Wednesday, April 30, 2014

Become active in the battle against MOC at:

Fighting MOC-the homepage!

Tuesday, April 29, 2014

After ANTI MOC petition HITs 10,000 signatures,ABIM CEO Baron debates Dr Wes

ANTI MOC petition causes ABIM concerns see and sign at: 

Dr WES: ABIM Thumbs Its Nose at Senior US PhysiciansYesterday, the President and CEO of the American Board of Internal Medicine (ABIM), in a moment that must have been heartbreaking for him, found himself in the position of having to<span>chasten</span> more than 10,000 unruly senior US physicians, thanks to a <span>petition</span> drive.  In his<span>statement</span>, the aggrieved Dr. Baron, in a plea for common sense, bemoans the fact that physicians do not care enough about patient care or safety to spend $200-400 dollars per year for the ABIM.  This is what the benighted ABIM is up against!  Senior physicians are nothing more than penurious whiners who fail to be appreciative of the Mothership.

Dr Wes summarizes further the ABIM problems at:;utm_medium=twitter&amp;utm_campaign=Feed:+DrWes+(Dr.+Wes) 

After this statement was issued by the ABIM
Statement from Richard J. Baron, MD, MACP, President & CEO of the American Board of Internal Medicine regarding anti-MOC petition

Philadelphia, PA, April 28, 2014 - ABIM has heard from many diplomates about their frustrations to the changes to the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) process. They have concerns about relevance, cost and the time it takes to complete MOC. A <span>petition</span>, signed by more than 10,000 physicians, raises many important issues.  read more at:

Saturday, April 26, 2014

MOC Deadline Looms Anew, as Resistance Mushrooms

PHILADELPHIA, PA (updated) — With just a few more days to register for their "maintenance of certification" (MOC), almost 9000 physicians have signed on to a cardiologist-led petitiondemanding that the American Board of Internal Medicine(ABIM) recall the changes it made this year to the MOC process.
After April 30, as previously reported by heartwire , the ABIM will begin publicly reporting that physicians who are not registered are "not meeting MOC requirements."
The petition, created by Dr Paul Teirstein (Scripps Clinic, La Jolla, CA) on March 10, gathered 200 signatures in the first day, and support has mushroomed.
"The changes in the MOC requirements have upset a large number of cardiologists," Teirstein told heartwire . "It seems that pretty much everyone I speak with is against these changes, and the main arguments against the changes I received are that they don't create value for physician—ie, they do not have significant educational value—and they take considerable time and increased expense."


Wednesday, April 23, 2014

American Board of Internal Medicine Policy Condones Keeping Conflicts of Interest Secret

This is very interesting how the American Boards regulate themselves (NOT) and have no trouble skirting all conflicts of interest!

for the full text!

The latest complication of the CareFusion/ Dr Denham/ NQF/ Dr Cassel/ ABIM case was the revelation that the current president of the NQF, Dr Christine Cassel, after resigning her position on the board of directors of for-profit publicly held group purchasing organization Premier Inc, was found to have been on the board of for-profit privately held predecessor of Premier Inc since 2008 (see post here).  Before Dr Cassel was CEO of NQF, she had been the president and CEO of the American Board of Internal Medicine for 10 years.  So apparently she was on the board of the predecessor of Premier Inc for about five years while she was leading the ABIM.

This relationship appears to be as serious a conflict of interest for Dr Cassel in her previous role as leader of the ABIM as it was for her current role as leader of the NQF.  Since she had this conflict for so long as leader of the ABIM without public disclosure, it seems logical to ask whether she was a long-term violator of ABIM policy, and hence sort of a long-term rogue CEO?

To answer that, one needs to review the ABIM conflict of interest policy.

What Sort of Conflicts of Interest Does the ABIM Ban?

The official wording is: 

It is the policy of the Board that Directors, Subspecialty Board and Committee members, consultants and other individuals involved in developing ABIM products will not be employed (as staff or as a consultant) at greater than fifty percent by a commercial entity, except in such instances where explicit exceptions to the policy have been made by the Board. Unless a compelling reason is presented for granting an exception, such individuals will be asked to resign their position of service to the Board.

