Earth Day Activism a Model for Physicians Supporting Lifelong Learning?

This is Earth Day and I marvel at the energy and passion of activism for changing the politics which interferes with efforts to preserve the planet. It makes me wonder, though, why doctors and patients don’t seem to have as much appetite for activism to fight for genuine lifelong learning and oppose wasteful activities like Maintenance of Certification (MOC) and Maintenance of Licensure (MOL).

I recently sent a letter to Iowa legislators asking for support of a law to protect Iowans against MOL. I got one reply, the leading sentence of which pointed out that the legislative session is over and any attention to my proposal would have to wait until next year.

The congressman also asked some questions that highlighted the political problems which still slow down efforts to bring a little common sense to the debate about what physicians need to do to stay current in terms of safety, skill updates, and knowledge building.

The congressman also asked me what The University of Iowa position is on MOL. I didn’t have a good answer. There is no open discussion about this issue here that I know of, at least not in my department. I wonder if one physician’s recent comments are pertinent:

Here’s my take: physicians don’t like conflict but love the classroom where they shine. In peaceful times, this works out fine. But while the science of medicine may be like the classroom, the business and politics of medicine are like the playground, where smart contemplative types don’t fare so well. Quite frankly, Jim, APA and AMA remind me of the Simpsons character Martin Prince on the Springfield Elementary playground, protesting his bullying and wedgies with statements like, “How can my membership in Honor Society and years of hall monitor service be so unappreciated?”. As the bullies just laugh and pile on.

We are under siege from politicians, PPOs, insurance, ABMS, Press-Ganey, HIPAA, hospital bureaucrats, EHR etc. Marcus Welby and APA/AMA types might be nice fellows but I don’t want them at a proverbial gunfight. Give me a son of a bitch like Clint Eastwood or John Wayne. Or the AAPS who is saying no and taking these people on.

If you can’t identify the sucker at the negotiating table, you are the sucker. Doctors have to realize they’ve been weak saps and played as such. Recognizing the problem is the first step, it will be tough turning them into fighters. Maybe some of the aggression that doctors hammer each other with can be turned outward.–Dr. James O’Brien, MD in a recent post.

Another question from the congressman centered on how the Iowa Medical Society (IMS) feels about it. I reminded him about the IMS website’s reminder about MOL during the Physician Survey about it, which just closed yesterday:

IMS policy, H-275-019, adopted by the 2013 House of Delegates, supports physician life-long learning and quality improvements to medical practice. IMS, however, opposes MOL for those physicians who are board-certified,  and/or are maintaining relevant CME and peer-reviewed quality medical practice, and/or are participating in maintenance of certification (MOC). IMS further opposes MOL implementation for other physicians absent sufficient supportive data demonstrating that MOL supports patient outcomes and improves the quality of medical care.    

The congressman could have gone to the IMS website himself and seen the only comment about the survey, which was mine:

“I sponsored the resolution to support lifelong learning and oppose MOL in Iowa, which was co-sponsored by the Iowa Psychiatric Society. It became IMS policy, H-275-019 in 2013 as mentioned above. I completed the survey and paid special attention to Question 31, which asks for free-text comments pertaining to lifelong learning and MOL. I think MOL could hurt recruitment and retention of physicians in Iowa, a physician shortage area, because there is no high level evidence-base supporting the premise of ABMS that MOC improves patient outcomes. MOL essentially ties medical licensure to MOC. In fact, a new study shows there is reason to doubt the claims of ABMS about the MOC, and by extension, MOL. The study is: Galliher, J. M., B. K. Manning, et al. 2014. “Do Professional Development Programs for Maintenance of Certification MOC Affect Quality of Patient Care?” The Journal of the American Board of Family Medicine 271: 19-25. see link http://www.jabfm.org/content/27/1/19.long. In almost every state with the exception of Colorado that the Federation of State Medical Boards FSMB claims the MOL implementation pilot projects are in progress, the state medical societies have adopted resolutions opposing MOL and MOC. I’m urging every Iowa physician to complete the survey, especially Question 31. Ultimately, the decision to implement MOL rests with state medical boards–not the FSMB.”

And his final question was “How many other professionals are also advocating for removal of MOL?”

Well, it’s not difficult to answer that question. He could look at the petition  against MOC, which amounts to a petition against MOL because MOL would essentially tie medical licensure to MOC or a process like it. While it might be difficult to find Iowans who are vocal activists supporting lifelong learning and opposing MOL, judging from my own petition, you can find that one of those who signed it is the President of the Iowa Psychiatric Society, Dr. Daniel Gillette, MD.

Doctors probably make poor activists because we’re so focused on patient care, duty, and integrity. We could make great activists for the very same reasons. The other unasked question is, can we change the culture and the politics of medicine without dishonoring the Hippocratic Oath? I think we can if we keep pressing on.

Happy Earth Day.

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