Your AMA …Cover for the MOC by Pat Conrad MD

Anyone wishing to cure an overabundant zest for living need only spend a few minutes reading AMA House of Delegates committee resolutions.  The formal tone attempting to dress up a truckload of self-important swirl not nearly dignified enough to be called bullshit is…Contemptible?  Loathsome?  It sure is boring.

Remember when the AMA came out against MOC in 2016?  Of course you don’t, because in the end they predictably backed off and went back “for more study,” the politician’s way of saying he ‘wants to spend more time with the family” right after his latest DUI.

The AMA has worked diligently AGAINST the interests of patients and physicians for decades, and like the ABMS, has made a boatload of money in the process.  Yes I know, the ABMS doesn’t really answer to the AMA, but the latter is a powerful voice for all physicians, and could help us in this fight against the Maintenance of Certification gangsters.  Wouldn’t they want to?

This week the Vichy sellouts of “The House of Medicine” met at their AMA ego orgy in Chicago.  Could this really be the year when they finally came out and opposed the MOC extortion racket?



Madam Speaker, your Reference Committee recommends that Resolution 316 be referred.

HOD ACTION: Resolution 316 referred.

Resolution 316 asks that our AMA call for an end to the mandatory American Board of Medical Specialties “Part 4 Improvement in Medical Practice” maintenance of certification requirement.  Your Reference Committee heard mixed testimony regarding the Part 4 requirement for American Board of Medical Specialties (ABMS) maintenance of certification (MOC). There was testimony concerning the relevance, burden, and cost of the MOC Part 4 process in addition to the other requirements physicians are required to fulfill for meaningful use, MACRA, etc. However, it was also noted that the broadening range of acceptable activities that meet the Improvement in Medical Practice (MOC Part 4) component has made this activity acceptable for other national value-based reporting requirements and continuing certification programs. It was also noted that the boards are implementing a number of activities related to registries, systems-based practice, and practice audits to show improvement in practice. The ABMS Multi-Specialty Portfolio Program offers health care organizations a way to support physician involvement in their institution’s quality and performance improvement initiatives by offering credit for the Improvement in Medical Practice component of the ABMS Program for MOC. Due to the Council on Medical Education’s ongoing work with the ABMS and the ABMS member boards to improve this process, your Reference Committee felt that this issue should be referred for further study. Therefore, your Reference Committee recommends that Resolution 316 be referred.”

If you couldn’t read the preceding statement without looking for the whiskey or a rusty knife, here are the low points:

  • The AMA will not oppose MOC
  • The “mixed” testimony included pro-MOC agents that (easily) seduce the AMA traitors with language regarding “value-based reporting requirements”, “systems-based practices”, and “audits to show improvement in practice.”  The AMA is using the phony, unproven quality-value based lingo to push their tacit support of the ABMS thieves.
  • And for some moral veneer and a wink, this report cheers the ABMS’ support of forcing physicians into “quality” initiatives forced on them by non-physicians.
  • “Since the Council on Medical Education is already working with the ABMS to screw all physicians for a fee, we don’t think the AMA should interfere.”

The AMA delegates, as a body, are traitors to anything decent in medicine.  Most of this already knew that, and now we have their support for the MOC in black and white.

Hear our podcast on the MOC here

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] 

  14 comments for “Your AMA …Cover for the MOC by Pat Conrad MD

  1. Russell
    June 16, 2018 at 2:37 pm

    If you don’t participate, eviscerate. Organized medicine represents a multitude of perspectives and interests, but is not going to do anything for you if you don’t show up. There were over 240 reports and resolutions to deal with at the annual meeting this year. The opportunity to get insights, evaluate the gamut of MOC issues from the various specialties, and come up with an assessment and recommendations is the best that could be expected. It was not an endorsement of MOC and it was not a reflection of complicity.

    The AMA does a lot of good for doctors and patients and it is physician led, better than most of the work setting doctors work in these days.

    • Doug Farrago
      June 16, 2018 at 5:34 pm

      Please. Your docs don’t want the MOC and you ignore them. I know you represent them and you are the second AMA representative to try and convince me and others that you all is well.
      Docs don’t show up BECAUSE YOU SOLD US OUT. You don’t listen. And so they leave.

      • Russell Libby, MD
        June 16, 2018 at 7:04 pm

        Not sure what selling you out means, but I am an independent practice doc who has taken advantage of the market opportunities to build a solid practice where other independent docs can build their careers. If we just give up and pretend criticism will foment change, we are not going to make a difference. I am also on the Physicians Foundation Board and funded DPC conferences. I want to see independent practice thrive. My service on the IPPS is to help others learn about how to deliver cost efficient high quality care through clinically integrated structures and to be leaders in the process. I have not sold you out.

        • Doug Farrago
          June 17, 2018 at 6:31 am

          Then quit the AMA because it negates everything you just said.

    • Pat
      June 16, 2018 at 10:53 pm

      “…evaluate the gamut of MOC issues from the various specialties, and come up with an assessment and recommendations…” This reads like Sir Humphrey bamboozling his boss on “Yes, Minister.”

