Mow Down Mandates; Cultivate Communication

OK, so you’re asking yourselves, “Hey, how are things going in Iowa on the opposition-to-Maintenance of Certification (MOC) and (Maintenance of Licensure (MOL) front?”

I’m glad you asked. I don’t have an answer about MOL yet because as far as I can tell from the Iowa Board of Medicine (IBM) website, the only thing connected to the issue I can see on the agenda for the next IBM meeting coming up in the next couple of days is a “Federation of State Medical Boards Presentation” at 11:00 a.m. on August 7, 2014, followed by lunch with the FSMB representatives.

saladimagesLet’s see, lunch. My daydream is that humble pie is on the menu for the FSMB..with all due respect, of course. I’ve been steady about my support of the principle of lifelong learning and opposition to MOL. One of my latest communications about it was to spend a full hour bending the ear of the interviewer looking for physicians’ perspectives on MOL in Iowa as followup for the Iowa Physician Acceptability Survey for MOL (what an inept title for that survey; MOL is unacceptable to most physicians!). I’m pretty sure lending me her ears was a trial.

The other item on the IBM agenda is the recent Institute of Medicine (IOM) Report on Graduate Medical Education That Meets the Nation’s Health Needs. I don’t disagree with the opinion of some that a lot of money has been thrown at academic medical centers for decades with basically no accountability for the ability of graduating residents to meet the needs of patients in today’s health care environment.

Aside from the report’s being very difficult for me to read because basically everything is in fine print, I’ve got some strong objections (as usual) to the strong tone of “mandate” in practically every other sentence. For once, I caught myself agreeing with the American Psychiatric Position (APA) position statements about it:

As APA points out, “While the IOM proposes to overhaul the GME payment system, it has not defined what a performance-based system would include…” Indeed, ever since the Affordable Care Act imposition via the Centers for Medicare and Medicaid Services of the MOC Physician Quality Reporting System MOC:PQRS, I’ve been pretty suspicious of any regulatory or governmental agency touting anything it’s pleased to call a “mandate” or threatening to legislate.

Can we legislate physician competence or mindfulness? Could they be better promoted by nurturing a culture of reflection and mindfulness to build a health care and health-promoting system which the majority of patients might value? Would it make more sense for academic leaders and policy-makers to ask these questions than to hit doctors over the head with mandates?

Rank-and-file doctors tend to respond to these mandates with stout opposition and refusals to participate until they are heard. In my opinion, a large part of the conflict between regulators and physicians is about a failure to communicate.


Jim pretending to mow the lawnSo, what about MOC in Iowa? I’ve been all about mowing down MOC and MOL in Iowa for years. As you know, the Iowa Medical Society (IMS) adopted my resolution to support the principle of lifelong learning and oppose MOL in Iowa last April. And my proposed Policy Request Statement (now that the House of Delegates system has been replaced by a more nimble Policy Forum), entitled “Opposition to Maintenance of Certification,” will be introduced on August 7, 2014.

Fancy that, the same day that the IBM meeting starts.

That will be followed by a “Testimony Forum,” for discussion until August 22, 2014. Official notices will go out to the IMS membership soon. I’ll get assistance from the IMS for ensuring that my Policy Request Statement will be written the way I intend and which will convey to members what they need to know to make the best decision for Iowans regarding MOC.  I’ve been very active already promoting opposition to MOC on the IMS LinkedIn site.

This could be my last hurrah before giving up my membership in the AMA and the APA. It’s getting far too expensive for me to keep paying for empty processes like MOC, promulgated by empty-headed bureaucrats and which leave me empty-handed.

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