Dr. John Toussaint’s Reply

Dr. Jim Amos, MDRemember that email message I sent to Dr. John Toussaint, MD the other day? The link is Can MOC and MOL Coexist with Lean Management Approach in Health Care? – The Practical Psychosomaticist. Recall, Dr. Toussaint is the CEO of ThedaCare Center for HealthCare Value in Appleton, Wisconsin, Who We Are – Center for Healthcare Value. Dr. Toussaint replied, and I would like to publicly thank him for his time and thoughtful remarks.

My question to Dr. Toussaint was this:

“I just wanted to know if you have an opinion about Maintenance of Certification (MOC) and Maintenance of Licensure (MOL). There is a MOL implementation pilot project being pursued by the State of Wisconsin Department of Regulation and Licensing. That reminds me; I still have a Wisconsin medical license. My resolution to oppose MOL in Iowa was adopted by the Iowa Medical Society House of Delegates on April 21, 2013. I’m also having communications with the Iowa Board of Medicine (IBM) about their implementation project for MOL. I just sent the IBM my presentation that I didn’t have time to give them by telephone conference on April 25, 2013 at the public portion of their regular meeting,

Dr. Amos’s Dirty Dozen on MOL in Iowa – The Practical Psychosomaticist.

My point is, I imagined you’d be opposed to MOC and MOL processes as well. But I could be wrong. Do you think MOL is right for Wisconsin? Do you think MOC and MOL are consistent with the lean management approach?”

Dr. Toussaint’s reply was simple and direct:

MJS John S. ToussaintDr. Amos,

In general I believe maintenance of certification should be based on improving individual performance, not on jumping through non-value added steps that regulators devise. If we looked at this from the perspective of the patient, what would they want us to be doing to ensure we remained competent to practice?Toussaint1 It seems an analysis of how we already are performing would be important to know. What quality performance metrics are used to determine whether we remain competent as physicians? In psychiatry it is different from internal medicine, obviously. Quality metrics are much more available today than even three years ago. At the Wisconsin Collaborative for Healthcare Quality we have measures on many primary practices and some specialty care practices. Frankly, if you are providing high quality low-cost care and it’s in the public domain, why would we have to jump through any regulator’s hoops?

John_ToussaintI think the question to ask about your issue with the present licensure debate is: Does the existing regulatory process ensure that physicians will deliver clinical quality results at the agreed upon standard for the community? If the answer is no then the process should be eliminated or changed. Thanks for asking for my input. Feel free to publish anything I have said here.


I think Dr. Toussaint’s million dollar question about whether or not the “existing regulatory process” works is food for thought. I wonder if the answer for Wisconsin might lie in the Wisconsin Medical Board and the Wisconsin Medical Society on-line documentation about MOL, which I’ve discussed in the post,  Wisconsin Not On Board with Federation of State Medical Boards MOL? – The Practical Psychosomaticist. It sounds like Wisconsin physicians believe in change, just not necessarily in the way the Federation of State Medical Boards (FSMB) suggests.

My next question, rhetorical as it might be, is why do so many, including the FSMB, think Wisconsin is committed to the MOL implementation pilot projects? And beyond that, what could Iowa physicians do as an alternative to MOL which would help move us closer to the goal of providing top-quality health care every day to each and every patient? This is not about MOC and MOL demolition; it’s about creating an honest culture of continuous improvement in health care delivery grounded in the best data available. When I keep the end in mind, I can focus on changing whatever is within my circle of influence.Stephen Covey quote

“…And we must build a culture of humanistic clinical excellence.”—Jamos the Elder

“…And we must build a culture of humanistic clinical excellence.”—Jamos the Elder

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