Thursday, June 15, 2017

Do Physicians Have the Right to Work Without Maintenance of Certification?

A previously ABMS Board-certified physician with 10 years experience fails her Maintenance of Certification examination. Does she have the right to work in the hospital where she has tirelessly and compassionately cared for critically ill patients for years, earned the trust of her colleagues and nursing staff, and taken call every fourth night?

According to the American Board of Medical Specialties, the American Hospital Association, and the AMA, she does not.

She must lose her privileges to admit to that hospital, be ridiculed publicly, and watch her career fold. According to these unaccountable organizations that don't directly care for patients, she does not demonstrate the "exceptional expertise" required to have a piece of paper hung on her wall that tells the world she's a great test-taker. According to the ABIM Foundation, she does not demonstrate "medical professionalism."

This is the crux of the debate about Maintenance of Certification now. For reasons that only our most jaded bureaucratic elite medical leadership can fathom, they have allowed a pay-to-play scheme to invade our medical education system so they can fund their Cayman Island retirement fundscar collections and health club memberships.

Today, the American Board of Medical Specialties fraudulently claims to US physicians that their version of time-limited board certification is a "voluntary process."

It is not.

It's Mafia-style pay-to-play scheme in medicine.

Chicago style.

Let that sink in.

-Wes

Thursday, June 08, 2017

On Transparency

"They may carry on the most wicked and pernicious schemes under the dark veil of secrecy. The liberties of a people never were, nor ever will be, secure, when the transactions of their rulers may be concealed from them."

Patrick Henry
Constitutional Ratifying Convention
June 9, 1788

***

"I am still processing the myriad allegations in the most recent Newsweek piece. But I want to be very clear about correcting two of the most egregious and misleading charges that have been leveled against me and ABIM.

First, we have never made any effort to obfuscate, hide or delay ABIM's financial information. It's publicly available on our website. Second, no one is trying to hide salaries. I earned $688,000 in compensation in 2014 and $55,000 in deferred compensation (payment of which is contingent upon completion of my five-year contract). "

Richard Baron, MD 
President and CEO, American Board of Internal Medicine 
In a published statement emailed to all ABIM diplomates, May 22, 2015

***

What is transparency, really? Why is it important, especially, in health care?

Disclosure of finances on a website does not define transparency. Nor is labeling that disclosure as "Platinum." That is merely selling disclosure as if it were transparency. Disclosure isn't always honest either. (We later learned that the ABIM omitted 6 key financial reports that year and Richard Baron, MD earned $123,984 in deferred compensation in 2014, not $55,000 as he claimed). The conditions to satisfy full disclosure pale in comparison to those for full transparency.

A better definition of transparency is provided by Transparency International:
 "Transparency is about shedding light on the rules, plans, processes and actions. It is knowing why, how, what, and how much. Transparency ensures that public officials, civil servants, managers, board members and businesspeople act visibly and understandably, and report on their activities. And it means that the general public can hold them to account."
Using this latter definition, ABIM is simply not a transparent organization. Nor are any other organizations that support the MOC physician re-certification program trademarked by the American Board of Medical Specialties.

Practicing physicians like myself, are largely to blame for our medical education and physician credentialing system's lack of transparency. For years, we held our obligation to serve our patients as an excuse to not become civicly engaged. We never demanded that our educational and credentialing system be held accountable to us and our patients - we just assumed they were - especially since many of the members of those organizations were physicians, too. We preferred to keep our heads down and work our long hours to become experts at our field. This effort came at great sacrifice to our families and loved ones. We blindly trusted that our bureaucratic physician colleagues would work in our best interest. We assumed it was about the profession.

But what transpired out of our indifference to the inner workings of our regulators has been the natural consequence of what happens to any institution (and government) that goes unchecked: corruption. Patrick Henry saw the need for transparency years ago and predicted "the most wicked and pernicious schemes under the dark veil of secrecy" without sufficient transparency and accountability hundreds of years ago. Disclosure of finances is not enough.

Transparency is limited when financial disclosures are delayed over a year and a half - as is the case with our IRS Form 990 tax form requirements. It is also limited when unelected members of our profession collude privately behind closed doors with third parties. But the ABIM has been the poster-child for all that is wrong with the physician credentialing and education system: from secretly funneling over $77 million of our testing fees to create a shadow "Foundation" that promotes itself as the model of "professionalism," falsely filing tax forms, off-shoring millions to the Cayman Islands for themselves, and threatening their diplomates with lawyers and former felons, we shouldn't be surprised.

It is transparency, not disclosure, that is critical to the integrity of our profession. As long as member organizations of the Accreditation Council for Graduate Medical Education insist that physicians pay MOC fees to remain credentialed in their profession, practicing physicians will push back because MOC has proven itself to be corrupt. By supporting the ABMS MOC requirement, academic programs perpetuate the corruption and monopoly interest inherent to MOC and risk compromising the integrity of their programs. Perhaps that is not important to those programs, but I suspect it's of the utmost importance to patients.

Spotlights on medicine are shining nationwide and people are watching, learning.

Transparency in our profession is long overdue.

-Wes