Physicians everywhere: You are good people, but you are doing evil by your complacency.

I am writing this to every physician who is frustrated with the certification system that we have in place and that is becoming increasingly encoded into our laws. We have reached a crossroads in the evolution of health care in America. We, as physicians, have been under assault literally for decades.

We have suffered degradations and loss of prestige as an army of administrators has constructed a fortress of policy around the hospitals and issued ‘guidelines’ which now are treated as treatment mandates for our patients. And, I am very sorry to say, many of us have been complicit in this tragedy.

Some physicians have been overtly complicit by taking non-practicing administrative positions and dictating not only how we should care for our patients, but also implying that we are not competent to do so. Many others have been silently complicit, as we have sat by and let the rot set in. As the great theologian and anti-Nazi dissident Dietrich Bonhoeffer said “Silence in the face of evil is itself evil: God will not hold us guiltless. Not to speak is to speak. Not to act is to act.”

We are now subjected to MOC in order to somehow prove ourselves, when by the very act of treating our patients and looking up information to do so shows that we are dedicated to maintaining our profession. Our profession: that is what is being called into doubt and what many bureaucrats would like to do away with. Instead of dedicated professionals seeking out the best treatments for our patients, they would prefer us to be interchangeable widgets.

Enough! It is time for ACTION.

Our leaders have abandoned us, and it is not enough to moan and complain to your colleagues. I have faith that you will continue to keep your knowledge up to date, but it is time to STOP ALL MOC ACTIVITY. DO NOT PAY ANOTHER PENNY TO THE ABMS, ABIM, or whatever specialty board you fall under.

CALL the hospital executives. ASK about the bylaws. PROPOSE changes to any language regarding maintenance of certification, and make sure the NBPAS is included as an acceptable alternative. DEMAND that these things be discussed at the hospital board meetings.

To anyone who is grandfathered in, or beyond the last needed certification, you are HURTING MEDICINE if you do not act. You need to help the people behind you who may be taking care of you when you are sick and dying.

Nelson Mandela said “We fought injustice wherever we found it, no matter how large, or how small, and we fought injustice to preserve our own humanity.” This is precisely how we need to shape our fight.

We must take action. Signing petitions is not enough. You should call your hospital administrators on a regular basis and let them know that the physicians are not happy.

Burnout is at an all-time high, and good men and women are leaving the field of medicine in record numbers. The surveys show that it is bureaucracy and maintenance of certification that is driving good people away. We must put a stop to this. Do not hang your head and say that the fight is lost, because the very future of American medicine is at stake.

The administrators of every hospital should be harassed until every single hospital in this country accepts alternate board certification rather than the ABMS monopoly.

Be brave and act boldly. I will leave you with a last quote to remember when you have doubts. “You should never let your fears prevent you from doing what you know is right.” – Aung San Suu Kyi

Timeline of corruption

Dr. Wes has another fantastic post with a timeline of the corruption at the American Board of Internal Medicine (ABIM).

We should keep shining the light of truth and hopefully someday we will get out of this miasma.

This will not get looked into until we have change in Washington. The Obama Department of Justice is in collusion with corruption throughout the government – just look at the IRS, never mind the ATF. It is the Chicago way. Corruption, lies, and more corruption.

There is a great movie out now (it is a foreign language film, but do not let that deter you) about how the German government and people after World War II acted as if nothing had happened. A generation of kids was raised with no knowledge of the holocaust and Nazi atrocities. It is called the Labyrinth of Lies. This is a fantastic film, and it deserves to be seen. It is also directly relevant to our government today and the lies which are destroying medicine.

The American College of Cardiology (ACC) has NOT been our friend in this, but I hope that we can change this. I confronted president-elect Rich Chazal about all of this and he says that it is “complicated”. He claims that the ACC has looked at the ABIMs books and they are “clean”.

He is either in denial about the problems or a liar. The books may look “clean” to trusting eyes, but may look entirely different to a forensic accountant.

We need an Attorney General who is willing to investigate this kind of regulatory capture and deep government corruption. I have no idea which of the candidates up for president can lead to this kind of change, but I can tell you who will not: Hillary, the Queen of Cover-up.

I don’t know where this will go, but the more stuff like this gets covered up, the more good people will be driven out of medicine.

Thank you for allowing the space to rant. The more awareness of this issue we can get, the better.

Regulatory Capture

db makes some good points about the problems in medicine today

My responses:

I would like to find anyone with half a brain in Washington and be able to strip all of this away.

