On 30 October 2025, the Court of Appeals for the Seventh District Circuit Court rendered its opinion on the Lazarou v American Board of Psychiatry and Neurology (ABPN) antitrust case (24-1994) involving the American Board of Medical Specialties’ (ABMS) Maintenance of Certification (MOC) program. The results, in a word, were laughable but entirely predictable.
This antitrust appeal asked the Court to decide whether the American Board of Psychiatry and Neurology (“ABPN”) is causing unfair competition in the continuing medical education market. The psychiatrists who brought this suit alleged that ABPN uses its monopoly over specialty certifications to force them to purchase ABPN’s “maintenance of certification” product. In their 51-page appeal, the plaintiffs argued that ABPN’s MOC product is a substitute for other CME offerings, which they had to prove to establish their case. The court found their theories unconvincing, stating that MOC’s requirements impose additional burdens on doctors and therefore cannot substitute for CME, concluding that “they have failed to plausibly allege that doctors see ABPN’s MOC product as reasonably interchangeable with CME,” and dismissed the case with prejudice.
Of course, the court’s circular reasoning is precisely the point: MOC is more burdensome (and costly) than self-selected CME for physicians, largely because the Boards have an admitted monopoly (Page 16 of the Opinion) on physician certification and MOC’s construct. To make matters worse, the Accreditation Council of Graduate Medical Education (ACGME)-accredited hospital systems have quietly tied MOC to physicians’ ability to secure admitting privileges and insurance payments. Is there any surprise then that organizations who benefit financially from MOC (like the American Hospital Association, American Medical Association, and ABMS) are member organizations of the ACGME?
We should note that during oral arguments, the Court adjusted the oral argument schedule at the last minute to be sure the same judge (Scudder) that ruled on the earlier Siva v American Board of Radiology antitrust case heard the Lazarou v ABPN arguments. And like the earlier antitrust case brought before it in 2022 (Siva v the American Board of Radiology) , the Board’s argument was given very short shrift in the Court’s opinion and a new reason to dismiss advanced by the Appeals Court.
The dissenting judge Maldonado’s full statement is noteworthy and is summarized very briefly here: “I am concerned with the continuous heightening of the pleading standards for antitrust claims in this circuit. This trend produces more prolix complaints filed with factual allegations that apparently still don’t make the cut for suggesting liability.” Further, she adds “the majority’s decision to affirm dismissal of Plaintiff’s complaint, even in light of amendments tailored to (the prior anti-trust case) Siva (v Am Board of Radiology) amounts to changing the goal posts in the middle of the game.”
What This Means Going Forward
Like releasing the Epstein Files, this case highlights that exposing even the slightest hint of MOC’s true intent, conflicts of interest, and inner workings must never be breached, even to the point of raising the bar of antitrust law requirements to find liability, lest it threaten cornerstones of the entire Medical Industrial Complex. The adverse effects of the ABMS MOC continuous certification program, like fraud, discrimination, and the like on health care costs, physician retention, physician access, physician burnout, and ability of physicians to serve as independent patient advocates must never be taken seriously.
For Physicians, What Now?
For physicians looking at less compromised employment opportunities, I would suggest they carefully consider Direct Patient Care models that are not subject to ABMS oversight or employment at institutions that accept the National Board of Physicians and Surgeons (NBPAS) re-certification pathway using self-selected CME for state licensure and hospital credentials. For physicians already employed at institutions that ONLY accept ABMS recertification for hospital privileging that want to avoid MOC they either must retire, change employment to a non-ABMS requiring institution, or not question the payments and busy-work mandated by the ABMS MOC monopoly to retain employment or hospital admitting privileges. Still, I would still encourage those physicians to ALSO hold NBPAS re-certification to help support that organization’s rising effort to disrupt the unproven ABMS MOC “continuous certification” monopoly.
-Westby Fisher, MD, Cofounder, Practicing Physician of America