Tuesday, April 22, 2014

Earth Day Activism a Model for Physicians Supporting Lifelong Learning?

Thoughts worth considering @

Friday, April 18, 2014

NOW the business of Paying physicians!

These are from the new CMS data on who gets paid what and of course anesthesiologists do NOT get reimbursed very well. you get paid the same for a CABG as you are charged to replace your windshield!

The Business of Testing Physicians

Wes Fisher posted this revealing information regarding the cost of MOC on his website at:
It is well worth a read!!!

Friday, April 04, 2014

The Business of Testing Physicians

If you want to understand the world of professional board certification, it is important to understand the business and politics of testing professionals. Such testing is big business. So big in fact, that huge international media and education companies that trade on the New York Stock Exchange have been created to service this need. According to one article on Reuters from 2012, "the entire education sector, including college and mid-career training, represents nearly 9 percent of U.S. gross domestic product, more than the energy or technology sectors."

Part of the expense of "maintaining" one's professional board certification goes for fees for the testing center where the computerized testing occurs.  Because cardiac electrophysiologists must hold two board certificates (Cardiac EP and Cardiology), we must pay for two rounds of test-taking fees: the first is included with our cardiology maintenance of certification (MOC), then we must pay a second $750 testing fee for the second EP test.  (Each test contained 180 questions - $4.17 per question).  I am assuming almost all of this goes to the company that administered my test: Pearson VUE.

ABIM holds a contract with Pearson VUE, a professional testing subsidiary of Pearson Education, the North American subsidiary of Pearson, PLC (NYSE: PSO) - an 9 billion dollar British corporation that claims it is the largest commercial testing company and education publisher in the world. It boasts Penguin Random House publishing and the Financial Times Group as some of its other far-reaching subsidiaries. Mr. John Fallon is the 52 year-old Chief Executive Officer of Pearson, PLC and earns a cool $2.55 million dollars annually while holding 282,147 shares of Pearson stock and plently of stock options.  He is joined by Mr. William T. Ethridge, age 62, who serves as "advisor" currently, but was previously responsible for the North American Educational Division of Pearson.  According to one source, William Ethridge was once chief executive of Pearson's North American Education division in 2008. According to Forbes, his total compensation in 2011 was $1,390,000 and he held a half million shares of Pearson stock at that time.

Pearson VUE states it "is built on a foundation of experience in electronic testing."  My experience with Pearson VUE was parodied in an earlier blog post. As I reflect, it seemed that Peason VUE was more concerned about storing my biometric palm scans and a digital photograph as much as they wanted to assure a fair testing environment. While the ABIM discloses this process on their website, doctors unaccustomed to such paranoid security measures are caught off-guard by these tactics and should be concerned about how this information is stored and used. Are previously-certified doctors really this sketchy?

Pearson VUE earns a pretty penny from its professional testing and its physician testing in particular. According to Pearson's most recent SEC filing:
"Professional testing continued to see good revenue and profit with growth test volumes at Pearson VUE up 25% on 2012 to almost 12 million [pounds] ($19.9 million). Key contract renewals included tests for the American Board of Internal Medicine, the Association of Social Work Boards and the Pharmacy Technician Certification Board. "
But profitting from physician education is a politically hot topic, too. Not surprisingly, Pearson Education seems quite active in this space spending $2,100,000 to lobby Washington during the last presidential election cycle in 2011 and 2012, contributing 7:1 to the Democratic side of the political aisle. Also, 6 of the eight current Pearson lobbyists have previously held government jobs.

Doctors should understand how and where their money and personal information are being used in the ABIM's MOC testing process, since much of those funds seem to support the corporations and political aspirations of those who are doing the testing rather than the needs of patients that the ABIM is pretending to protect.


