Marshall on Oncology Taking the Boards: A Frisking, Then a Mugging

http://www.medscape.com/viewarticle/822051


This is good listening from a ABIM SUPPORTER now railing the MOC process!

ANTI MOC petition at 5700 signatures and growing!

If you have not signed THIS petition against MOC, please do so and share this link with your friends! Already over 5700 signatures!
http://www.petitionbuzz.com/petitions/recallmoc

AAPS MOC Update from March 25, 2014

Anyone interested in an update on the ABIM's extortion Ponzi scheme known as MOC can review the Association of American Physicians and Surgeons MOC Update at: 

http://youtu.be/0zmAvdhnaxM

or this
https://www.youtube.com/watch?v=0zmAvdhnaxM&amp...

or this  https://www.youtube.com/watch?v=0zmAvdhnaxM

So many roads to Rome!

OPEN letter to ABIM's CEO Dr Baron to openly Debate MOC: Anytime anywhere!

http://medicaleconomics.modernmedicine.com/medical-economics/news/moc-changes-aim-lessen-burden-physicians-debate-continues?page=0,5

MOC changes aim to lessen burden on physicians, but debate continues

Publish date: MAR 24, 2014

^Print

By: Beth Thomas Hertz

AAFP: Maximize quality, minimize burden

Mindi K. McKenna, PhD, MBA, director of the continuing medical education division of the American Academy of Family Physicians, agrees with Puffer that family medicine has already made many improvements over the years that some other specialties are just now making.

“For instance, tightening up the frequency in which practice assessment and performance improvement kinds of endeavors are undertaken and reported, having a secure exam, having that kind of ongoing approach to maintaining your competency and effectiveness,” she says.

She says a lot of thought went into the nuances of the details of the revisions. “ABMS’ communications indicated that they were working really hard to find that balance of enough stability and consistency over time that it doesn’t put an undue administrative burden or cost on physicians,” she says. “We provided comments and encouraged ABMS to continue to be cognizant of trying to find ways to maximize the value for patient care to ensure that patients are getting the best possible care while minimizing the burden on physicians.”

Dissenters' view

Despite the optimism expressed by these leaders, some physicians say the latest changes do not address the real problem. “The fact that they are calling these ‘new rules’ is somewhat preposterous considering how long this has all been in effect,” says Ron Benbassat, MD, who has been in practice in California for 20 years and is certified and recertified by ABIM. He is a leader in the organization Change Board Recertification.

 “All board certificates must be converted to lifetime status. Only then will MOC be voluntary,” Benbassat says. “We already engage in lifelong learning through CME requirements to keep our licenses. MOC is nothing more than a money-making scheme by the boards.”

The combined revenue of all the boards in the United States is more than $350 million, Benbassat says. “Who benefits from these tests? I would argue that it is the 450 board members, not the 800,000 private physicians in the United States,” he says.

Benbassat also objects to the boards’ statements that they accepted comments online during the revision period. Several opponents of MOC provided Medical Economics with e-mails they received stating that their comments were not being posted because they did not meet the criteria set by the moderator. “Many people tried to submit statistics and information about MOC and they were rejected,” Benbassat says.

Baron readily acknowledges that some dissenters’ comments were not allowed on the ABIM forum. “It’s not an open forum. It’s a moderated forum, and it is moderated according to principles that are posted on the site,” he says. “We welcome input on the program, but if people are going to take a subject area and post comments that say there shouldn’t be any program, people will not bother to read the comments or engage in the conversation.”

“When people say all we care about is money and that the program should be done away with, we simply don’t regard that as a comment that is engaged with how to make MOC better. We know there are people think there should not be MOC and they have lots of places on the Internet where they make that point. We are trying to manage a civil discourse on a subject on which there is a range of opinion,” he says.

He points out that many comments critical of MOC were allowed past the moderator.  “It is one thing to offer specific criticisms of the program, but another to say there shouldn’t be a program and we don’t see the role of this conversation to be to give a platform to that,” Baron says.

·          

COMMENTS:

