Can We Oppose MOL Without Opposing MOC?

There were two major events that occurred on April 20, 2013, which included a debate on Maintenance of Certification (MOC) and a pre-debate meeting “Reinventing Independent Medical Practice & Physician Sentiment on Maintenance of Certification”, see link AAPS New Jersey State Chapter – Events – 4/20/2013 – Physician Meeting & Debate – MOC.  Photos suggest the event was well attended. The debate issue was resolved in favor of the MOC being an unproductive burden on physicians. Thousands of physicians think the MOC is more than just an inconvenience. There were many tweets, and you can find a summary with video at the link, http://www.aapsonline.org/index.php/site/article/summary_of_april_20_2013_debate_on_moc/.

The debate was on my mind while I was making my introductory remarks at the April 20, 2013 Iowa Medical Society House of Delegates Reference Committee discussion about my resolution to oppose Maintenance of Licensure (MOL) in Iowa, which was adopted, essentially by unanimous vote with minor changes, Oppose MOL Resolution Adopted by IMS House of Delegates in Iowa – The Practical Psychosomaticist. One of my salient points against MOL was that if physicians are already participating in MOC, then MOL is duplicative and unnecessary. IMS members generally agreed.

After the IMS House of Delegates meeting, I found out that the Medical Society of the State of New York (MSSNY) had adopted a resolution opposing both MOC and MOL, Medical Society State of NY adopts resolutions in opposition to MOC and MOL. While all of these events are going on, I got a message from a physician  who conveyed his support of what I say and do about these issues. He said, “I note with amazement that I am not alone in the issue of maintenance of certification.”

He was amazed, despite the growing and, what seems to me, obvious groundswell of opposition to MOC and MOL that has been going on for years since its inception. It’s a comment on how challenging it is for busy physicians to unite and collaborate in an effort to convey to the public in all transparency that we all support “continued lifelong learning by physicians and the improvement to quality of practice”, just as Iowa’s resolution opposing MOL says. We just don’t believe MOC and MOL in their current forms help us accomplish that. We are arguing against mediocrity, empty busy work documentation that is window-dressing and not genuine reflective self-assessment. The colleague who contacted me included a quote in his message:

“After one year of voting, it’s very clear that the vast majority of practicing physicians oppose the current MOC process. ”

I don’t know who voted. I don’t know why it was only one year of voting. I don’t know where the voting took place. All I know is that it rings true. My colleague also told me he had allowed his American Board of Internal Medicine (ABIM) certification to expire for various reasons, and that “One of the saddest reasons was that in primary care, there is almost no benefit to maintenance of certification.”

I am saddened. I’m saddened that we, as physicians, all feel so isolated from one another that we’re “amazed” to learn that we share vital concerns about the direction our profession seems to be taking.

Are we all aware and is the public aware of the two most important articles about MOC that I’ve seen published in the last year?

http://www.jchimp.net/index.php/jchimp/article/view/20326

http://www.jchimp.net/index.php/jchimp/article/view/19753

Are we all aware and is the public aware that predicating opposition to MOL, as I have done, on the wasteful duplicative nature of that layer of bureaucratic regulatory capture because it is little more than the MOC itself except that it would be tied to medical licensure, is not much more than a minor skirmish against the real challenge, which is what the MOC itself represents?

That’s right, I said the MOC itself is not the challenge, but what the MOC represents. The real challenge is to oppose the rush to erect false images of continuous quality improvement, which is driven by a false belief that we can mandate “reflective self-assessment” or “performance-in-practice” yet clothe it in the seat-time-waste-time of CME, and expensive, time-consuming MOC activities, only much later remembering that this emperor has no clothes because there’s no data showing this changes anyone’s practice or improves outcomes.

All of this reminds me of a presentation by Dr. John Toussaint, MD made in 2008 at The University of Iowa at a lecture entitled “Quality in Health Care Is An Oxymoron. How Do We As Health Care Professionals Change That?” The lecture series was called the University of Iowa Health Care Speaking of Excellence (What? Not speaking of competence?). Dr. Toussaint is an internal medicine specialist who was President and CEO of ThedaCare Center for HealthCare Value (http://www.createvalue.org/about/john-toussaint/).

Dr. Toussaint’s point was that, in order to change how we deliver care, “In the end this is all about culture.” In the end, changing the culture of health care delivery systems and how we improve our ability to provide high quality care is about changing the culture. It’s really not all about the complicated and shallow documentation specialty certification boards require of us as physicians.  According to Toussaint, it was more about setting and delivering “…the highest standard of health care performance in measurable and visible ways…”

I don’t believe the MOC is the highest standard; and that’s why I’m so uncomfortable with it. More than that, large numbers of physicians are uncomfortable with it, even to the point of taking the MOC to Court, AAPS Takes MOC to Court. They don’t think it’s just inadequate for the purpose of providing high-quality care. They think it violates antitrust laws and is driven by greed.

I recall a colleague saying this issue would not go anywhere, “It Will Not Go Anywhere…” – The Practical Psychosomaticist.

Ain’t that nuthin’.

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