Open Letters to the APA and the AMA House of Delegates to Oppose MOC and MOL

I’ve now sent two messages to the American Medical Association House of Delegates (AMA HOD) and as of August 3, 2013, a short note to the AMA through their tricky secure contact form requesting they draft and approve a resolution to oppose Maintenance of Certification (MOC) and Maintenance of Licensure (MOL) for national consideration. I’m going to post my second letter here to the AMA HOD, fully realizing that the contact form on the AMA website is probably meant only for AMA delegates:

I’m a consulting psychiatrist practicing in Iowa. I was the sponsor of the adopted resolution to support the principle of lifelong learning and to oppose Maintenance of Licensure (MOL) in my state. It was co-sponsored by the Iowa Psychiatric Society. Similar resolutions have been adopted in Wisconsin, Ohio, North Carolina, Michigan, New York, New Jersey, and most recently, Florida. The Florida Medical House of Delegates resolution also included opposition to Maintenance of Certification (MOC). They also recommended that the American Medical Association (AMA) adopt a similar resolution for national consideration.

According to David Pittman, author of the article “AMA Will Debate MOC, Guns, and the ACA” in the Medpage Today on-line article on June 13, 2013 covering the June AMA annual meeting, the AMA covered MOC proposals “…that could put the AMA at odds with the powerful American Board of Medical Specialties.” One resolution that was up for debate “would authorize the AMA to advocate against time-limited certification and oppose discrimination against physicians who are not certified in MOC programs.”

The article also mentioned a separate resolution describing the MOC program as costly, time-consuming, and results in significant disruptions to the availability of physicians.

A third resolution sought to add transparency to the ABMS by having the AMA call for the organization and the 24 specialty boards to release detailed reports on revenue, expenses, and salaries of senior staff and board members. The antitrust lawsuit filed by the American Association of Physicians and Surgeons (AAPS) called the MOC programs “a money-making, self-enrichment scheme.”

I hope the AMA House of Delegates will consider putting this issue of an AMA HOD resolution opposing MOC and MOL on the agenda at their next scheduled interim meeting November 16-19, 2013 in Gaylord National, National Harbor, Md. In fact, I read the article in the July 3, 2013 issue of American Medical News about the American Medical Association (AMA) House of Delegates directing the AMA to evaluate how Maintenance of Certification (MOC) processes “can be burdensome” to doctors.

Please lead the many thousands of doctors who believe in lifelong learning and continuous improvement in patient care and who do not believe that MOC and MOL serve patients.

This letter represents my own opinion and not necessarily the opinion of my employer.

You could send a similar letter to the AMA yourselves, if you choose. Just think, if the many thousands of physicians in America flooded the AMA with letters like this, they might just listen. Then I would have to wear red pants to work.

And why I am I not writing a letter to the American Psychiatric Association (APA)? As a matter of fact, I did:

I’m a consulting psychiatrist practicing in Iowa. I was the sponsor of the adopted resolution to support the principle of lifelong learning and to oppose Maintenance of Licensure (MOL) in my state. It was co-sponsored by the Iowa Psychiatric Society. Similar resolutions have been adopted in Wisconsin, Ohio, North Carolina, Michigan, New York, New Jersey, and most recently, Florida. The Florida Medical House of Delegates resolution also included opposition to Maintenance of Certification (MOC). They also recommended that the American Medical Association (AMA) adopt a similar resolution for national consideration.

I have always supported the principle of continuous improvement. You can see that on my blog site, The Practical Psychosomaticist. I believe that Maintenance of Certification (MOC) and Maintenance of Licensure (MOL) interfere with my effort to deliver excellent health care.

Psychiatrists who were board certified after 1994 have to participate in ABPN’s 10-year MOC program. During each 10-year cycle, I’m responsible for demonstrating I’m keeping up to date with my medical knowledge and practice. There are 4 MOC program components for diplomates to fulfill, of which Part IV is Performance in Practice (PIP), the most controversial and labor-intensive component. It comprises three PIP units over the 10-year MOC cycle, each of which includes a clinical module and a feedback module.

These modules require me to subtract time from patient care to satisfy regulatory requirements. The ABPN requires only that I document my collection of feedback data— not that I did anything about it. There’s no high-level data showing that these activities improve patient outcomes.

In 2011, an APA referendum critical of the ABPN’s MOC PIP requirements was supported by 80% of APA voters but it failed to pass because only 25% of members cast a ballot, far fewer than the 40% needed. In 2013, an APA Caucus was organized to again discuss this as well as the recent lawsuit filed in Federal court against ABMS regarding MOC.

