  • Based on the task force’s recommendations, we believe significant changes are needed to the certification process. (Yes, get rid of the MOC.)
  • Options include improvement of the ABFM certification process, as well as possible assessment of other entities that may provide alternative certification choices for members. And while not being actively pursued at this time, the AAFP will undertake a preliminary evaluation of the steps that would be involved in establishing a certifying body that would meet the needs of members. All this points to the need for process improvement, whether through the ABFM or elsewhere. (Wait, none of this entails getting rid of the MOC. WTF?).
  • Finally, we will continue to strive for more dialogue with the ABFM to work on a common vision that recognizes that physicians are key stakeholders in the certification process, and that our needs are an important consideration in the process. We plan to discuss improvements to the continuing board certification process, including the need for multiple alternatives to the current proctored exam requirement. (Again, you are not listening! Get rid of the MOC. We don’t want improvements. We want it gone!!)

So, once again, the AAFP is trying to play word games.  They are not listening to their members.  ALMOST NO FAMILY DOCTOR WANTS THE MOC!!!  Dollars-to-donuts the AAFP does nothing to rid of us of it.  I shouldn’t say us because I left them years ago.  But for those of you who still believe in them please note the above.  The AAFP makes a lot of money via CME indirectly off the ABFM and the MOC.  They will not help you.  John Cullen just proved that above.  And if he wants to debate me on it then I welcome him on my podcast.  Just shoot me an email, Johnny.

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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] 

  15 comments for “Hey, AAFP, Why Can’t You Hear Us? Get Rid of the MOC!

  1. mamadoc
    May 18, 2018 at 10:58 am

    The AAFP was and is useless. They don’t have the answer, they’re part of the problem.

  2. May 18, 2018 at 7:13 am
  3. Pat
    May 16, 2018 at 5:01 pm

    “And while not being actively pursued at this time, the AAFP will undertake a preliminary evaluation of the steps that would be involved in establishing a certifying body that would meet the needs of members. All this points to the need for process improvement, whether through the ABFM or elsewhere.” This is the sort of obfuscatory bullshit that made Sir Humphrey Applebey famous on the hit series “Yes Minister.” Pure bullshit designed to misdirect. I hate the traitorous AAFP and any of their figureheads who try to cheerlead decent people into the dead-end discipline. Bastards.

  4. Kurt
    May 16, 2018 at 1:27 pm

    “They will not help you. John Cullen just proved that above. And if he wants to debate me on it then I welcome him on my podcast. Just shoot me an email, Johnny.”

    Doug, shoot Johnny an email and challenge him to a “verbal duel”. If he declines or doesn’t
    answer, you can call him a spineless “wimp” here on Authentic Medicine!

    • Doug Farrago
      May 17, 2018 at 12:25 am

      do you have an email address?

  5. Jennifer Hollywood
    May 16, 2018 at 12:29 pm

    I always thought that it was interesting that even though the AAFP and ABFM are separate, that the AAFP found a way to make money off of us via MOC learning modules and courses for Board Review. There is a huge conflict of interest. If the AAFP were to support the repeal of MOC then the AAFP stands to lose a lot of money. The AAFP seems more interested in collecting my money and selling me things than actually fighting for MY rights.

  6. bbneo
    May 16, 2018 at 11:33 am

    Medical Professionalism = bending over under the yoke of ABMS / ABFM according to AAFP.

    Medical Professionalism ACTUALLY = keeping rentseekers out of medicine to keep the focus on doctors and patients and the practice of medicine

  7. Bill Ameen MD
    May 16, 2018 at 11:05 am

    Cullen is not just geographically remote from the mainstream of FP’s (being in the middle of Alaska), he’s intellectually remote. Be brave, John, as new President of AAFP, and don’t just follow your predecessors…Go back and get rid of MOC, for the sake of young family doctors just starting out. And get rid of recertification while you’re at it, unless you and ABFM can show us the evidence. Doesn’t state-by-state CME requirement take care of it? And why did I have to re-study obstetrics for every recertification exam from 1982 to 2006 when I hadn’t delivered a baby since 1976??

  8. SP
    May 16, 2018 at 9:57 am

    “…our needs are an important consideration in the process (MOC)”
    That quote sums it up perfectly.

    It should read: “our needs are THE ONLY consideration in the process”
    NOW you can see where the problem really lies.

    btw: I am in the process of doing the AAP “MOCA” pilot. Some genius came up with an open book exam with a 5 min countdown clock for each question. So one time the clock malfunctioned and the question disappeared. It was counted as WRONG on my score. On many others, the questions are written poorly (according to the ABP the questions are written by “busy”practicing pediatricians just like me-Who are these sellouts and when did they have time to write these questions?-an inherent vicious cycle paradox unto itself)-so you burn about 2 minutes trying to figure out what they are asking.
    Can anyone explain the rationale?

