Magnifying the Physicians Voice

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A Radiologist Reviews the Siva v ABR Oral Arguments

Ben White, MD (a practicing radiologist) gives a cogent (albeit limited) review from a doctor’s perspective of the Siva v American Board of Radiology oral arguments presented 16 February 2022 to the three judges of the 7th Circuit Court of Appeals on his blog:

In response to the ABR’s it’s-my-party-and-I’ll-cry-if-I-want-to stance, the judge is flabbergasted:

“There’s no possible way…You can’t take the position that ‘we are the ones that certify and therefore we can define the content of the certification requirement without regard to the limitations of section 1 [of the Sherman Antitrust Act].’ That cannot possibly be your position”.

The ABR lawyer says no, but she’d just said that very thing and then literally reiterates it again in almost the same words.

This was presumably met with a long blank stare during the very pregnant pause in the audio.

So, she meant yes.

And the ABR is not entirely wrong, because MOC isn’t really a CPD product. The CPD part of MOC (OLA) is merely the veneer of credibility for the program. MOC isn’t really about CME.

It’s a tithe.

Read the whole thing.

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ABIM Raises Annual MOC Fees 25% for 2022

The American Board of Internal Medicine (ABIM), in the midst of a global pandemic and record levels of physician burnout, medical education debt, and retirements, added insult to injury to the dwindling internal medicine physician workforce by raising their annual Maintenance of Certification (MOC) fees 25% from $165 in 2021 to $220 in 2022. Physicians with more than one certification can add another $120 per year for each additional certification the want to “maintain.”

Physicians receive nothing new to explain this massive single-year increase in fees for their “MOC points.” It is just the same old every-10-year high-stakes test (or if a doctor prefers, answering hundreds of proprietary timed “longitudinal assessment” questions pushed to their cell phone as they try to do their jobs).

Because the ABIM’s MOC product is now indelibly tied to the validity of a doctor’s initial ABIM specialty board certification, physicians that work at hospitals that require board certification from an American Board of Medical Specialties’ member board like ABIM, they will be left with little choice but to pay the fees and participate in this product’s requirements if they want to maintain privileges at those hospitals.

But that is not how it always was. And while the Court of Appeals of the Third Circuit sided with ABIM in the antitrust suit against them, in oral arguments (1:57:00 in the transcript) before the judges of Court of Appeals of the 7th Circuit in a similar lawsuit against the American Board of Radiology (ABR), the judges seemed to take notice of the importance of the HISTORY of how that tie was established. While we cannot predict how the Appellate judges will rule in the ABR antitrust case, there might be a glimmer of hope for working physicians employed at hospitals to end the gaslighting and forced participation in ABMS Maintenance of Certification for credentialing if the court remands the ABR case back to the District Court level.

Physicians interested in help in the forced participation in the unproven MOC program are encouraged to join PPA (its free and allows us to know who our supporters are) and consider a donation to the legal effort via our GoFundMe page or directly to PPA and (earmarking your donation “Legal” in comments).

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Top Ten Reasons to (Still) Be a Physician

With all the negative press, the pay cuts, health care reform, the COVID-19 pandemic, and the consolidation of health systems and corporatization of medicine that diminishes our voice, I am still approached by people who secretly whisper in my ear, “Would you have your child go in to medicine?”

On first blush, I am tempted to answer “No way!” given the administrative hassles, the negative changes in the public’s perception of our profession, the front-load of education and the long hours of clinical training and late nights involved. But those observations, while real, are at best superficial. Drilling down with more careful analysis after a challenging week on call, I find it worthwhile to stop and ask myself what still makes medicine special for those of us crazy enough to subject ourselves to this lifestyle. I decided to put together a list of things that were important to me and would welcome additions to the list from others.

10. Independence – No matter what happens on the larger public policy and procedure scale with guidelines and mandates, when it comes to decisions regarding a patient’s care, it will always be the one-on-one interaction between the patient and the doctor that will ultimately decide the best approach for care for an individual patient.

9. Respect – The title “Doctor of Medicine” still carries weight in our society. With that respect, however, comes significant moral imperatives to maintain that respect.

8. Flexibility – For those not adept at one-to-one interactions with people (hence, the clinical side of medicine), there are a myriad of opportunities opened with the MD or DO degree in public policy, research, the basic sciences, journalism, consulting, business, etc. It is this flexibility of options that are open to doctors that ensures job security.

7. Variety – I have been doing medicine a long time and have yet to see two days’ activities or two patients that are the same. Ever. Bottom line: medicine is never boring.

6. Influence – Physicians matter. People know it. But you’d better be ready to be cornered at cocktail parties.

5. Reward – I cannot not think of anything superior to helping a fellow man or woman at a time when they are most vulnerable or in the greatest need. And while less and less frequent these days, it also occasionally provides an upgrade to business class or a free beverage when you help treat a hyperventilating patient on an airplane.

4. Trust – Like Smith Barney says, you have to “earn it,” but once a patient’s trust and confidence, it’s the tie that binds. By virtue of your title, you are invited into the most secret parts of patients’ lives to share their deepest concerns – a truly remarkable privilege. Corporate meetings never leave me with that feeling, if you get my drift.