      Gamut of issues?? There is NO evidence that MOC improves anything, and yet it is a proven instrument of widespread extortion. What issue would you like to explore?

      Assess and recommend all you like, that is all you AMA self-praisers can do. You have had decades of your own ICD/CPT extortion racket which made hundreds of millions, and yet you still did nothing to improve the lives of doctors or patients. You peddle esoterica, and chest thump about gun safety, even while supporting the ACA, mandatory EHR’s, and whatever latest MIPS/MACRA/WTFBS the government will tell you to back.

      Not complicit?? Can you not read? Your own damn report stated “ The ABMS Multi-Specialty Portfolio Program offers health care organizations a way to support physician involvement in their institution’s quality and performance improvement initiatives.” You are as complicit as all hell, and dishonest to boot.

  2. Steve O'
    June 14, 2018 at 8:44 am

    Are patients merely tasks on the factory floor?
    From Frederick Winslow Taylor (1911), The Principles of Scientific Management
    Perhaps the most prominent single element in modern scientific management is the task idea. The work of every workman is fully planned out by the management at least one day in advance, and each man receives in most cases complete written instructions, describing in detail the task which he is to accomplish, as well as the means to be used in doing the work.
    And the work planned in advance in this way constitutes a task which is to be solved, as explained above, not by the workman alone, but in almost all cases by the joint effort of the workman and the management. This task specifies not only what is to be done but how it is to be done and the exact time allowed for doing it.
    And whenever the workman succeeds in doing his task right, and within the time limit specified, he receives an addition of from 30 per cent. to 100 per cent. to his ordinary wages.
    Scientific management consists very largely in preparing for and carrying out these tasks.

    The goal is to reduce each task to its minimal complexity and lowest requirement for skill, on the part of the workman.

  3. Steve O'
    June 14, 2018 at 12:28 am

    Local MD’s are the meat cogs is the factory floor. Nobody understands motivation, pride or quality atop the Medical Industry, so the formula of Q=(1-disapproved motions made by worker)/widgets made per day. The meat cogs must be disabused of any sense of pride in their efforts.
    Fifty years of this approach have driven American manufacturing offshore, not because of labor prices, but that it’s bad management.

  4. Bob
    June 13, 2018 at 2:06 pm

    Physicians are becoming increasingly and inexorably more irrelevant in the medical- industrial complex, so later means never.

  5. William E Green III, MD, DFAPA, FASAM
    June 13, 2018 at 7:00 am

    Why I have recently dropped my membership in the AMA, after 37 years of paying ever rising dues “loyally” every year! They are “in bed” financially with some of the same people who are trying to “improve” our medical practices, yet they are either NOT physicians and have NO clue what we are doing, or they are no longer practicing any clinical medicine and just wanting to secure they’re never ending “gravy train” corporate careers. One of the “benefits” of going through my practice mail is shredding the never ending “dues statements” from the AMA!!!

  6. Stephen Rockower
    June 13, 2018 at 6:33 am

    Just because an item is referred doesn’t mean they are not doing anything, it means they are not doing it -right now-… There is significant opposition to MOC within the House of Delegates. Timing is often important. There will be more opportunities at the next meeting in the fall and again next June.
    I did not attend that Reference Committee hearing, so I did not hear the testimony they did, but I am reasonably sure it is not being buried and forgotten.

    • Momma G
      June 13, 2018 at 11:44 am

      Who are you? You make it clear you’re making money in this racket by defending it. Everyone but you can see that no action at this time means there will be no action. And let’s say I’m wrong. They still hung doctors out to dry for the next cycle of needless tests and staggering fees. Take your excuses down the road. None of us are listening.

      • Doug Farrago
        June 13, 2018 at 12:55 pm

        I believe Stephen is “a Delegate representing Maryland at the AMA, helping to determine medical policy”. To be fair, he KNOWS I hate the AMA and still reads my stuff so we will give hi that. Maybe he sees the garbage and is trying to change it. Who knows? That being said, Momma, they DID hang everyone out to dry and no action is still no action.

        • kurt
          June 13, 2018 at 2:20 pm

          I quit years ago from the AMA and am walking from the AAFP this next dues cycle.
          Unless “A” group comes out clearly against “MOC” by saying the certifying organizations should be involved with initial “for life” certification with 50 hours a year of CME thereafter, I will remain “organization-less” for the next 4 years until I can retire at medicare age. I will dissuade medical students from considering primary care as I’ve seen many young docs totally unsatisfied 5 years into practice, DPC people notwithstanding but despite what Doug says, DPC won’t work everywhere. Too high a public aid, Medicare and the “entitlement” set and one will lose their shirt no matter how much marketing is done.
          One wants to do DPC they have to be especially careful where they setup their practice and the economic environment where their patient base comes from. On the up side, do this right and if the practice “works”, one can eventually give the one finger peace sign to the ABFM and simply do 50 hours a year CME to stay “certified” (That is of course if one doesn’t do hospital work anymore which is where FP is headed.)

    • James Tinsley
      June 16, 2018 at 7:31 pm

      Given the overwhelming evidence against MOC why would they procrastinate like that. It’s a BS cowardly move.

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