Tuesday, September 16, 2014

NBCRNA IRS 990s and the exponential growth of profits in this non-profit!

Gross receipts $3,292,415

Gross receipts $8,001,719

Gross receipts $16,570,001
So you see an exponential growth in income at this NBCRNA and there is certainly NOT an exponential growth in that profession in these 3 years! ALl information is on file at Guidestar.com, or as a NON-profit they  are REQUIRED to provide this information on request-and I wonder what they will charge you for that!

Tuesday, August 12, 2014

MOC the Pablum for the masses of the ABMS

MOC is all just Pablum for the masses and there is no better analogy: see: 
ANother invention that SEEMED a good idea which is NOT!

Is Pablum Necessary? New recommendations on what baby's first foods should be (hint: it doesn't include infant cereal) 
by Teresa Pitman 
In the 1920s, many babies were being fed with homemade formulas that consisted primarily of sweetened cow’s milk and water. Doctors at Toronto’s Hospital for Sick Children wanted to find a baby food that could supplement this formula, as many babies of the time showed signs of vitamin deficiencies and malnourishment. 
In 1931, they invented Pablum, a powder that could be mixed with water or milk and spoon-fed to even quite young babies. The original ingredients included: ground wheat, oatmeal, cornmeal, wheat germ, bone meal, brewer’s yeast and alfalfa plus added vitamins and minerals. It was the first infant cereal, and it quickly became the standard first food for babies. 
Over time, many companies began producing their own variations. Because of concerns about allergic reactions, most now use just a single grain (such as oats or rice). 
But times have changed. As more babies are once again being breastfed, and the quality of formulas available to parents has improved, recommendations about adding complementary foods have also changed. The Canadian Pediatric Society and the World Health Organization now both recommend that babies be exclusively breastfed for six months, and then continue breastfeeding with added solid foods for two years and beyond. 
When a baby starts on solid foods at six months or later, there’s no need for a highly processed, semi-liquid food like Pablum or another infant cereal. These babies are ready for REAL food! In fact, the World Health Organization recommends that babies be offered the foods that are part of the family’s usual healthy diet. 
- See more at: http://www.babypost.com/babies/infant-developme...

Saturday, August 9, 2014

Putting Quality on the Global Health Agenda-NEJM & IOM crap

I read the article praising Institute of medicine political statements from the NEJM and wrote the following (naturally not accepted for publication). I used real definitions to define the problem, not politically motivated ones:
Placing the “mea culpa” in real terms regarding "quality healthcare".
The recent perspective on quality in healthcare continues to miss many essential realities. Quality is also defined as:”A measure of excellence or a state of being free from defects, deficiencies and significant variations.”
Rehashing the Institute in Medicine’s particular brand of definition, emphasizing: “it is safe, effective, patient-centered, efficient, timely, and equitable” simply does NOT describe modern medical care:
Safe: The very nature of healthcare (surgery, drug administration, anesthesia and procedures) is extremely dangerous, while this fact is typically minimized in expectations and when obtaining informed consent.
Effective: Typically the patient’s ability for self-healing is only promoted by treatment, typically introducing drugs and procedure related specific known dangers in the process-often as dangerous as the disease itself.
Patient centered: Increasingly emphasis decries utility of preventive care including PSA, mammograms, pelvic and even routine yearly physical exams-emphasizing cost effectiveness over patient centricity.
Efficient and timely: would require maintenance and preventive care-currently not emphasized-see above.
Equitable: you cannot purchase health, only health care. Poverty and lifestyle remains after healthcare, as a causative factor.

By failing to recognize that quality healthcare starts with having health and maintenance, whereby the patient is the primary source of health, we will never get past placing blame on physicians and health care systems for inadequate quality. Physicians cannot consistently replace that, which is already lost. The continued emphasis on “adverse outcomes” blaming heathcare systems, ignores the many patient centered causes of sickness including poverty, handguns, rampant drug, tobacco and alcohol abuse, obesity and multiple other life style choices including “extreme” and professional sports-which are not typically terminated by the patient, even after problems are treated and causality confronted. Adverse outcome continues to be defined as anything less than an optimal desired (advertised) outcome typically=restitutio ad integrum! This “failure” is not equal to malpractice, deficient or even inadequate care. Patients come to hospitals, when problems become severe and baseline health is marginal, increasing the risks from receiving care.
The example of the inability to decrease maternal mortality by financing all deliveries in hospitals is not surprising, as provision of care introduces specific risks (a la Semmelwiess or modern expected risks): I.e. failure to provide adequate pre and postpartum care, C/section rate risks are certainly as, or even more important, than delivery in a hospital vs home . We need to quite blindly accepting corporate definitions from the IOM or elsewhere and accepting all blame for complications.