Monday, April 14, 2014

Should Maintenance of Certification be repealed? from Society of Physician Entrepreneurs (SoPE)

Please join me in following the active discussion on how to stop MOC at:

To effectively fight MOC and MOL:
I suggest joining your LARGEST state medical organization and push for/with them to run against MOC by pushing for legislation at the STATE level where NO medical organization is earning off the MOC! They also have YOUR dues, an active legal and lobbyist organization and opportunity to educate YOUR WORKING colleagues to oppose the national extortion. Join the Association of American Physicians and Surgeons as the only national organization actively opposing MOC and with a lawsuit in NJ-See: also for information and join us at: and work to educate everyone about the extortion!
Monitor activley YOUR state medical board and intrusions by the FSMB (MOL originators) who wish to couple your license to MOC for THEIR profits.
Corporate golden rule: He with the gold rules!
At any rate-everyone who knows about this extortion scheme needs to actively oppose it in medical societies, move to change hospital bylaws to require "demonstration of prior certification" vs active certification or MOC active participation-BECAUSE the ABIM and ABMS are forcing all boards to follow their plans to Bait and $witch traditional lifelong certificaiton in to "Requrieing MOC". MOve to state legislators to STOP the CMS and federal PQRS-MOC incentive due to fine doctors who do NOT participate starting next year 1.5-2% of all CMS payments-the ABMS lobbied congress to get this law passed to create the regulatory capture necessary to make MOC Manditory and still espouse that it is "voluntary". See:
for an orientation of the reality or if you like video, see:

Sunday, April 13, 2014

Instructing the new Chair of the Board of Regents on representing the membership and not the ABIM

Becoming Chair of the Board of Regents of the ACP

by RCENTOR on APRIL 12, 2014
- See more

Please take the time to read this postion of the new chairman and take the time to add a comment or two to instruct him that indeed, there is a real need to abandon the ABIM as a physician adverse organization!
It is the job of the ACP to represent the physician membership against ALL political, corporate and regulatory capture and compromise. The ABIM is the leader in the MOC proposition under C Cassel MD for DECADES. In 1974 the first attempt at voluntary recertification was “offered” and in 1986 “ABIM concludes voluntary recertification is a failure; adopts prospective time-limited certification”-which was published in the ACP’s very own journal at: Ann Intern Med. 2000;133:202-208.
It is time for the ACP leadership to RENOUNCE MOC and MOL for the unqualified extortion schemes and Regulatory Capture they are. They produce nothing-specifically NO QUALITY! It is time to take action to protect patients AND this profession from being controlled by politicians and corporate dictates to facilitate the transfer of medical care to the lesser educated Nurses, PAs and Pharmacists who would love to practice medicine after a shoestring education by rote mechanisms of “guidelines” fitting the patient to the plan and not the plan to the patient. The ACP leadership OWES society and members at the minimum this much-not just issue #5! - See more at:

Thursday, April 10, 2014

Wes Fischer sums up Anti MOC in a nutschell

Heart doc calls for a time-out for ABIM MOC Mandate

April 10, 2014 6:00 am by  | 0 Comments
MandrolaFrom (registration required), John Mandrola, MD calls for a "time-out" for the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) mandate:The matter for debate is whether the ABIM method - and to be frank, it's arm-twisting tactics - is the best means to achieve physician quality.
Doctors are taught to be skeptical of evidence. Here, there is simply no evidence to judge. We can't know whether this brand of medical education achieves improved patient outcomes. Maybe it will. Maybe it will not. Or, perhaps it could make it even worse. How could aggressive education and measuring quality make things worse? Think heart-failure metrics and an 89 year old, who, a week later presents with a broken hip from all those evidence-based pills. I have many more examples, but I promised brevity. Read the whole thing.
Some additional thoughts and suggestions to the ABIM:
  • Given the unproven nature of the MOC process to assure physician quality and the ethical breeches created by the ABIM's proprietary process, "board certification" as defined by the ABIM should revert to a lifelong certification to put the ABMS and its subsidiaries in competition with all the CME sources available.
  • The new ABIM MOC rules that are now set to go into effect 1 May 2014 can cause "sudden and unanticipated" revoking of Board Certification based on failure to completely comply with MOC at ANY TIME. This should not be permitted.

