You Gotta Pay to be in the Phone Book

Back in the Summer of ’99, I was excited and a little nervous to drive 5 hours down to Orlando to take my very first family medicine board exam, and I was really proud to get a passing score in the mail six weeks later.  Seven years later, having left family medicine forever for the ER, I had only the mild background sort of anxiety associated with a test that could potentially affect my employment status.  Write a check, pass, forget it.  Ten years further on, it was time to do it again.  I bought a thick, comprehensive review book and actually studied, hating every minute of it.  I resented the periodic wallet biopsies that the American Board of Family Medicine Hoo-$#%&*ray! had performed on me over the preceding decade, and the expense of the upcoming test, the lost income, and the lost day it represented.  I resented the anxiety of yet another test that could impact my livelihood.  Most of all, I resented begin forced yet again to do something that held absolutely no value to me.  The ABFM adds nothing to my life, my happiness, or my income.  It has not changed the way I practice at all, other than making me work an extra shift now and again to afford their extortion.  All the MOC represents to me is a threat.

The ABFM website line that MOC currency “assures patients that you are up to date, work regularly to improve your care and are worthy of their confidence” is insulting, and a huge load of smarmy crap. 

Patients don’t care if their physician is MOC current.  They don’t even know what it means.  That is a line sold by the extortionists at the ABMS and all their gobblin’ members to physicians, the media, politicians, and to each other.  It’s sold by the associate toadies in groups like the AAFP, and the figureheads at the AMA, a group so agreeable it could teach the British Royal Family a thing or two about impotency.  Insurance companies and hospitals mostly just want docs to grind the mills for them and I doubt they really care who maintains MOC, but hey, lawyers and PR, so why not be on board?

It’s a safe bet that Cliff Knight, MD, the AAFP’s senior vice president for education, would not agree with me.  He is excited about a new ABFM pilot program that will allow vassals, I mean “Diplomates!” the choice to go totally on-line from home or office.  “The pilot consists of 300 questions broken into 25-question segments per quarter. The questions can be answered at your own pace in an open-book format. Each question must be answered within five minutes. (Yes, you can use resources you might find in a family medicine practice. No, you can’t phone a friend.)”  If I was to phone a friend during, it would only be to bitch about having to endure this insulting farce.  I wonder if they are going to pursue the “cam” option from a couple years ago wherein the test taker had to be on a home cam, visible to a faceless proctor at all times.  That would’ve been a time to break out the Speedos, if I owned a pair.

And what about these approved questions and feedback that “provides references to back up the ABFM’s evidence regarding the correct diagnosis and treatment.”  When I was last tortured with one of these exams three years ago, there were questions I could not have answered if I had just completed residency the week before.  I was asked which was the “best” stent choice for a multi-vessel CAD anginal patient.  The right stent, obviously, is the one the cardiologist recommends, but that wasn’t one of my options.  There are many practice styles, approaches, and interpretations, and the AFBM has no business or credibility beyond the initial board exam at determining a physician’s fitness to practice. 

“In addition to eliminating travel costs and time away from practice, the online exam tells me immediately whether or not I have answered a question correctly and provides references to back up the ABFM’s evidence regarding the correct diagnosis and treatment.”  Well goody!  It’s great to eliminate the travel time (I do all of my other bothersome CME on line at home anyway, where the I keep a hot pot of coffee and a better brand of liquor nearby).  So it’s free, right?  I mean the AAFP trumpets itself as a philanthropic organization, and I’m suuuure their officers are all serving gratis, so anything they promote should also be for free, just to improve our professional community, right?  Right?  No, it won’t be free Dr. Knight, which means you are advocating theft, using the threat of unemployment to steal from your colleagues to put into the ABFM coffers (that helped pay their last CEO almost $800K a year).  I don’t care whether you believe MOC is right or not, that is the result.  

Dr. Knight:  “Some FPs value the benefits of the pilot; others would rather be done with the process in one day. Fortunately, we now have options. Pick the one that’s right for you.”  I want the one that is free and voluntary.  That way I decide the value of my efforts to myself, not you.  Or don’t you trust your fellow diplomates to determine their own worth?

I have always and still believe that an initial board certification is valuable, proper, and necessary.  Beyond that, it only exists as a money grab for the parasites who push MOC.  After the first “pass,” board certification is akin to the classic scene from Steve Martin in “The Jerk,” jumping for joy and wildly proclaiming, “The new phone book’s here! The new phone book’s here! … I’m somebody now! Millions of people look at this book every day! This is the kind of spontaneous publicity, you’re name in print, that makes people. I’m in print! Things are going to start happening to me now.”

Pat Conrad MD

Pat Conrad is a full-time rural ER doc on the Florida Gulf Coast. After serving as a carrier naval flight officer, he graduated from the University of Florida College of Medicine, and the Tallahassee Family Medicine residency program. His commentary has appeared in Medical Economics and at AuthenticMedicine.com . Conrad’s work stresses individual freedom and autonomy as the crucial foundation for medical excellence, is wary of all collective solutions, and recognizes that the vast majority of poisonous snakebites are concurrent with alcohol consumption. 

  3 comments for “You Gotta Pay to be in the Phone Book

  1. Steve O'
    August 13, 2019 at 4:57 pm

    The pretense is that the I.T. dispenses knowledge to lesser doctors, the leaky receptacles of central wisdom who parrot the words of the wise.
    These bilge scows of knowledge will be replaced by apps soon enough. For everyone in the cult knows there is ONE RIGHT ANSWER, to which a surjective dyad can be linked. Never mind, you field slaves, toil on!

  2. George Voigtlander
    August 13, 2019 at 4:34 pm

    Like most bureaucrats saying when it’s about quality, it’s about the money! I let my board certification expire the only limitation is that I can’t see Kansas Medicaid patients in the ER, they never paid when I was “boarded” so no loss there.

  3. Celia B Entwistle MD
    August 13, 2019 at 3:29 pm

    I agree. It is always and only about the money. Well there is the component of the people in the ivory towers think everyone else is a greedy idiot with time to spare. “They” know best for all of us–as if the average physician has no skin in the game of being competent. And a multiple choice exam tells the whole story. It is the same for the ER boards.

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