The FSMB proposes MOL as a framework for license renewal which “supports a physician’s commitment to lifelong learning.” Pilot projects are purportedly underway in several states to study and implement MOL. In fact, several state medical societies, a few in states participating in pilot projects, have adopted resolutions expressly opposed to MOL, again, including Iowa, Ohio, Michigan, Wisconsin, North Carolina, and New York,  New Jersey, and Florida.

The American Association of Physicians and Surgeons (AAPS) filed a lawsuit in Federal Court on April 23, 2013 against the American Board of Medical Specialties (ABMS) for “restraining trade and causing a reduction in access by patients to their physicians.”

According to David Pittman, author of the article “AMA Will Debate MOC, Guns, and the ACA” in the Medpage Today on-line article on June 13, 2013 covering the June AMA annual meeting, the AMA covered MOC proposals “…that could put the AMA at odds with the powerful American Board of Medical Specialties.” One resolution that was up for debate “would authorize the AMA to advocate against time-limited certification and oppose discrimination against physicians who are not certified in MOC programs.”

The article also mentioned a separate resolution describing the MOC program as costly, time-consuming, and results in significant disruptions to the availability of physicians.

A third resolution sought to add transparency to the ABMS by having the AMA call for the organization and the 24 specialty boards to release detailed reports on revenue, expenses, and salaries of senior staff and board members. The antitrust lawsuit filed by the American Association of Physicians and Surgeons (AAPS) called the MOC programs “a money-making, self-enrichment scheme.”

I hope the AMA House of Delegates will consider putting this issue of an AMA HOD resolution opposing MOC and MOL on the agenda at their next scheduled interim meeting November 16-19, 2013 in Gaylord National, National Harbor, Md. In fact, I read the article in the July 3, 2013 issue of American Medical News about the American Medical Association (AMA) House of Delegates directing the AMA to evaluate how Maintenance of Certification (MOC) processes “can be burdensome” to doctors.

I hope the APA will consider doing the same.

Please lead the many thousands of doctors who believe in lifelong learning and continuous improvement in patient care and who do not believe that MOC and MOL serve patients.

 This letter represents my own opinion and not necessarily the opinion of my employer.

“…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

 

Related posts:

There’s A New Poll in Town – The Practical Psychosomaticist

AMA HOD Resolution to Oppose MOC and MOL for the Red Pants Revolution? – The Practical Psychosomaticist

AMA Will Debate MOC, Guns, and the ACA

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Comments

  1. A form letter for people to send might be helpful, with the appropriate addresses:

    I am a _________ psychiatrist practicing in ____. Recently, a resolution was adopted in Iowa to support the principle of lifelong learning and to oppose Maintenance of Licensure (MOL). It was sponsored by Dr. James Amos and co-sponsored by the Iowa Psychiatric Society. Similar resolutions have been adopted in Wisconsin, Ohio, North Carolina, Michigan, New York, New Jersey, and most recently, Florida. The Florida Medical House of Delegates resolution also included opposition to Maintenance of Certification (MOC). They also recommended that the American Medical Association (AMA) adopt a similar resolution for national consideration.

    According to David Pittman, author of the article “AMA Will Debate MOC, Guns, and the ACA” in the Medpage Today on-line article on June 13, 2013 covering the June AMA annual meeting, the AMA covered MOC proposals “…that could put the AMA at odds with the powerful American Board of Medical Specialties.” One resolution that was up for debate “would authorize the AMA to advocate against time-limited certification and oppose discrimination against physicians who are not certified in MOC programs.”
    The article also mentioned a separate resolution describing the MOC program as costly, time-consuming, and results in significant disruptions to the availability of physicians.

    A third resolution sought to add transparency to the ABMS by having the AMA call for the organization and the 24 specialty boards to release detailed reports on revenue, expenses, and salaries of senior staff and board members. The antitrust lawsuit filed by the American Association of Physicians and Surgeons (AAPS) called the MOC programs “a money-making, self-enrichment scheme.”

    I am asking the AMA House of Delegates to consider putting this issue of an AMA HOD resolution opposing MOC and MOL on the agenda at their next scheduled interim meeting November 16-19, 2013 in Gaylord National, National Harbor, Md. This is in keeping with the article in the July 1, 2013 issue of American Medical News about the American Medical Association (AMA) House of Delegates directing the AMA to evaluate how Maintenance of Certification (MOC) processes “can be burdensome” to doctors (See: http://www.amednews.com/article/20130701/house/130709966/6/).

    Please lead the many thousands of doctors who believe in lifelong learning and continuous improvement in patient care and who do not believe that MOC and MOL serve patients.

    This letter represents my own opinion and not necessarily the opinion of my employer.

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