3. Humility – Medicine will always keep you humble since there will never be a time when you can know it all or cure it all – ever. It’s both the blessing and the curse of our profession: the learning, both professionally and spiritually, never ends.

2. Fascination – Every day we work with the most amazing technology imaginable. The wonder of it is incredible: ask anyone who’s ever reached in an abdomen to remove ischemic bowel, prescribed an antibiotic to cure a pneumonia, or ablated an tachycardia that affected someone their entire life and rendered it of historic interest only. Even something as simple as cutting the skin with the belly of a 15-blade scalpel while listening to the patient chat idly about their grandkids thanks to remarkable local anesthetics during minor surgery, you are reminded of the amazing wonders of modern medicine every day.

1. Teamwork – Medicine is, by definition, a team sport. No physician can do what we do in isolation. Our “Club Med” has challenging pre-requisites, but once in, it is a vocation where we share collectively in the trials and tribulations of patient care. We win and we lose, together. Whether we are doctors, nurses, technicians, administrators, clerical staff, safety personnel or maintenance workers – each of us are constantly working for a common goal – the health and well-being of our patients – and when it works, nothing, I mean nothing, is as cool as that.

-Wes Fisher, MD
Treasurer and Co-Founder
Practicing Physicians of America

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122 Million Reasons Why Psychiatrists and Neurologists Should Help End MOC

From the first amended complaint in the class action antitrust lawsuit filed against the American Board of Psychiatry and Neurology (pictured here):

MOC is not about maintaining standards as ABPN contends. It is a revenue-driven commercial endeavor, motivated by tens of millions of dollars in new MOC fees.  As indicated by the failure of its earlier voluntary (continuous professional development) CPD product, MOC is financially successful only because it is mandatory and tied to certifications. ABPN’s financial results amply document this. After the launch of MOC, from 2004 through 2018, ABPN’s “Program service revenue” exceeded its total expenses by a yearly average of $4,448,338, as reported in its Forms 990 filed with the Internal Revenue Service (“IRS”). But for its reporting status as a supposed not-for profit organization, this translates into almost $4,500,000 in average annual profits before investment and other income is taken into account.

During the same time, ABPN “Net assets or fund balances” skyrocketed over 971%, from $12,610,227 at the beginning of 2004 to $122,470,594 in 2018. In other words, while it took ABPN almost seventy years to accumulate net assets (assets less liabilities) of $12,610,227 from selling certifications, ABPN net assets increased almost ten-fold to $122,470,594 as a result of selling MOC, including $97,169,079 in cash, savings, and securities on hand at year-end 2018.

Learn more about our fight to end Maintenance of Certification and what you can do,

Join PPA
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Pediatricians Roar Back At MOC

In January, American pediatricians, long overworked and underpaid, received an email from the American Board of Pediatrics (ABP) informing them that the ABP had been ‘listening’ and was now going to increase the number of required Part 4 (quality improvement) Maintenance of Certification (MOC) points required to be earned by pediatricians to “maintain” their certification. Within days, thousands of pediatricans signed a petition stating that “most pediatricians want to fully get rid of part 4.”

Pediatricians are already confronting so many bureaucratic challenges, that adding even more needless bureaucratic busy-work to their plate infuriated thousands. Pediatricians are keenly aware that MOC is a time-consuming, burnout-inducing moneymaker for the specialty boards with no proof of benefit to patients or physicians.   Because of the potential harms caused by tying a pediatrician’s initial certification and right to work to MOC (a continuing educational and quality assurance exercise), PPA and other organizations have been pushing back at the profiteering specialty boards, whose executives make triple the salary as those in the trenches practicing medicine. 

PPA crowd-source funded nearly half a million dollars to support plaintiffs in antitrust lawsuits against the boards of Internal Medicine, Radiology, Psychiatry and Neurology.  Two of these lawsuits will have judgments coming soon (oral arguments presented to the 7th Circuit Court of Appeals can be heard starting at 1:57:00 on the Court’s YouTube page). If any one of these lawsuit survives, it will serve as a precedent against other member boards, including the American Board of Pediatrics.

In response to this outcry, PPA hosted an informative webinar with NBPAS, an equivalent recertification board, which as of November 2021 meets all national accreditation standards for health plans. NBPAS believes that physicians are capable of choosing the CME that best suits the needs of their patients.  There is no part 4, no recurring test, and their board is volunteer, so the fees are over 70% more affordable.  You can visit the NBPAS site for materials to help you ask your hospital to accept NBPAS recertification.

All physicians can help this ongoing anti-MOC effort by first joining PPA (it’s free and helps us know who you are) and then donating here. Or if you prefer, you can send a check to PPA at the address below.  Our board members work for free, your money will go entirely to support the lawsuit and to maintain our website. In light of the stress and work endured by all physicians over the past two years, it’s time the boards truly listened and responded to the real needs of physicians by eliminating unproven and unnecessary mandates! 

Practicing Physicians of America
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New Braunfels, TX 78130