    Of course, A 5 minute clinical encounter like this is definitely an accurate representation of what happens in a typical patient conversation:

    Dr: I’m sorry, but it may be a rachitic rosary, a rare genetic bone demineralization problem or an accidental fracture.
    Patient: Dr., you have exactly 5 minutes to tell me what my child has and recommend the appropriate treatment: Starting NOW….
    Dr. Ummm…let’s see the x-ray is a little fuzzy and you haven’t shown me the Vit D levels or Ca levels, but Johnny fell on his head yesterday off of his bike…
    Patient: Sorry Dr, but your 5 minutes are up…I am just going to fade away into the internet ether.
    Thanks for playing with us today. The ABP would like to thank you for participating! After you pay the re-take fee, come back tomorrow and try again…

    Yeah, that’s pretty accurate for me.

    I sent questions asking about the bizarre time-limited but “open
    book” concept during their helpful and informative webinar and then as follow up questions on subsequent feedback and contact forms.
    No one will answer despite repeated attempts.

    Where is the evidence based research that five minutes to answer an open book question is an important indicator of anything but the fact that I don’t suffer from arthritis as I madly access google?
    Someone please explain.

    Perhaps a subversive move would be to send videos of a typical encounter/ patient care/ehr nightmare day to our respective boards -all of us at the same date, same time-Crash their website and demand that they review the videos. Just a thought.

  9. Kurt
    May 16, 2018 at 9:22 am

    I’m leaving and going to save the 4 grand for retirement. The AAFP isn’t
    worth the time of day. I should’a joined Doug a long time ago.
    Just about every FP/primary care doc I know hates what has happened to
    the practice of medicine. Blaming us for patients non-compliance and making
    docs piss on everything in the f’ing EHR has destroyed any satisfaction of practicing.
    Until the majority of the remaining membership of the AAFP walks away (ie. stops paying dues money.) they will never get the message.

    Nothing short of initial certification and 50 hours of CME/yr that the doc believes will help them in their practice should be the status quo.
    FP…. The bottom of the medical sh–pile with all the uncompensated work the
    ivory tower bastards came up for us to do! I pray for their condemnation to Hades every Sunday in church. Praying for a positive change doesn’t seem to work!

    • sp
      May 16, 2018 at 9:33 am

      praying for condemnation to Hades in Church is a funny irony. Thanks for that one!

      • Kurt
        May 16, 2018 at 10:56 am

        We Catholics have a prayer for everything. See the prayer to St. Michel:
        (Sorry to interject religion but there is humor in this.)

        Saint Michael Archangel,
        defend us in battle,
        be our protection against the wickedness and snares of the devil;
        may God rebuke him, we humbly pray;
        and do thou, O Prince of the heavenly host,
        by the power of God, cast into hell
        Satan and all the evil spirits
        who prowl through the world seeking the ruin of souls.

        If that isn’t a desire to send one’s enemies to Hades while in church I don’t know what is! 🙂

        Once I retire. I’m going to make a 3 hour appointment for confession to cover all the
        swear words I’ve used while working. They’re used to display displeasure at how we are
        treated as docs. Once I’m done, I’ll never need to use that language again. (Something like that occurred with my father. Once his business was establish (nothing to do with medicine mind you) we never heard a cuss word out from him ever again. I believe he was stressed with our families financial security and once the company was established, the stressor was relieved.

        • Perry
          May 16, 2018 at 11:13 am

          You realize St Michael is the patron saint of Radiologists? How they came up with that one, I’ll never know.

  10. May 16, 2018 at 8:17 am

    Looks like it’s time for a Listening Tour. Let’s get some execs to come out and sit on stools through ‘small towns’ in America, listen to the doctors talk about how they have contemplated quitting medicine, know doctors whose health has suffered due to administrative burden, and are just counting the days until they retire. Then the execs (seated with sport coat, dress shirt, but no tie) will nod earnestly, pull up the microphone to the mouth and say, ‘I believe you, I was there once myself, and that is why I am so excited about the latest whiz-bang burnout wellness tool we have…..’ and then blow into the next town. After a Summer of Listening they can put a release, Problem Solved. MOC Reform is Real. Everyone is So Happy.

    • Kurt
      May 16, 2018 at 6:02 pm

      That is why people need to vote with their feet and keep their dollars to themselves.
      That’s the only way the AAFP will get the message. One can still kowtow to the ABFM if
      it’s that important to be able to keep ones job where they are at and save the $740.00 or so
      for CME and MOC review courses.

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