	PAULMKEMPEN I continue to be astounded that the ABIM refuses to openly debate the topic in an open forum. The Benjamin Rush Society invited the ABIM and ABMS to debate MOC in their home town of Philadelphia last April-they failed to come (http://www.youtube.com/watch?v=AetMD0OYVkY). The ABIM does NOT want to debate the issues openly in a neutral forum because the whole extortion process is unwanted by physicians in General, and it provides no index of quality. The ABIM and ABMS are trying to introduce these changes under the radar through the gradual program of lobby congress and hide from Open discussion. MOC is simply a money making extortion program self-serving to the certification industry. The ABIM itself concluded as early as 1986 and themselves published in 2000 the fact that voluntary MOC would not be possible (ANN INT MED 2000; 133:202-08 . THAT is why they imposed it with artificially restricting the certification to 10 then 8 and now to Continuous subscriptions to MOC to maintain a certificate that they themselves deem to be "VOLUNTARY". I hereby OPENLY invite the ABIM to debate ME and my colleagues in any open format before practicing physicians any time and any place. I would invite Medical Economics to sponsor such a debate and poll the general physician population in attendance to finally clarify openly the disgraceful and unethical extortion of physicians for corporate executive's gains. The fact that Dr Baron and the ABIM actively excluded comments to their website that they do NOT want to hear is testimonial to these facts stated clearly above-they only hear what they want to hear and I quote: "Baron readily acknowledges that some dissenters’ comments were not allowed on the ABIM forum. “It’s not an open forum. It’s a moderated forum, and it is moderated according to principles that are posted on the site,” he says. “We welcome input on the program, but if people are going to take a subject area and post comments that say there shouldn’t be any program, people will not bother to read the comments or engage in the conversation.” “When people say all we care about is money and that the program should be done away with, we simply don’t regard that as a comment that is engaged with how to make MOC better. We know there are people think there should not be MOC and they have lots of places on the Internet where they make that point. We are trying to manage a civil discourse on a subject on which there is a range of opinion,” he says. He points out that many comments critical of MOC were allowed past the moderator. “It is one thing to offer specific criticisms of the program, but another to say there shouldn’t be a program and we don’t see the role of this conversation to be to give a platform to that,” Baron says." Mar 24, 2014	·         edit ·         reply
	Dr. Jon Schneider I do not mind having my name used. I very much appreciated this article in that the MOC needs significant changes. I think the idea of alternatives to going to a testing center are essential to this process. I feel strongly, too, that the MOC has to be more flexible about refunding the high cost of testing when people such as myself are dying of cancer and are no longer able to sit through a five hour test. I reluctantly signed up for the MOC in 2011 and clearly informed them of my concerns about my cancer progressing. This year my concerns became a reality. I suggested alternative testing or a refund several times with the repeated response that it is a "firm policy to NOT refund fees." It became apparent that the Board was more concerned with the money than my well being. I would appreciate any advice in regard to this issue.  Mar 24, 2014	·         repl

- See more at: http://medicaleconomics.modernmedicine.com/medical-economics/news/moc-changes-aim-lessen-burden-physicians-debate-continues?page=0,5#sthash.zzWQewtE.dpuf

Sign this petition to end MOC

Go to :
http://www.petitionbuzz.com/petitions/recallmoc\
sign and comment. this is self explanatory!

ASA rejects open discussion of recertification at the annual meeting 3 years in a row!

Sent this to ASA leaders in response to the refusal to even discuss Recertification among the membership-no surprise there!
As you both have probably noticed, the open pro-con discussion on MOC proposed for this year and to which you wer agreed to participate, has now for the third year been disallowed by the ASA leadership. I am wondering very loudly WHY? If the AMA was openly discussing this matter in Chicago this past summer and formulating resolutions regarding this matter, discontent is mounting in the media and the NEJM's poll in 2010 already demonstrated strong opposition-just why should the ASA (which was forced down this road by the ABMS and ABIM) is so reluctant to talk in open session among the membership?

Thoughts?

Paul
Clinical decisions. American Board of Internal Medicine maintenance of certification program--polling results.
Kritek PA, Drazen JM.
N Engl J Med. 2010 Apr 15;362(15):e54. doi: 10.1056/NEJMclde1003227. No abstract available.
PMID: 20393173 [PubMed - indexed for MEDLINE] Free Article
Related citations
Select item 20220192
7.
Clinical decisions. American Board of Internal Medicine maintenance of certification program.
Levinson W, King TE Jr, Goldman L, Goroll AH, Kessler B.
N Engl J Med. 2010 Mar 11;362(10):948-52. doi: 10.1056/NEJMclde0911205. No abstract available.
PMID: 20220192 [PubMed - indexed for MEDLINE] Free Article
Related citations

Thank you for your interest in the ASA Annual Meeting, October 11-15, 2014 in New Orleans, LA. The review process has been completed and we regret to inform you that your Point-Counterpoint entitled Does Board Recertification Do More Harm Than Good? was not accepted.

ASA received many high quality submissions, but given the limitations of time and space, regrettably not all can be accepted.

Thank you very much for submitting your Point-Counterpoint. We hope that you will consider the ASA Annual Meeting as an appropriate forum for future presentations.

Webinar Update on the ANTI-MOC movement!