As an anesthesiologist and for example, where the expectation is to provide general anesthesia (versus no anesthesia needed) for a MRI scan, in the most extremely hostile physical environment known, to merely “take a picture”, expected complications will always prevail and provide “adverse outcomes”. It is time to capture all inherent/statistical/expected risks and start tabulating adverse outcomes based in the real world.

This is the article available at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1402157
Putting Quality on the Global Health Agenda
Kirstin W. Scott, M.Phil., and Ashish K. Jha, M.D., M.P.H.
n engl j med 371;1 nejm.org july 3, 2014

Thursday, August 7, 2014

Public Health & Policy MOC: Dissecting the Issues MedpageToday

Public Health & Policy

MOC: Dissecting the Issues

Published: Aug 6, 2014
Paul Kempen, MD, PhD, has been actively investigating the certification industry and background, introducing the term "regulatory capture," which he defines as the use of laws to create compliance with corporate self- serving programs. Kempen is an anesthesiologist now in private community practice after decades of academic practice. He regularly posts atwww.Changeboardrecert.com and his blog.

SEE: http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/47085?xid=nl_mpt_DHE_2014-08-07&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=ST&eun=g821443d0r&userid=821443&email=daraparvez%40gmail.com&mu_id=6133776&utm_term=Daily 

Sunday, July 27, 2014

FLorida Joins list of states resolving to Oppose MOC-the best set of resollutions yet and serve as example to any state without!

Today, the Florida Medical association House of Delegates passed the following resolution without a single vote of dissent among the 300 delegates in attendance: .

RESOLVED, That the FMA acknowledges that the certification requirements within the MOC process are costly, time-sensitive, and result in significant disruptions for the availability of physicians for patient care, and therefore, the current MOC programs should be modified; and be it .

RESOLVED, That the FMA opposes any efforts to require Maintenance of Certification (MOC) program as a condition of medical licensure, or as a pre- requisite for hospital/staff privileges, employment in State of Florida/county medical facilities, reimbursement from 3rd parties, or issuance of malpractice insurance; and be it further .

RESOLVED, That the FMA advocates that the lack of specialty board recertification should not restrict the ability of the physician to practice medicine in Florida. .

RESOLVED, That the FMA monitor the American Health Legal Foundation who is seeking legislation to prevent hospital staffs and insurance companies from refusing to credential physicians who do not participate in the MOC program. .

RESOLVED, That a copy of this resolution be transmitted to the AMA House of Delegates.

The number of states openly opposing this regulatory Capture= Extortion is on the rise and this set of resolutions should serve as template for EVERY state on MOC

