MOC changes aim to lessen burden on physicians, but debate
continues
Publish date: MAR 24, 2014
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.
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COMMENTS:
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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 |
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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 |
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