When the chains of bureaucracy obstruct the physician’s ability
to care for patients appropriately, the physician has an ethical duty to
discard the chains and escape, to be free to practice according to the
physician’s best clinical judgment, as opposed to the substituted
judgment and whims of arrogant bureaucrats.
Lawrence R. Huntoon, M.D., Ph.D.
The American Association of Physicians & Surgeons has taken a stand on the ridiculous burden of annual Board recertification. The onerous and tedious requirement of annual board certification is without evidence to support its efficacy. It has long gone past the goal of quality maintenance and taken on the life of a self sustaining monster with the apparent self-interest of monetary gain and power. Here are some comments by my longtime associate and friend, Howard Mandel, MD FACOG as well as Dr. L.R. Huntoon that expose another view of annual MOC (Maintenance of Certification).
Dear Dr. Huntoon:
I thank the editors of the Journal of American Physicians and Surgeons for their publication of Dr. Dubravic's insightful article regarding board certification and recertification. As an obstetrician/gynecologist who finished my residency in 1985, I was required to take my boards and earned a 10 year certificate. If I would have graduated in 1984, I would have been boarded for life. The ABOG, requires a two part exam, the first written and the second a three hour oral examination, part of which is based on the first entire list of all the physician's hospitalized patients plus a significant number of representative outpatient visits. I passed both examinations the first time and was reboarded 10 years later. Since that time, my speciality board has changed the requirements to six years and now a yearly exam as well as the MOC. In Los Angeles where I practice, we have observed the erosion of younger physicians partaking in our local speciality meetings. The LA OB/Gyn Society is a skeleton of what it once was. The LA OB/GYN Annual Assembly, which was once world renown, with upwards of 700 participants attending, barely has 150 attendees, many of which are retirees. I hypothesize that the numerous hours and costs required to maintain our certification have added to the demise of these once impressive meetings and organizations. Another unfortunate outcome is the destruction of the collegial relationships developed by OB/GYNs in our region. I would scientifically study my theory, yet I am too busy preparing for yet another annual examination. Perhaps, the ABMS or any of the individual sub specialities can spend some of their resources on why comradery, collegiality and membership in local organized medicine has plummeted since the introduction of reboarding.
Howard C. Mandel M.D., FACOG
10309 Santa Monica Boulevard
Los Angeles, California 90025
And another message from Dr Huntoon, The Editor-in chief of the Journal of American Physicians & Surgeons:
Subject: Re: MOC article from the Journal of American Physicians and Surgeons
This is not unlike what happened with the AMA.
When the AMA made the "secret" agreement with the
government for exclusive use of the CPT coding system (in 1983),
the AMA made a huge leap in the direction of no longer being
financially dependent on membership dues for survival.
Once an organization gets in a position of no longer depending
on membership dues for survival, they are no longer accountable
to the membership and the needs of the membership.
In the current MOC environment, our specialty organizations see the
potential for huge windfall profits as the specialty organizations will be providing
the CME and practice evaluation tools needed to comply with MOC.
Once the specialty organizations start down this road, there will be no turning back.
The specialty organizations, like the AMA, will no longer be dependent on membership
dues for survival and accountability to the membership will be severely eroded or lost.
The leadership of specialty organizations, many of whom are in academic medicine and
who may see a significant financial benefit by providing compliant CME/evaluation tools,
are not likely going to lobby to stop this trend.
It is likely that the grassroots membership is the only hope for stopping it.
Alas, physician apathy and reluctance to "get involved" or "speak out against"
the trend are significant barriers to overcome.
Those who believe in exerting ever increasing control over medicine (like implementing
onerous MOC and MOL requirements), fail to appreciate the adverse consequences
of their actions.
A significant percentage of physicians in this country are over the age of 55.
As physicians get closer to retirement, many will simply refuse to jump through
all of the nonsensical, non-evidence-based bureaucratic hoops, just to remain in
practice in an environment where they can be expected to be paid less and less
which each passing year. They will retire or do something else.
The shortage of physicians, which will occur, cannot be replaced over night.
Many patients will suffer with increased waiting times and decreased access to care.
The MOC/MOL bureaucrats who engineered this debacle cannot provide the care.
Ultimately, we need to educate patients about these predictable adverse consequences
As a start, feel free to copy the articles our journal has published on MOC and
place them in your waiting rooms for patients and distribute them to your colleagues.
AAPS has published a White Paper on our recertification survey. You can find all of the
articles we have published by searching the Cumulative Index on our website under the terms
"maintenance of certification" and "maintenance of licensure."
Our journal website is www.jpands.org
And, as I have said before, we would be happy to accept more commentaries
on this topic.
L.R. Huntoon, M.D., Ph.D., F.A.A.N.
Journal of American Physicians and Surgeons