Doctors everywhere, I implore you. I know you – I am one of you – and I know your nature. We want to soothe, to placate, to moderate pain.
This current MOC fight is anathema to many of you. In many of your minds it is too hard, too dangerous, and too disruptive. What is most disturbing is that some of you think that it is unnecessary or even pointless. Please let me show you why this is not true. Indulge my extemporation, so that I may show you why this is critical to our future.
Why it is necessary to fight the Maintenance of Certification program:
Many of you may be asking why it is necessary to fight this fight. Why not just go through the MOC modules, earn your points, pay your fees, and be done with it? This is not a money fight (we will discuss this later). This is a fight for principles. You are a professional, and maintaining your status as a professional requires you to be up to date on the key elements of your area of expertise. We already face requirements placed by our medical boards for continuing medical education. I personally could not face my patients if I were not informed of current advances in medicine, particularly in my field. It is part of being a doctor and a professional.
The ABMS and ABIM would have you believe that patients are demanding that their doctors undergo some artificial trials in order to determine that they are competent, because they have no other way of deciding if their doctor is good. I have more faith in the abilities of the average patient. Patients have a sense of the competence of you as their doctor, and they are able to ask questions to probe your knowledge. They also have the freedom (for now) to go to a different doctor if they are not impressed.
The ABMS and ABIM are playing on your underlying insecurity that you do not know everything, but what they are implying is that you need their help to prove that you know anything. They are using your inner fears to their advantage. I can tell you with certainty, that with everything you have gone through, you are more than competent, you are very knowledgeable, and you do not need more and more certifications on your wall to prove that fact.
Continuing medical education is a good thing – that we can agree on. But beyond the requirements of the medical boards and your own personal search for knowledge we do not need any new programs.
Why it is necessary to fight MOC now:
This fight is insidious. The people who are thrusting this upon us are financially enmeshed in this system and do not have your best interests in mind. This fight needs to come to a head now, because the majority of the regulations that will hinder us in the future have yet to be written.
The passage of MACRA, which was the ‘SGR fix’, brought in new concepts for physician pay. Now we will be paid in one of two ways, the Alternative Payment Models (APMs), or Merit-Based Incentive Payment System (MIPS).
If you are part of a larger system or in some specialties, you may get paid as part of a lump sum through the APM. God only knows what crumbs will be left of the lump sum after the hospital system takes its part.
For others who will be in the MIPS system, your pay will be determined by (straight from the cms web site):
- Resource use
- Clinical practice improvement
- Meaningful use of certified EHR technology
Note that we have the old MOC part 4, practice improvement, which was supposedly put to rest, rising like a zombie to stalk us again. And we are also to be judged on ‘quality’, which no one can seem to define. Supreme Court Justice Potter Stewart famously defined obscenity with the phrase ‘I know it when I see it’. This is about the best we can do for defining medical quality. The real obscenity today is the ABMS/ABIM system.
What about the money?
I said before that it is not about the money, but it is. Certainly to the non-practicing bureaucrats at the ABMS/ABIM it is about the money, because they do not do anything productive on their own. They have to take your money to pay for their own salaries. And it is your hard earned money. To some of you it may seem a pittance, but to others these are large sums. Please take pity on your fellow doctors who may not be in as good of a financial position. The greedy overlords of the certification scam are filleting us to obtain their seven figure salaries. I wonder how often they take call.