MOC: The Race for Money

I found the tweet above after I got the usual American Medical Association Political Action Committee (AMPAC) dues invoice asking for the millionth time for a $100 fee to help fund their political action activities. I read the letter and marveled at the ironic ring of one paragraph:

You have trained for years; have invested significant amounts of money; and have dedicated countless hours to your profession and your patients. Unfortunately, many politicians who make decisions that impact your practice do not understand or appreciate the sacrifices you have made. We need to let them know where physicians stand and make sure the resources are available this November.

The AMA House of Delegates (HOD) didn’t go far enough in June. It failed to adopt a resolution calling for a Moratorium on MOC. I thought they realized I have trained for years, invested significant amounts of money, blah, blah. By the way, simply saying that MOC should not be tied to licensure is really no more than what I and many other physicians have been stating in the many resolutions adopted by state medical societies–that Maintenance of Licensure (MOL) is duplicative, unnecessary, would probably drive up the cost of obtaining and renewing a medical license, would not guarantee better medical or psychiatric care, and would likely interfere with recruitment and retention of doctors.

Comply and OpposeI’m not impressed with the AMA HOD or AMPAC. They ask me for money and I can tell you that I can’t afford them anymore. That’s because I’m already paying too much to keep up with MOC requirements to all the cottage industries springing up to cash in on the bonanza created by the American Board of Medical Specialties (ABMS) aided and abetted by specialty boards.

Let’s see; who else is asking me for money? Oh yes, The Focus Journal of Lifelong Learning in Psychiatry, which provides CME, Self-Assessment, and Performance in Practice (PIP) materials for MOC credit. They already sent me the 2nd Renewal Notice for my subscription, only days after they sent the first Renewal Notice. They can’t get their hands on my $368 fast enough. That’s just for a year because I refuse to fork over $662 for a two year subscription. Only one of the candidates for the American Psychiatric Association (APA) President-Elect, Dr. Renee Binder, MD, proposed making the subscription an APA membership benefit. She was elected, but I’m not holding my breath. Membership in APA now is close to $1,000 annually. I can’t afford them anymore, either.

moneyWhere is all of this money going? Take a look at the board tax returns and it’s clear. I have trained for years. I have invested significant amounts of money. I have dedicated countless hours to my profession and my patients. Unfortunately, the ABMS, specialty boards, and the Federation of State Medical Boards (FSMB) are making decisions that impact my practice. They do not understand the sacrifices I have made. A slowly growing number of physicians are signing a petition pledging non-compliance with MOC in order to let the boards know where physicians stand and make sure resources are not wasted further on fattening the wallets of board executives.

Ironically, some of those physicians may be prevented from practicing because MOC is increasingly being tied to hospital privileging and insurance panel assignment.

My bank account would have been lighter by $1,500 recently if it had not been for the professional allowance my department gives me as part of my employment benefits. That was to cover the cost of applying for and taking the MOC recertification exam for Psychosomatic Medicine–which I won’t have to take again because I’m so close to retirement. And the AMA wants to study whether MOC influences physicians’ decisions to retire. Well, study this:

I got another couple of pieces of mail recently. They were from my employee benefits office and my retirement fund’s advisory services office:

The Federal Government now requires we send you a paper notice at least once a year regarding your retirement savings options…You have the option of saving additional money beyond the regular University Retirement Program with both before and/or after-tax options. If you are in a position to do so, saving early and often for your retirement is a wise idea.

You’re in a race with your money. We want to help you both win. You may not realize it, but your retirement portfolio is about to change–if it hasn’t already. That’s because the typical retirement portfolio has two phases: an accumulation phase, when assets are being built up; and a distribution phase, when assets are drawn down for income to live on.

Since you could live 30 or more years in retirement, it’s important to make your assets last as long as possible. That creates a new set of portfolio management challenges.