I would like to point out there will be a Webinar on March 23, 2014 and the particulars are viewable at:
http://www.aapsonline.org/index.php/event/webinar_moc_update
1.5 CME credits are available and NO MOC Points!

American Board of Family Practice practices unethical publication and disclosure

This Self serving, funded study in the ABFP's very own "journal" was reported in the AAFP's Newsletter:

Data from a recently published study<span>(www.jabfm.org)</span> conducted by the AAFP National Research Network (AAFP NRN) suggest that the American Board of Family Medicine Maintenance of Certification for Family Physicians (ABFM MC-FP) program -- specifically, the self-assessment (Part II) and performance-in-practice (Part IV) modules -- have a positive influence on quality of care.

Talk about conflicts of interest-but none were declared-you need to read the article at:http://www.jabfm.org/content/27/1/19.full.pdf+html

and especially the comments at:http://www.aafp.org/news/health-of-the-public/2...

to appreciate the paid advertising nature of this pseudoscience and attempt to self justify this certification program and MOC. 

And of course the BEST part of that article is this printed at the bottom ogf the first page:"Conflict of interest: none declared."
These people publish non-science as science,fund it, pay the writers, publish in their very OWN "journal"where conflicting views will be SUPPRESSED and then do not have a conflict to declare. This is the next greatest area of attack against these boards-not just the fallicy of the MOC and BC, but the collusion, obfuscation and lies of the corporate organizations upon the publich at large.If any of you are members, please post my statements-I actually "registered" to be able to comment and when I tried, was unable BECAUSE I WAS NOT A MEMBER! Talk about self serving and closed realities
WHAT BULL$%!+!!!!!!

Please sign this ANTI MOC  petition and ask your friends to do it too.http://www.thepetitionsite.com/580/584/211/abim-should-recall-the-recent-changes-to-maintenance-of-certification-moc/ 

This title ran at the AMA website and is completely false:

Increasing body of evidence supports maintenance of certification

kmpnpm wrote: There is NO body of evidence to support MOC, as this is continually changing under the pressures of the ABIM to extort physicians into compliance with their monopoly. The quoted Journal supplement was published after the ABMS paid between $35-50K to finance that supplement-this was nothing more than corporate paid advertisement under the guise of "science". The only near objective paper in that supplement was authored by the editorial staff and clearly questioned the validity and utility of MOC. Even BOasrd Certification has NEVER been validated as a mechanism to improve care. MOC is a "bait and switch" tactic of the ABMS corporate program, which changed lifelong board certification into a temporary measure and now has become something one MUST YEARLY purchase to remain valid. I Urge every physician to simply let the ABMS certification "lapse". Board certified is PAST tense and having certified once is "certified". If physicians continue to act like sheep, they will be fleeced to the slaughter! The Canadian and UK programs are nothing like ABMS MOC, emulating the AMA's PRA-CME documentation of lifelong learning. There is NO need for the ABMS to assert that "we must do this to validate learning-before someone else-nonphysicians force us to". Every State Board is a group of physicians monitoring lifelong learning.It is time to abandon the ABMS's extortion program. 3/11/2014 6:55 PM CDT drjefmd wrote: Reading this article is like reading federal government propaganda; "The Department of the Treasury is working closely with the Federal Reserve to ensure that the inflation you BELIEVE you are experiencing isn't nearly as bad as the extremists claim." Both the AMA and the ABMS are benefactors of MOC monies. They create an obligatory program then sell the only "recommended" materials to help you pass. Seems perfectly fine...IF you are one of those who benefit from the newly increased revenue stream! I have introduced language to our hospital bylaws committee to end recertification requirements. Despite what the AMA and ABMS say, it IS enormously costly and burdensome and I have found it not one iota more useful than a standard CME course, which I can choose all by myself, with no threat to my career if I don't choose what they think I should do.

Actively defeating MOC and the ABMS monster!

How to defeat the MOC pirates in your back yard:
1) Get involved in your state medical society-the very largest one!
2) Change your Med Exec bylaws to prohibit  MOC or Certification (as this will always expire per ABMS new rules) as  requirement for membership! CMS is on your side!:

