Friday, June 12, 2015

JAMA issue 5/12/15: Professionalism and Governance: Pure BS

I tried to rebut the propaganda published here and the editors again reject as damage control:
The JAMA issue from May 12, 2015, was a theme issue entitled: Professionalism and Governance,  proclaiming to be a “series of Viewpoints by scholars and academic leaders “.(1) The issue appears to be a clear attempt at damage control, in the face of mounting physician dissatisfaction with “top down” imposition of corporate certification and regulation agendas upon practicing physicians and patients- and now mainstream media reporting of this ordeal in Newsweek. Overwhelmingly representatives from multiple“ legacy” non-profit corporations,  who together built these intertwined industries (including the AMA as “Stakeholders”) with multimillion corporate annual incomes,  again opined how to “fix” education, certification, regulation, etc, of the medical profession to meet their needs as private interest groups,(earning from impositions on practicing physicians and pushing their corporate agendas and outdated testing programs). (2) While both ABMS and ABIM have repeatedly found opportunity to publish their message in multiple journals and internet sites (often owned by the boards) and at times after buying complete “supplements” in medical journals for this purpose and hiding the significant conflicts of interest involved, JAMA now felt obligated to endorse them with yet another free opportunity to facilitate this regulatory capture of medicine.( 3) Opposition has successfully availed social media in grassroots fashion and against overwhelming odds, in spite of limited consideration by the JAMA or the AMA-even from within. Over 17 state medical societies have repeatedly passed resolutions along with the Young physician’s AMA component mounting resolutions at the annual AMA meetings in recent years. Yet respected and authoritative practicing physician opponents of regulatory capture  are remarkable by their absence in this “balanced presentation” of JAMA, including and to name only a few-Drs Wes Fisher (http://drwes.blogspot.com/ ), Ron Benbassat (http://www.changeboardrecert.com/ ),  Charles Cutler (PA Medical Society debate-http://www.pamedsoc.org/MainMenuCategories/Education/MOC/Video-MOC-Debate.html ), Richard Amerling (AAPS lawsuit against ABMShttp://www.aapsonline.org/index.php/site/article/aaps_takes_moc_to_court/ ) and William Carbone (CEO of the certification agency ABPS http://www.abpsus.org/.
Practicing physicians have become the weakest component driving healthcare policy, with government, pharmacy, university, insurance, computer-EMR, hospital, medical devices and many ancillary industries and professionals dictating practice parameters often over patient prerogatives using their multimillion corporate profits. Physicians increasingly become mere “employees” or are replaced by non-physicians as less educated “providers”-physicians being controlled, not controlling medicine.  This may specifically be the demise of the trust patients extend to physicians. We are losing self-regulation to numerous corporate and government entities and agendas! (4)
MOC and Board Certification are both apparently imposed without relevant data or proof of value, the costs are now forced upon physicians removed from the clinical care and their families, to do whatever outside private interest corporations and government decide must be performed for compliance. (5) Compliance is NOT education!  Past failures serve as anecdotal  opportunity,  to evoke emotion via press reports of serial murder (Dr. Harold Shipman) or hospital mismanagement (Bristol, England)  to facilitate regulatory corporate program growth appeasing political needs-while not addressing any specific problem with recertification. (6)
We only need ONE oversight organization with teeth (state medical boards), which licenses practitioners as physician led organizations and without corporate profit incentives, not the current multitude of independent and profiteering corporations with self- enriching intentions.(1) EJ Emmanuel summarized the problem in this sentence: “ The threat of money to the ideals of medicine is not new.” It is time to cut waste by eliminating the multiple redundant “non-profit corporations” reaching into the medical pocketbook (providing six and seven figure incomes to their CEOS) and specifically providing NO improvement in care. We need to expand Ronald Reagan’s greatest fear “I am from the government and am here to help!”  to include these armies of the non-productive “non-profit organizations” and now stand up for medicine as practicing  professionals.
If medical care is a “right”,  then medical education should be provided by the government at no cost-to reach everyone and without corporate funding influence or  repeated “unfunded mandates”. The negative commercial influence of medical industries as CME sponsors is thus renounced.  Currently,  the intrinsic earnings and conflicts of interests of “accreditation industry giants” (ABMS, FSMB, ACCME, ACGME) are completely ignored as if they were benevolent or producing some unidentified improvement in care. (3) There really is no difference in profit vs non-profit corporations or hospitals, when the price is high and staff earnings so outrageous! To see the CEO of the Pediatrics board earing $1.3 million a year,  while the board itself earns $2 million,  raises significant questions regarding the legality of  “non-profit” status and inappropriate  inurement to select individuals.  The NBPAS is emerging as a real competitor to ABMS,  with no salaries for their executive leaders!
Dr Nisson correctly stated private practice physicians are at disadvantage from universities-they have no universal access to medical literature on any computer. (7) Legislation forcing medical  information  become freely publicly available for anything listed in PubMED/the US National Library of Medicine after 6-12 months is appropriate. Let everyone read the whole articled and not just the excerpt, thus enabling a complete understanding of published “science”,  which only in this way becomes possible,  rather than hidden behind an often self-serving  “conclusion” of the author disseminated as fact in the excerpt. Break the corporate bonds of information dissemination and reduce the number of private profit publishers producing mountains of hubris. The internet makes information readily available, while requiring payment of $25-50 for a single article view (of material already typically privately funded and submitted for free to the publisher),  sight unseen (or based on authors biased excerpt conclusions),  does not!
Finally, let all CME providers,  including MOC products,  compete on an even playing field (possible only with the return to universal lifelong certification as is found in every other industry and was originally intended) with physicians choosing what they deem meaningful learning to them and for their patients and practice. Let competition provide for growth of quality-the good old American way.  It is completely germane to apply the “choosing Wisely” approach of the ABIM to board certification and MOC and recognize this as one of the most wasteful tests of all-false positive “failures”  limiting practice, by pushing good physicians from practice at a time of shortage-and profiting only the ABIM and their affiliates. This hypocrisy of the ABIM to continue with their recertification  program is unbearable.  Eliminate the multiple oversight corporations earning millions via regulatory capture of medicine. (4) Electronic databases mandated by the federal government should increasingly allow for widespread evaluation of practice-make that work…. not physicians doing ever more useless and non-clinical busywork at such wasteful cost. It is time to abandon the certification industry of the past century and move forward using the extremely expensive EMR and insurance based analysis,  also being increasingly imposed at this time. Let all doctors treat patients with their valuable time and let those bureaucrats  demanding the evidence,  find and prove their programs with outcome based data first-the gold standard of medical science!


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