Saturday, July 26, 2014

The death penalty, the ABA and political extortion of physicians by the Boards

Three major journals have now published about the extortion of american physicians-the political force of certification revocation-and ONLY the ABA (anesthesiology)  of all boards has done this. Please consider the following and anyone needing a copy of any article contact me off line. The first is particularly salient-the second displays the ABA's firm and clear position that certification loss threatens ability to practice and should be used to extort physician complliance to board's whims-decided by 20 pompus individuals who do not practice medicine, but politics:
Societal and Medical Ethics: Regarding Execution by Lethal Injection
Multiple recent opinions regarding physician execution and corporate American board prohibitions raise many important issues. (1-3) As physicians and definitive experts, we are obliged by society to participate in many aspects of dying: terminal care, ICU admissions or denials (fiscal and physical triage), euthanasia, withdrawal of life support, abortions, heart beating and non-heart-beating organ donation and “do not resuscitate” classifications and indications. Such involvement as anesthesiologists has recently been deemed “imperative” (4) In modern industrial societies, over 90% of ICU deaths are “managed events”. (5) Organ donation euthanasia is being discussed as a means to facilitate the supply of needed organs, as have been invasive non-heart-beating methods. (6) Optimally, organs are recovered from heart-beating donors: perhaps it is time to discuss or provide medical care to recover all useful organs from the
condemned, who choose to donate organs before circulatory arrest, as an act of contrition, to benefit living patients and increase their hope of living. Brain dead donors are as legally “declared dead”, as are those condemned to die and are without hope of further life. Death is certain at this point. Ronald Phillips, a condemned murderer, has recently been denied the opportunity to donate organs and benefit others, which would have been readily possible, humane and practical, using standard heart beating donor methods. ( 7, 8) Why refuse and to what purpose?
Times have changed since the American Medical Association (AMA) issued it’s opinion
guideline first issued in 1980 and last revised in 2000, stating, "A physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution. The AMA now represents less than 20% of physicians and by no means, the profession as a whole. Medical ethics must reflect contemporary society, which even the AMA openly declares. The US population danced in the streets after Osama Bin Laden was “terminated”. Drone attacks are now contemporary federal policy-even directed at US citizens. Organ recovery has been a priority for over a decade in the US. The Ohio Medical Board recently specifically prohibited involvement in “the actual administration of the execution agent itself”, while only two death-penalty states, Illinois and Kentucky, specifically bar doctors from the execution chamber. No one should be forced to participate in an execution, be restricted from following their conscience, voicing their opinion
or performing legally sanctioned actions including “consulting with ……. lethal injection personnel”.
The only board, the American Board of Anesthesiology (ABA) and original signer issuing the prohibition noted: “Even though board certification is not required to practice medicine, in many fields it is a de facto requirement for physicians to practice within their specialties.” (2) The ABA has thus threatened to revoke certification for capital punishment involvement of any kind, including consulting distant from the actual act. Dictating as a dozen corporate enforcers without legal mandate, assuming to represent the profession and threatening an individual’s employment ability without a voice of the diplomates, who are not members but merely rent the diplomate under current artificially created corporate recertification licensing, is a mere political ploy, remaining itself unethical and frankly un-American. The prohibition of involvement in lethal injection occurred with significant dissent from the national American Society of Anesthesiologists. * It is noteworthy that the Boards have used this same threat and
regulatory capture to force physicians to subscribe to their corporate programs, profiting only the boards (netting $400 million annually), while devoid of outcome based data demonstrating any quality improvement from their certification or recertification programs, in spite of repeated attempts over decades. (9) This was summarized in the ABIM’s own internally sponsored Meta-analysis. (10) These corporate and political actions raise serious questions as to the ethical nature of these boards themselves, operating without effective external oversight by the profession itself. “Business ethics” should not supersede professional ethics, who do not serve or represent the professionor society at large.*

Personal Communication, Alexander A. Hannenberg, MD

1) Waisel DB: Revocation of Board Certification for Legally Permitted Activities. Mayo Clin Proc. 2014;89:869- 872.
2) Truog RD, Cohen IG, Rockoff MA. Physicians, medical ethics, and execution by lethal injection. JAMA. 2014 Jun 18;311(23):2375-2376.
3) Sawicki NN: Clinicians' involvement in capital punishment--constitutional implications. N Engl J Med. 2014;371:103-105.
4) Papadimos TJ, Gafford EF, Stawicki SP, Murray MJ. Diagnosing dying.
Anesth Analg. 2014 Apr;118(4):879-82
5)Widdicombe NJ, Van Der Poll A, Gould A, Isbel N. Donation after cardiac death in nonsurvivable burns. Anaesth Intensive Care. 2013;41:380-385.
6)Wilkinson D and Savulescu J: Should we allow organ donation euthanasia? Alternatives for maximizing the number and quality of organs for transplantation. Bioethics. Jan 2012; 26(1): 32– 48.
7) Associated Press: Death row inmate's wish raises ethical questions November 14, 2013. Available at: http://www.foxnews.com/us/2013/11/14/death-row-inmate-wish-raises-ethicalquestions/ Accessed 7/19/2014
8) Kempen PM: Lethal Injection, Anesthesia, Medicine and Organ Donation – Ethical and Clinical Considerations Regarding the Pending Supreme Court Case: Baze vs Rees. The Open Anesthesiology Journal, 2008, 2, 7-12.
9) Kempen PM: Maintenance of Certification and Licensure: Regulatory Capture of
Medicine. Anesth Analg. 2014 Jun;118(6):1378-86.
10) Sharp LK, Bashook PG, Lipsky MS, Horowitz SD, Miller SH. Specialty board
certification and clinical outcomes: the missing link. Acad Med 2002;77:534–42 

Wednesday, July 16, 2014

Two new websites oppose MOC!