The boards and the other cogs in the MOC machine and I are all in a race for my money. I’ve been running in this race for a long while and my position regarding retirement doesn’t look half-bad. That’s part of the reason I prefer retirement to pledging non-compliance with MOC, although I wish the petition signatories well. In the long run, I think retirement will eventually foster the inevitable changes that must come for MOC. If I and other doctors retire from participating in the big MOC lie, it may have more of an impact than non-compliance, which could just lead to losing my job. That would make it harder for me and others to retire in a secure position, stalling the inevitable evolution that is already beginning in places like Missouri, where the governor just signed a law that will allow medical students to act as “assistant physicians,” in response to the physician shortage.:

That physician shortage will be exacerbated by the boards’ move to force doctors to participate in MOC as a condition of licensure, the AMA objection notwithstanding. While the next generation of doctors may view this change as an opportunity and just part of the cost of doing business, there are a few of us who wonder what the potential consequences might be for patients. As a teacher of medical students and residents, I do more than wonder based on what I see every day in the hospital. Board leaders may believe that pushing out gray-hairs like me won’t hurt their bottom line–but I think it could hurt patients.

Young doctors and patients need older doctors like me.

shooting yourself in the footBoard leaders pressuring rank-and-file physicians to participate in MOC and rank-and-file physicians who think mass-noncompliance with MOC is an effective response would do well to remember one thing. It’s a mistake to shoot yourself in the foot.

I have trained for years; I have invested significant amounts of money; and I have dedicated countless hours to my profession and my patients. Unfortunately, the government and many corporations don’t understand that the decisions they are making which impact my practice reduce the meaning of my dedication from a passion for helping others heal into a race for money.


9 thoughts on “MOC: The Race for Money

  1. Jim, by “complying” with MOC, you are feeding the beast that not just robs your wallet but eats away at you professionally. While I have agreed with most of what you say, I still believe saying “no” is the most effective way to expose the lies of MOC.


    1. And I deeply respect your decision, Arvind. MOC, through my academic position which requires me to feed this beast, feeds my wife and I. I can’t imagine a more ironic position for me.

      Will you try to understand my need to expose the MOC lie in other ways?


  2. Well stated Jim, my sentiments exactly. I do not understand why so many physicians signed the petition to stop MOC while so very few are willing to sign the pledge to say no. Is it the FEAR of peer pressure or the realities of the extortion politics of the ABMS’s unproven program?


  3. If medical student “assistant physicians” don’t work, I have the perfect solution to the doctor shortage. We should have all the people who TRULY care about the well-being of patients care for the patients. The Managed Care Execs, Big Pharma Bigshots, Malpractice Lawyers, ACA Politicians, EMR Execs and Designers, and the folks who run the ABMS. Then no one will care if those namby-pamby, evil, money-grubbing doctors have retired because they don’t want to participate in MOC.

    Liked by 1 person

    1. I’m following your blog posts about your journey to the ABPN MOC Recertification exam. It makes me want to grind my teeth because I’ll have to put up with it in just a few years. Talk about the MOC money grab; good grief! Good luck!


  4. JIm,

    Great post.

    Physicians are seen as an endless revenue source for regulators, professional organizations, and political action committees. If any of those entities is evaluated on their ability to preserve or improve the practice environment – they all get very low marks. I don’t know how anyone can continue to give money away and not get any results and instead continue to get a worsening situation. MOC is a significant part of the deteriorating scenario, but it is only the most recent step in the decades long downward spiral.

    You also touched on an element that touches all Americans and not just physicians and that is the retirement account. There are at least as many special interests set up to make money off of retirees as there are set up to take advantage of physicians. Many of these accounts are held with companies that collect brokerage fees for various services, management fees for any investments in their own funds and (considering the time investment) they also get an even higher fee to manage the funds when the person retires. One of the financial services companies has posted the amount of money the average retiree needs for medical expenses not covered by Medicare and that number averages about $250,000 for the duration of retirement. Add in a similar amount for property taxes and the fact that the average amount in most 401Ks is substantially less than either figure points out why the current system is a general failure.

    Add in the fact that the financial services industry manages the economy to maximize volatility and any can lose 30-40% of their retirement funds in any given year and there are no longer any safe investments it is clear that there are very few people who are able to securely finance their retirement.

    I think that all of this chaos comes back to giving money to people with the hope of improving your security and the security of those around you and a serious lack of accountability on the part of the responsible institutions.

    Liked by 1 person

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