“A Tremendous Whack”

“If you have an important point to make, don’t try to be subtle or clever. Use a pile driver. Hit the point once. Then come back and hit it again. Then hit it a third time – a tremendous whack.”–Winston Churchill

I’ve been watching the progress of the petition to the American Board of Internal Medicine (ABIM) to rescind it’s latest set of changes to the Maintenance of Certification (MOC) program. It has thousands of signatures, which grows daily and should indicate to the public how highly despised the MOC is.

When I compare it to my own perpetually stalled petition to support lifelong learning and oppose Maintenance of Licensure (MOL), I wonder what the difference is between psychiatrists and internists.

I guess it’s the determination of internists to show the country and the world their belief they can still change the minds of the leaders of the only organization to which they have any chance of appeal. While it’s unlikely that the ABIM will modify its MOC program in response to any petition, there has been no other recourse other than the lawsuit filed against the American Board of Medical Specialties (ABMS) in April 2013 by the Association of American Physicians and Surgeons (AAPS). I haven’t seen an update on how that’s going so far. But one of the comments about it sounds like it comes from a psychiatrist because the American Board of Psychiatry and Neurology (ABPN) is mentioned:

“I just donated $500 and wish I could donate much more. I recertified in 2010 which required too much time and money, but this was nothing compared to what has since been implemented constituting a maze of incomprehensible hoops to jump through, utterly impossible to wrap my brain around. These “steps” being implemented could not have ever been conceived by a rational person, let alone a physician working with patients. Did they ever hear of boundary issues, issues of transference and counter-transference? How could the ABPN betray us like this? I am appalled by the hypocrisy of these men and women who call themselves physicians. It is all about the money and nothing more. We are being treated like naughty and irresponsible children who require increasing amounts of supervision and punishment – all by physicians who have no doubt been grandfathered into the system. How sadistic and irrelevant this has become. in addition to the $$ what else can we do to take back what is ours.”

So if this psychiatrist’s sentiment is shared by most practitioners in the field, why is my petition to oppose MOL dead in the water? Arguably, opposing MOL is the winnable battle since it’s up to individual state medical boards, not the Federation of State Medical Boards (FSMB), to decide whether or not MOL gets adopted. In fact, Iowa licensees have only recently received a link to the online Physician Acceptability Survey regarding MOL. It includes Question 31, which I’ve been rattling on about in what may be a futile effort to encourage doctors to give the Iowa Board of Medicine “a tremendous whack” about whether or not they support MOL.

The efforts to show the American public what the empty and wasteful MOC and MOL processes really are sometimes include a few whacks which look promising but which may glance off the shoulders of the giants of the large corporations like the ABMS and the FSMB.

Who’s whacking who?

 

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Comments

  1. I completely, whole-heartedly agree with these sentiments. The whole thing really, really pisses me off. The patient reviews are atrocious. However, the peer reviews, especially in light of the ABPN descriptions, are equally absurd. In my small town, there are only four psychiatrists. We are supposed to have 5 peer reviews, and these are supposed to from different peers in each successive set. The ABPN appears to recognize this difficulty by allowing psychologists and nurses to do these reviews. But then, what is the purpose of these reviews? If psychologists and nurses can critique psychiatrists, then what exactly is it that we do? Indeed, I ask why this should not be expanded to include secretarial staff and housekeeping.

    The self-assessments? These are required, and are supposedly tied to follow-up CME if the psychiatrist is less than successful. However, why would a psychiatrist wanting to avoid all of the subsequent hassles pick a topic they know little about? On the other hand if a psychiatrist is honest and conscientious enough to honestly assess their skills with challenging material, then they are also conscientious enough to maintain their skills on their own. They not need to be prodded into doing so. I despise this process almost as much as i despise the “evidence-based” Collaborative Care model.

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  2. Jim – the psychiatrist’s comment is dead on.

    The MOC Caucus was very active in the APA until

    “the referendum on the issue of informing the ABPN as follows regarding its proposed maintenance of certification requirements.

    1) The patient feedback requirements for the purpose of reporting to the Board is unacceptable, as it creates ethical conflicts, and has the potential to damage treatment.
    2) The requirements other than a cognitive knowledge examination once in 10 years, regular participation in continuing medical education, and maintenance of licensure, pose undue and unnecessary burden on psychiatrists.”

    The actual vote was: Support 5,525 (80%) and Do not support 1,418 (20%), but it did not count because a vote by 40% of the members was needed. The vote was finalized in Feb. 2011.

    I always questioned 1) above and thought that it was a cop out. As we now know item 2 has been greatly expanded.

    I think the practical matter is that physicians will be progressively exhausted and at some point will just stop jumping though hoops. At that point health care companies and state boards will have to decide if they support the interests of the ABMS or the people of their state who need physicians. I also applaud the internists for meeting the problem head on and wish that psychiatrists had that level of political will, but they apparently do not have a 40% of the voters requirement?

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