My Comments to APA LinkedIn Members and 2014 Election Candidates

The essay below is my comment posted on the American Psychiatric Association LinkedIn web site. It’s about Maintenance of Certification (MOC) and Maintenance of Licensure (MOL), critical issues in 2014 for psychiatrists, candidates seeking election for APA office, and all physicians, for that matter.

Please consider reading the Medical Economics on-line article  “Top 10 challenges facing physicians in 2014” at link,0&contextCategoryId=146  and note that MOC and MOL are nowhere mentioned.

Then read comments below the article from Drs. Paul Kempen and Jonathan Weiss. I think they’re both right that it’s mystifying why MOC and MOL are not specifically listed. Dr. Kempen led the resistance to MOL in Ohio, where it was defeated. Ohio was one of the original 11 states where the FSMB is trying to impose MOL by “collaborating” with state medical boards on the MOL implementation pilot projects.

It’s noteworthy that almost all of the 11 state medical societies have adopted resolutions opposing MOL and, in some cases, MOC as well.

Just type in “Maintenance of Certification” or “MOC” in the search box at the Medical Economics site and you’ll learn more about how rank and file physicians feel about this wasteful system.

I would like to alert psychiatrists who practice in shortage areas that MOL could contribute to the shortage by providing a disincentive to physicians from either staying in or relocating to these areas. 

You have to ask yourselves why the ABMS and the FSMB continue to push MOC and MOL in the face of this growing opposition. It’s hard not to suspect that it’s all about money when you see the boards’ Form 990 tax returns at link

But let’s just assume that the boards’ intentions were to build a practical, evidence-based method to help psychiatrists provide high-quality care for their patients and engage in reflective, lifelong learning. I can’t think of a framework that does a worse job of that than MOC, especially for psychiatrists.

My dissent on this issue crosses the boundaries of both the boards and the opponents who call on the boards to let go of MOC and MOL. I respect both sides even though the boards didn’t respect mainstream physicians.

However, it doesn’t make sense to me to persist in demanding that the boards give up the MOC. I don’t think that’s achievable.  Why should the ABMS listen to the grass-roots now when they never asked for our participation in the decision to launch MOC in the first place?

I’m willing to work with whoever else is interested in developing reasonable reforms to MOC to present to the ABPN. These would include but not be limited to:

  • Dropping the PIP peer and patient feedback review activities because they are simply too vulnerable to cronyism and cherry-picking. I’m uncertain how the ABPN would audit that and I think genuine change in my practice based on feedback from others has to come from the inside out. It can’t be mandated by an external administrator who electronically tracks documentation of an honors-system subject to being gamed.
  • Adding PIP clinical activities that are practice-relevant and which don’t interfere with day-to-day practice.

On the other hand, there is no reason to impose MOL on any physician. It’s duplicative and unnecessary when we’re already participating in MOC and this was the main reason I was able, with the support of the Iowa Psychiatric Society, to get the resolution to support the principle of lifelong learning and oppose MOL adopted at the Iowa Medical Society House of Delegates meeting in Coralville, Iowa in April 2013. Several other states have done likewise.

What I’m proposing is that rank and file psychiatrists take back the principle of lifelong learning from the boards currently corrupting it… and own it.

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