What is Happening to the Profession I Love?

What is happening to the profession I love? I found out recently that the Medical Society of New Jersey adopted a resolution to oppose Maintenance of Certification (MOC), American Board of Medical Specialties under Fire for Maintenance of Certification™ Program | Welcome to the Medical Society of New Jersey’s official blog.

I know some will cheer it. I’m not sure how much difference it will make. Though it brings to a considerable handful the number of state medical societies formally adopting resolutions to oppose a system of lifelong learning that some call “lifelong larceny” (referring to the obscene amount of money it brings to so-called ‘non-profit” boards)–those of us who love our profession and want to convey that we do indeed love the principle of lifelong learning will probably remain in the minority of physicians recognized as long as we formally and informally oppose MOC and its duplicative, redundant second cousin, Maintenance of Licensure (MOL).

I’m getting older and long for retirement sometimes as I watch the conflict over this issue and others threatening the integrity of the practice of medicine. I would never recertify again if I knew that I could make a living as a psychiatrist without this empty, regulatory shackle.

But I can’t. And boards know it. How did this happen? Physicians let it happen. I’m doing what I can to show I love what I do and love the principle of ensuring that I’m the best doctor I can possibly be. But the irony is I don’t have time to do what I think I should as long as I’m compelled to do time-wasting, foolish documentation of activities like “feedback” which will be meaningless cherry-picking nonsense.

And this nasty infection is spreading into residency training programs in the form of “Milestones”, another mind-numbingly complicated and time-consuming snare promoted by the same regulatory organizations that make the MOC, Save Time for Patients – The Practical Psychosomaticist.

And it had to be a reader to bring to my attention that the Federation of State Medical Boards (FSMB), who is promoting the MOL, (which practically no state wants, Roll Call for MOL? – The Practical Psychosomaticist) may have been a subject of a U.S. Senate Finance Committee investigation for conflicts of interest surrounding drug company funding of Dr. Scott Fishman’s book “Responsible Opioid Prescribing: A Clinician’s Guide.” A quote from the reader is “It should be noted that Fishman as well as the FSMB are currently under U.S. Senate investigation for their alleged involvement in pushing opioids for profit fueled by the pharmaceutical industry. The Senate wants answers as to whether the FSMB, Fishman and others promoted misleading information about the risks and benefits of opioids while receiving financial support from opioid manufacturers.”

The story originally broke last year in a Wisconsin newspaper, Follow the Money: Pain, Policy, and Profit. Many organized groups who have a beef with the FSMB picked up the story, one them referring to the FSMB as a “rogue organization”:

Senate Finance Committee Reacts to Reports of Opioid Abuse and Conflict of Interests: Letters to Manufactures and Organizations – Policy and Medicine

ANH-USA: Is Your State Medical Board in Bed with the FSMB?

Pain Medicine News – Senate Finance Committee Investigates Rise in Prescription Opioid Use

Makers of pain pills, advocacy groups at center of Senate probe – Medical Marketing and Media

I cringe as I read this again, because I actually praised Fishman’s book and had no idea that it might have been under any shadow. I sent a message to one of the Iowa legislators who wrote the letter to the FSMB about their role in this thorny issue. I asked if there really is an ongoing investigation, because the letter looks like it’s a year old now, 05092012 Baucus Grassley Opioid Investigation Letter to Federation of State Medical Boards. I have not yet received a reply. It looks like I may have another bone to pick with the FSMB.

But let’s be clear; I still believe that Fishman’s book does not convey any bias toward big Pharma. I have actually read the book, unlike many of the critics. And to be fair, I could not find a record of any sort of investigation against FSMB on the U.S. Senate Finance Committee website, though I found it very confusing and difficult to navigate.

The point is that this kind of “news” further shakes my faith in the major organizations which purport to have the best interests of patients and physicians at heart.