Those in hospital bound specialties simply need to change the medical staff requirements to eliminate certification as a requirement-if that even exists! Federal CMS guidelines prohibit board certification as a sole criteria to prohibit membership-this is anticompetitive! 
According to CMS: 
§482.12(a)(7) Ensure that under no circumstances is the accordance of staff 
membership or professional privileges in the hospital dependent solely upon certification, fellowship or membership in a specialty body or society. 
http://law.justia.com/cfr/title42/42-3.0.1.5.21... 
§ 482.12 Condition of participation: Governing body. 
The hospital must have an effective governing body legally responsible for the conduct of the hospital as an institution. If a hospital does not have an organized governing body, the persons legally responsible for the conduct of the hospital must carry out the functions specified in this part that pertain to the governing body. 
(a) Standard: Medical staff. The governing body must: 
(1) Determine, in accordance with State law, which categories of practitioners are eligible candidates for appointment to the medical staff; 
(2) Appoint members of the medical staff after considering the recommendations of the existing members of the medical staff; 
(3) Assure that the medical staff has bylaws; 
(4) Approve medical staff bylaws and other medical staff rules and regulations; 
(5) Ensure that the medical staff is accountable to the governing body for the quality of care provided to patients; 
(6) Ensure the criteria for selection are individual character, competence, training, experience, and judgment; and 
(7) Ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely upon certification, fellowship, or membership in a specialty body or society. 

HIPPA-protecting patients or just another means to target doctors?

This month’s ASA newsletter highlights “ethics” in an unusual sequence  at: http://viewer.zmags.com/publication/8ca586af#/8ca586af/6.

We read about HIPPA violations, while 60 Minutes last week featured the fact that anyone using the internet has already divulged extensively their personal information: http://www.cbsnews.com/news/the-data-brokers-selling-your-personal-information/ . The amount of information is extensive and exceeds that of the government. DO you think this whole protection actually does anything for patients, given the fact that it often leads to difficulty in obtaining needed patient information from “outside sources”.  Is it time for everyone to just back off? The ACA has made nothing accountable, shovels all data to government and PRIVATE CORPORATIONS in the name of quality assessment (i.e. the anesthesia quality Forum) (See http://viewer.zmags.com/publication/8ca586af#/8ca586af/42)  Is it time for everyone to just back off? Do docs need to attack the federal bureaucracies to stop wasting medical dollars to make every patient a “top secret” to practicing physicians while simultaneously making every patient a “test subject” for federal  data collection and then no one actually uses this information in an ethical manner?

Ethical implications of “special relationships” in medicine.

Once again we see colleagues lining up to point fingers at colleagues, imposing additional restrictions on doctors, well above any other group in society. The article in the ASA newsletter is found at: http://viewer.zmags.com/publication/8ca586af#/8ca586af/22 and the target is married surgeons/anesthesiologists caring together for one patient-creating conflict in legal malpractice awards to patients. Personally, this is more likely to result in an award being issued if lawsuit develops!   Why not use the example of an MD/CRNA team-this is more commonplace? I am tired of colleagues creating ever more reason to punish and constrain physicians in medical care. We see dynasties in the US presidency and god only knows how many deaths result from presidential decrees. But we physicians continue to target only our own PRACTICING DOCS.

Is a personal relationship in medicine any different than politics, law, plumbing? Why do we continue to point fingers at ourselves? Personally caring for family members is also prohibited in many states  by such ill found “ethical standards”,  although as parent, caregiver, spouse or power of attorney, NOTHING would be possible without informed consent from the “special party”!

Of course the ASA and the ABA are also very “married” to each other, exchanging leadership positions readily and creating financial adventures to extort money from practicing physicians-Yes I am referring to the scandal called MOC,  or for anesthesia: MOCA (trademark here!).  Spouses can be targeted as individuals but Corporations like the ASA and ABA remain immune (as they are in power and control this publication), although they are essentially the same people cashing in on our labor.

A Colleague recently wrote this regarding the problem:

Most doctors are not aware of the specialty medical boards copyrighting their educational materials.  Under the Hippocratic tradition, the dissemination of medical knowledge was expected to be free and without charge. 

Not long ago, an internist subspecialist sat for a board exam, but later provided a test question to a board review course that was not "blessed" by ABIM.  The response from ABIM?  Litigation, which even included attorney fees!  Dr. Christine Cassel, then head of ABIM, literaly ruined this physician for doing something that ABIM does routinely!  Has anybody else noticed how ABIM advertises its review products, along with questions like those which appear on the board exams?  Yes, and ABIM charges hundreds, if not thousands of dollars for these products? 

How does one copyright medical information?  How is such copyrighting helping disseminate medical knowledge?  Why would a specialty medical board sue a physcian for helping to disseminate this knowledge?  Is it to protect its money stream and Dr. Cassel's lucrative career? 

Dr. Cassel, of course, is no longer at ABIM.  She went over to head up the National Quality Forum,. while Dr. Richard Baron, previously at NQF, came over to head up ABIM.  Dr. Cassel, meanwhile, apparently was simultaneously "serving" on directorships of organizations that would benefit from NQF, earning significant sums on these "side jobs". 

So, thank you Dr. kmpnpm for pointing out the Hippocratic versus the hypocritical.  Let us hope that doctors will choose the former, and ditch this MOC business.