Opened on July 08, 2014

  1. The American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program is onerous and provides little value

  2. There is no data that MOC improves patient outcomes

  3. The MOC modules are irrelevant busywork that reduce physician time for patient care.

  4. MOC is costly for physicians and has become a money-making enterprise for ABIM

  5. There is no public demand for MOC

  6. The existing Continuing Medical Education requirements are a preferred approach to life-long learning.

  7. To date, despite numerous calls for change, ABIM has not made meaningful changes to the MOC program

Therefore, I pledge not to participate in MOC unless significant changes are made to the program. If I have previously enrolled in MOC, I will boycott future enrollment unless significant changes are made to the program.

 If you support this pledge, please send it to your colleagues and your hospital medical staff office for distribution.

 Supported by Physicians for Certification Change 


The Physicians for Certification Change (PCC) are board certified or board eligible physicians from all specialties who are concerned about the recent changes to Maintenance of Certification (MOC) requirements. Our goal is to influence certification organizations like the American Board of Internal Medicine (ABIM) to change their policy regarding MOC.  We believe recent requirements are onerous, expensive and lack value.  While we do not have complete agreement on every recommendation, most members of PCC believe MOC should be changed in the following manner:
  •  Allow CME to satisfy all MOC biannual activities. Eliminate, or make optional, the medical knowledge, practice improvement and patient safety computer modules that have little practical value.
  • Charge a nominal fee (eg $100 per year) to track annual CME attendance as a substitute for MOC
  • Cut ABIM’s costs and correspondingly reduce initial certification and recertification fees by at least 20% over the next two years
  • Vastly simplify the ABIM website and MOC administrative tasks so physicians do not waste time on administrative activities
  • Members are divided on the issue of requiring recertification exams. Many believe the exam questions are not a reliable gauge of physician’s knowledge. Others favor requiring a recertification exam every 10 years, but the exam should be fair and easily passed by a physician in practice who keeps up with the literature and engages in adequate CME.

Founding members of the Physicians for Certification Change include:
Paul Teirstein, M.D.; Gregg Stone, M.D.; David R. Holmes, M.D.; Martin B. Leon, M.D.; Mladen I. Vidovich, M.D.; Kirk N. Garratt, M.D.; David Cox, M.D.; Andrew D. Michaels, M.D.; Peter B. Berger, M.D.; Chris White, M.D.; Bonnie H. Weiner, M.D.; Jeffrey W. Moses, M.D.; Michael Lim, M.D.; Augusto Pichard, M.D.; Dean Keriakes, M.D.; Samuel M. Butman, M.D.; Andrew Doorey, M.D.; Lloyd W. Klein, M.D.; Allen Jeremias, M.D.; Carl Tommaso, M.D.; Peter Pelikan, M.D.; Ramon Quesada, M.D.; Emmanouil Brilakis, M.D.; James Goldstein, M.D.; Bob Applegate, M.D.; Ted Feldman, M.D.; Morton Kern, M.D.; Charlie Chambers, M.D.; John Hodgson, M.D.; Aaron V. Kaplan, M.D.; Arnold Seto, M.D.; Craig Thompson, M.D.; David Rizik, M.D.; John Hirshfeld, M.D.; Karen Smith, M.D.; Peter Ver Lee, M.D.; Nauman Siddiqi, M.D.; Zoltan G. Turi, M.D.; Amir Lerman, M.D.; Roxana Mehran, M.D.; Igor Palacios, M.D.; Mitchell W. Krucoff, M.D.; Joseph D. Babb, M.D.; Westby G. Fisher, M.D.; E. Magnus Ohman, M.D.; Carlos E. Ruiz, M.D.; Steve Ramee, M.D.; Ajay Kirtane, M.D. & Kimberly A. Skelding, M.D.