I’m saddened by the American Association of Physicians and Surgeons (AAPS) decision to file a lawsuit in federal court against the American Board of Medical Specialties (ABMS). But it had to be done, painful as it is to reveal to our patients and the rest of the world at large that the house of medicine is rocked by such divisive controversy.

How do we heal this wound?



  1. Hi Dr. Amos- This ran across my email feed today. I figured the self-declared ‘geezer’ and MOC and MOL advocate would be interested. An excerpt:

    Wick added that a task force is being formed that will develop a white paper for the AMA board and House of Delegates outlining key issues and problems confronting seniors [physicians over the age of 65].

    Probably the most important of those—and the most urgent message for aging physicians—is the importance of ongoing self-assessment and keeping up with continuing medical education and maintenance of licensure.

    “Senior Physicians Can Ensure They Stay Atop Their Game”
    by Mark Moran, Psychiatric News


    • Many thanks, Eric. As a matter of fact, I already have a post about this. I published “POGOe Has a New Face and Quizzes!” earlier today and mentioned the story about Wick’s comments and more about senior physicians and MOC. The AMA and the APA are barking up the wrong tree. Senior physicians are likely to retire en masse if they’re threatened with MOC and MOL, further exacerbating the physician shortage.

      How about that? Great minds think alike!

      Best wishes,

      Jim Amos, MD


  2. Hi, Dr. Amos,
    I read your article in The Carlat Report, and checked out your blog. Actually, I wrote the article in the May edition about CPT coding.
    I’m very concerned about MOC, and not just because it’s a waste of time. It’s an outside entity intruding into sessions with my patients. My patients need to fill out a form about me, as though they couldn’t tell me what they think directly. I need to use unproven, or bogusly proven checklists, or else I’m not doing a good job. And none of this has any basis in fact. There is no evidence that it improves patient care.
    I blogged about this issue a couple months ago, (http://psychpracticemd.blogspot.com/2012/11/alphabet-soup.html) and I tried to stir up some sentiment among friends/colleagues who were board certified when I was (2005). Most people I’ve spoken with aren’t as abashed as I am, and certainly no one wants to take any action.
    You’ve written letters, even to the president, and articles and a whole bunch of stuff. I’m becoming increasingly discouraged and resigned. Is there any hope?


    • I can’t tell you how much I appreciate your comments. My amazement that there are other like-minded physicians out there on this issue is indicative of one of the main challenges to getting traction in a movement to take back the role of champion of the principle of lifelong learning from large, faceless organizations like ABMS, FSMB, and specialty boards like ABPN–we’re isolated from one another. We tend to be hard-working loners. There are notable exceptions, like http://www.changeboardrecert.com/, although exceptions tend to prove the rule.

      In all this turmoil over MOC and MOL, including the recent filing of the lawsuit in federal court against ABMS, http://www.aapsonline.org/index.php/site/article/aaps_takes_moc_to_court/, I can’t help but wonder what our patients think. This is all about them, or should be. In fact, the focus of the boards is on money and I think patients should know that.

      I think there is hope for preserving the patient-physician relationship. I’ll be discussing my opposition to MOL with my state board on June 28, 2013 by telephone during the public portion of their regular meeting. As you probably know, my resolution to uphold lifelong learning in the continuous improvement of patient care and to oppose MOL was approved by the Iowa Medical Society House of Delegates in April. Maybe you could add your name to my petition at http://www.ipetitions.com/petition/iowa-medical-society-house-of-delegates/

      Could I add a link to your blog site to my blogroll?

      Many thanks,

      Jim Amos, MD


      • Thanks for the excellent links. I did sign your petition. You can certainly add a link to my blog, and I’m gonna assume I can link to your blog, as well. Also, I think I want to do another MOC post. It’s important to keep people thinking about it. If it’s okay, I’d like to link to here, as well as to some of the other links you sent me.


      • You are welcome to link to whatever you want here. Thank you very much for allowing me to link to your site. It is very well done.

        Best wishes,



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