1. Meaningful use – this is just silly now that most people are using EHR. I have been 100% electronic for 7 years but still do not meet “meaningful use” requirements without jumping through hoops. The government spent 40 years developing VISTA/CPRS – they should just say we all have to use that and give it to us. (it is already available in some form for free due to FOI requests)

2. Approval forms – I think I should be paid for everything I fill out. Lawyers bill for all paperwork. We should as well.

3. Prior authorization – You do of course recognize that ‘prior authorization’ is purely devised to save the insurance companies money, right? It is an entirely meaningless hoop to jump through, because the studies prove that adding hoops/regulations means that you get less of that activity. They know that a good percentage of studies will just not be done because it is too much of a hassle.

4. Billing requirements (E&M coding) was put into place to try to compensate appropriately due to complexity but it is a joke. Templates have made the notes meaningless. The only way to do away with this is to have some TRUST in the doctors. How about the old Reagan doctrine of TRUST but VERIFY. Doctors can write whatever they want in their notes to make a meaningful contribution to the care of the patient and to communicate to other doctors, like the old days. Doctors then bill at whatever level they deem fit for their services. Random audits of say 10% of the notes would be performed, and people abusing the system would be drummed out.

5. Performance measures are meaningless. Let good doctors charge more for their services. People will pay if they like their doctor. If you are a crappy doctor, people won’t pay.

6. Admission diagnosis is the dumbest thing that some hospital bean counter ever thought of. I usually admit people to the hospital because I have no idea what their diagnosis is, and I need to do some tests to figure it out.

The bottom line is that doctors have allowed business people to take over medicine. The business people were the C students when we were busting our asses and making As. Why do we let these losers come in and take over the whole show?

We have had pitiful leadership in medicine. People are too busy taking care of patients, or to scared to stick their neck out. Our “leadership” of non-practicing physicians has gotten into bed with the politicians and have gotten fat and happy sucking the teat of the government. The entire system is hopelessly corrupt. The AMA makes its money from the coding system. The ABMS/ABIM make their money making doctors jump through hoops filling out satisfaction surveys and taking tests. And now all of this is being codified by nameless and faceless bureaucrats in Washington under the aegis of MACRA.

The “SGR fix” was a scam and has taken more power away from the doctors.

The doctors have to take back the system if we are to have any hope for American medicine.

We will have to strike or revolt or something – if anyone has ideas of where to start, let me know.

ABMS is Evil Incarnate

The Maintenance of Certification (MOC) program is a money-making scheme concocted by a group of non-practicing physicians who are paying themselves high salaries and living large on the backs of working doctors. This is a corrupt system, and ethically wrong, despite the American Board of Medical Specialties (ABMS) and the American Board of Internal Medicine (ABIM) putting out press releases about the “benefits” of MOC, and the importance of having “quality” physicians.

Unfortunately, this program has now been codified into law as part of the sustainable growth rate “SGR Fix” legislation. This is crony capitalism at its worst. There are major conflicts of interest here, and the ABMS and ABIM are colluding to extort money from practicing physicians to finance their high salaries.

And exactly what are these high salaries for? These doctors do not see patients. They sit in meetings and make themselves feel important by telling other physicians what they are doing wrong.

Most working physicians are too busy to have noticed what has been happening behind their backs, but when they do see the full consequences of the current legislation there will be an uprising. We will have to wait and see the fallout of the alternative National Board of Physicians and Surgeons (NBPAS) and the ongoing Association of American Physicians and Surgeons (AAPS) lawsuit, but I hope that enough physicians wake up to what is happening before it is too late.

The ABIM has failed us, the American Medical Association (AMA) has failed us, and even the American College of Cardiology (ACC) has failed us. Richard Chazal had the gall to tell the Alabama ACC that we should be working with the ABIM/ABMS because trying to get out of their corrupt MOC schemes is “complicated”. He says that the ACC reviewed the ABIM books and they were “clean”. He also defended the ACC support for MACRA, because he said that “we needed to end SGR”. Yes, and we got a poison pill in MACRA to do it. He was too blind to see the truth. MACRA puts in place APMs – the rules have not been written yet, but essentially, the hospital/ACO will get paid, take whatever they want, and give the doctor whatever crumbs are left. If you don’t join an APM you have to demonstrate “quality” – and who gets to define that, under MACRA? the National “Quality” Foundation led by Christine Cassell, who just golden parachuted out of the lead spot at the ABIM. It is time for physicians to reclaim the doctor-patient relationship – including the documentation and payment – from all of the bureaucrats and bean counters out there, be they MDs or not.