  • Since state medical boards are all headed by physicians, the marketing my the American Board of Medical Specialties and the ABIM that physician perform their MOC process to prevent government agencies from providing an alternative to their MOC process is pure propaganda. There are many many government and private agencies that monitor physician performance including hospitals, insurance companies, CMS, Medicare, Medicaid, trial lawyers, the Better Business Bureau to name a few.

  • The ABIM's "board certification" is based on test-taking ability and not patient care metrics. As such it cannot be considered a patient care quality measure of any kind and should not be tied to CMS Physician Quality Reporting System (PQRS) payments to those who care for Medicare patients.
I believe it would be in the best interest of the ABMS and ABIM to listen the the growing chorus of dissatisfaction that is currently echoing throughout the country. I know many physicians are already boycotting the process. Until the ABIM and ABMS change their policies this boycott will continue, especially since doctors know that the incomes of these societies are being directly paid by their physician fees.
Just sayin'-
Here's a link to an anti-MOC petition underway.

Read more:

Resistance to MOC and MOL now expands to other professions-CRNAs

I copied this from the CRNA FB page and am re-posting it here because I thought it was worth sharing. Any thoughts? Input? Anyone get this email?
IPGE, Inc.
April 8, 2014
We are contacting you as a concerned coalition of CE Providers.
In 2016 the CPC Program created by the NBCRNA will go into effect and replace the current CE Program. It will require you to earn a new type of credit referred to as the "assessed credit". These credits are earned on-line or at AANA prior approved programs that provide an end of event evaluation. The evaluation may take the form of a ten question quiz following each lecture, or it may take the form of a skills demonstration such as evaluating placement of an endotracheal tube or using ultrasound for vascular access or regional anesthesia. 15 assessed credits will be required each year of a 4-year cycle.
You will also need to earn 10 non-assessed credits called "PAU's" each year of the four-year cycle. These credits are self monitored and can be earned in a variety of non-traditional ways. These would include but not be limited to writing a book or a book chapter, attending non-prior approved seminars, presenting a lecture, providing volunteer missionary work, assuming department management roles, etc. These credits are subject to periodic audit by the NBCRNA.
Every other cycle (every 8 years) a re-certification exam must be taken and successfully passed.
Another requirement is the establishment of "Competency Modules" that will provide 5 assessed credits. You will need to complete one module each year of the four-year cycle, BUT you may earn all of your 15 annual assessed credits by completing these modules. The modules will only be available on-line for the present time. So it is possible for you to complete all of your assessed CE requirements by computer for an indeterminate period of time. We estimate it will take 5 hours to complete a Module if current standards are applied to the modules. Now this doesn't sound so bad does it? The problem is that the creation of modules by CE Providers has been made so exceedingly difficult and expensive by the NBCRNA that it appears the only provider that will be able to do it is the AANA. Certainly state associations could not meet the requirements. So this means that the AANA could conceivably become the only provider of credits for you to become re-certified. This monopolization of CE will force all other providers out of business and it will spell the end of the live seminar that has been the traditional backbone of our CE since the inception of the profession. It may also cause the demise of State Associations since without a CE format there is little need or incentive to spend the necessary funds or take the time to attend a state meeting. Should this happen, states may not be able to recruit enough members for a quorum to conduct business. Do you suppose that the ASA is watching this with eager eyes and legislative ears. Once unorganized, states will not be able to meet challenges put forth by organized ASA members and you can only imagine what that might mean for your practice.
Furthermore, it has been rumored that the AANA may provide the required modules to you at no cost as a benefit of membership. Although this has not been confirmed, if it does happen, this will more than likely mean the end of your CE funding in lieu of payment of your AANA dues. Once employers learn that you can be re-certified by sitting at home on a computer they will jump at the chance to rid themselves of providing meeting costs as a benefit.
Please be assured that we, as Providers of Traditional CE are not opposed to change or periodic review of our standards of credibility. On the other hand we are very much in favor of this type of activity, however, we are also of the very strong opinion that anything that could produce such a radical change in the requirements and delivery of our professional CE should be done with complete transparency and openness to those it will affect. Also, any new program should be sent to the community of interest, all CRNA's, and others with an opportunity for comment. This being accomplished, comments should then be assimilated and carefully considered for every change outside the current CE process. Finally, a cost analysis for provider and the individual CRNA should be clearly stated before any new CE process is implemented. None of these criteria were met in the establishment of this CPC Program. From its very inception to the ultimately botched roll-out, the process was conducted in secrecy and in a dictatorial manner. Now we find ourselves in the dilemma of having to squash it before it squashes us.
To summarize, we are of the opinion that this CPC program has the very real potential to destroy the infrastructure of our specialty as we know it. To allow this to happen is professional suicide. We urge you to contact your state president, the AANA President and Board of Directors and express your opinion of this program. It is not too late to put in place a moratorium and replace this program with something more rational and less threatening to all CRNA's.
Below is a Resolution Proposal that we hope to introduce at the AANA Meeting in September. We welcome your signature as a concerned CRNA. To indicate your support of the resolution simply reply to this email by typing
YES in the subject line no later than April 27, 2014. Also, feel free to forward this email in order to share this information with your colleagues who will also be affected.
Thank you so much for your attention and support.
