Letter from the Wing Tip Generation

So I got the message that exhorting AMA members on the AMA Forum to call for MOC to go would not only fall on deaf ears—it would probably not fall on any ears because there are barely any practicing physicians left in the organization to hear.

Doctors have fled the AMA and are steadily leaving because they don’t believe the AMA listens to them and does not represent them, especially on the MOC issue.

Only me and an 80 year old family doctor who left comments for the AMA Reference Committee on the Maintenance of Certification (MOC) issue to be discussed at the House of Delegates meeting in June in Chicago.

Wing Tips Most of the docs who resist the over-regulation of physicians are older, from what you might call the wing tip generation, to which I proudly belong. Here are the words of the only other commenting physician in the AMA Forum:

MOC has become a burden, especially on older doctors. I have been recertified five times and am 80 years old. Primary care in a rural poor community. I don’t need a ten year MOC, and cannot afford it anymore. Seems we are flagellating ourselves in the public square so as to show ourselves as remaining competent.

I am pleased to read [Dr. Jim Amos’] post. It is reaffirming that I am not a wingnut, a lone frustrated voice in the dark. On a broader scale it must mean something when we read of frustration levels rising in America’s providers of care; 20 percent of doctors are over 65. 300 doctors commit suicide a year. 90 percent of doctors would advise their children not to go into medicine. Something is not right. Life long learning is a more noble approach and appeals to our intellect and pride. Love that term. I read journals for one hour a day. There is no check box in the MOC process for this.

Doximity alerted me to a 2004 New York Times article, “The Bell Curve,” in which the author used appraisal of the performance of leading hospitals regarding the treatment of cystic fibrosis to reveal the great disparities amongst them. Just like on a bell curve, a few hospitals did poorly, most were average, and a few consistently outperformed all the others.

Why? It seemed to result from the ingenuity, aggressiveness, integrity, and insistence on excellence of individual physicians.

These kinds of leaders are not always well-liked, and even make enemies. But they save lives by combining humanism with humor, and a willingness to sometimes break the rules.

They don’t seem like they’d sit still for the checkbox mentality, and the competency theme which drives the MOC and Maintenance of Licensure (MOL) soulless gimmickry promulgated by the boards.

I’m getting older and I would like nothing better than to stop this fight and to enjoy my wife’s garden, so beautiful in the spring, bleeding hearts waiting only for a little rain.

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My clock is running down, but not my implacability. In the distant future, this will be remembered as a time when many misfortunes rained down on the heads of doctors all over America. But we’ll prevail, especially if the young remain willing to learn from the old.


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