Bernie Kuzava, CRNA
Sandy Ouellette, CRNA
Larry Hornsby, CRNA
Peter Strube, CRNA
Paul Hilliard, CRNA
2014 Resolution On Proposed Continued Professional Competency Requirements for Recertification
Whereas, the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) has moved forward to establish new recertification requirements as defined in the Continued Professional Certification (CPC) Program that will significantly impact the community of interest such as the members through CRNA forums at state, regional, hospital departmental grand rounds and national meetings, the AANA Continuing Education Committee and continuing education meeting sponsors and managers;
Whereas, the requirements for two of the proposed components of the CPC program - the competency modules and the assessed CE units -- have significant and far reaching ramifications which may threaten the continuing ability of State Associations and CE sponsors to offer quality post graduate and continuing education programs for CRNAs which have been a long standing hallmark of this profession;
Whereas, requirements for assessed CEs and competency modules can serve to incentivize online learning over participation in live meeting events that may have the unintended effect of harming not only AANA State Association's ability to convene their business meetings due to lack of sufficient numbers of members but also networks of CE providers by the inability to implement the logistics required;
Whereas, should the NBCRNA online only competency modules policy proceed, it can create a disincentive for CRNAs to pay costs (as well as for employers to offer this benefit to CRNAs) for attending live, in person continuing education meetings in the future as all 4 planned web based competency modules can be taken by a CRNA in one year and can also be counted as assessed credits;
Whereas, there are open market concerns should AANA be a vendor for the competency modules for members that could be offered at a significantly lower fee or no fee than could be offered by other CE vendors creating a competitive disadvantage to all other meeting sponsors; now, therefore, be it
Resolved, the AANA Board of Directors support a moratorium on the proposed CPC to be implemented January 1, 2016; and
Resolved the AANA Continuing Education Committee evaluate the CPC program components of competency modules and assessed CEs and formulate recommendations for modifications as provided in the AANA bylaws, and, if evidence demonstrates that there is value for some other form or variation of the currently proposed plan that can be determined to positively impact the profession that the alternative plan be proposed and opened to the community of interest for comment inclusive of all CRNA's before adoption;
Resolved that once given the support of the CRNA community for any proposed new plan for recertification that it be pilot tested, validated and shown to be reliable in demonstrating competency before it is implemented
The current CPC proposed plan incentivizes online learning over live meeting involvement where many would argue that psychomotor skills and competencies might be better taught and assessed. Additionally, web only competency modules can discriminate against many CRNAs who may be older and less interested in technology. While some CRNA's prefer this format, others do not and many avenues for continuing education should be available. There is strength in diversity. Presently the requirement for assessed units could be obtained annually by taking 3 of the 4 web-based competency modules online alone with no timeline for other methods of delivery.
Since AANA intends to be a vendor, there is a competitive disadvantage to other program sponsors to offer these modules. This can serve to disenfranchise many if not most other CE providers, the majority of which are state associations and department grand rounds. Since the modules require content development, validity and reliability of assessed items, pilot testing and a plan from the developer of how credits will be transferred to NBCRNA, a fee to NBCRNA for transfer, a non-refundable fee of $10,000 to NBCRNA for review of 4 modules and possible selection and a site to launch the web based activity, the cost is not within reach of most vendors. The estimated cost would be for anyone willing to do this could approach $100,000.00 and in addition, hiring information technology (IT) personnel to oversee and manage the program. Vendors must also provide reports of reliability every 6 months to NBCRNA, must provide a financial statement indicating financial ability to provide the modules, and must resubmit the modules, for a fee, to NBCRNA and AANA for reevaluation.
The power of the AANA as an organization rests in the ability and encouragement of its members to meet, network, discuss and debate political issues and discuss clinical challenges. It is at the district and state meetings that future AANA leaders are developed and any initiative, even if well intended, that may result as a consequence of enactment reduce or diminish the need for these meetings can disrupt the very fabric that has made AANA the pacesetter in all of advanced practice nursing. If a significant portion of required credits after 2016, or 4 modules and 60 assessed credits in 4 years, are obtained on line, there will be no need for CRNA's to attend meetings. This can serve to incentivize CRNA employers currently reimbursing for continuing education to withdraw that benefit and harm will be done to the AANA and all members. State associations that depend on meeting revenue to support critical operations will be disadvantaged by low attendance and it is unlikely CRNAs will see the continued value of AANA membership when they become even more isolated from their peers.
This resolution, if adopted by the members will allow needed time for all stakeholders to address these concerns and support plans to meet the same goals set forth for all professions striving to ensure that its members maintain competency in their practice. There are many different forms of assessment and practice based evaluations that are worthy of study without creating unnecessary hardship on professionals and disrupting a professional association's culture in the course of accomplishing it. The large community of interest before implementation can do this with a program that is based on evidence, is developed in collaboration with AANA, is pilot tested and involves comment. The makers of this resolution are NOT opposed to changes in recertification but are opposed to the implementation of CPC until a more thorough study and evaluation of the impact and ramification of this program has been conducted.
Sandra M Ouellette, CRNA
Tafford Oltz, CRNA
LaRayne Oltz, CRNA
Peter Strube, CRNA
Bernie Kuzava, CRNA
Larry Hornsby, CRNA
Mike Fallacaro, CRNA

Thursday, April 3, 2014

Call Time-out for the ABIM MOC Mandate John Mandrola-another Cardiologist weighs in on Medscape!

A strong argument can be made that the biggest story from theAmerican College of Cardiology 2014 Scientific Sessionswas the contentious debate concerning the quasi mandate to enroll in the American Board of Internal Medicine(ABIM) Maintenance of Certification (MOC) process. Managing editor of heartwire Shelley Wood, covered this issue in a report aptly titled: "Today Is the Day: Cardiologists, Did You Register for MOC?"
I've been trying to put together my thoughts on this one for a while. My good friend and colleague, Dr Wes Fisher (Chicago, IL), has led the opposition to mandating MOC testing. Wes's blog and Twitter feed hold a trove of reasons for his opposition. As for me, I needed a nudge to start writing on this contentious topic.
My inertia ended when reading the hubris evident in the words of two doctors Wood interviewed for her piece....  Doctors are taught to be skeptical of evidence. Here, there is simply no evidence to judge. We can't know whether this brand of medical education achieves improved patient outcomes. 


Tuesday, April 1, 2014

Another blog for you to read!

Retired Doc has been analyzing the future of medicine under the control of CMS and ABMS/ABIM so take a look. It looks familiar-alot like the 50's here and the 30-40's in Germany:
This blogger is hot and analytical and needs to be advertized. See:
as well as