Back on the MOC Again

Well, my wife and I just got back from vacation in downtown Milwaukee where I snapped quite a few pictures, and it’s remarkable how much of it reminded me of the first Policy Forum of the Iowa Medical Society, now in the Testimony Forum stage. Of course, I didn’t think about my Policy Request Statement (PRS) 14-02: Support of Lifelong Learning and Opposition to Mandatory Maintenance of Certification (MOC) the whole time we were in Milwaukee.

Part of the charm of the Milwaukee Riverwalk are its oddities, one of which puzzled us for a while until we checked it out with the Milwaukee County Historical Society. It was the plaque we found on a building just across the street from the Pabst Theatre:

A clue to famous Milwaukee restaurant

I thought the word “Histeric” was just misspelled until my wife pointed out the line “Department of the Ulterior.” Two misspelled words on the same plaque? That had to be more than a coincidence. And then I googled the name Margaretha Geertruida Zelle–which turned out to be Mata Hari, a famous spy. Gaining a bit of perspective by getting a picture from across the street revealed a helpful clue.

Clue to popular MKE restaurant

But we didn’t solve the mystery until a very knowledgeable historian at the local Milwaukee County Historical Society cleared it up by describing a popular spy-themed restaurant billing itself under the fake name “International Exports, Ltd,” located just around the corner from the plaque. We had heard about this club previously from the tour guide during our ride on The Milwaukee Trolley Loop. Unfortunately, we didn’t get a chance to experience the place. I’m sworn to secrecy about the real name because I looked it up on the internet and had to take a pledge. See if you can find it.

What were we talking about? Oh yeah, PRS 14-02: Support of Lifelong Learning and Opposition to Mandatory Maintenance of Certification (MOC). I’m struck by the similarity of the controversy over one of the art pieces (The Calling by Mark di Suvero) at the end of Wisconsin Avenue to that surrounding MOC…some people love MOC while others hate it.

The Calling by Mark di Suverno in MKE


The Calling really attracts a lot of hate and it’s often compared unfavorably with the Quadracci Pavilion behind it (obscured by fog in the shot above) at the Milwaukee Art Museum, frequently praised for its integration of form with function:

Quadracci Pavilion MKE


Combining form with function or otherwise making the pursuit of lifelong learning practical is how I prefer to frame the debate about MOC, which in its current form doesn’t help physicians in that regard. If you look at the petition signed by thousands of doctors who pledge to boycott MOC, you get the sense that MOC lacks everything which would make it successful. In general, physicians are dedicated to the principle of lifelong learning and the vast majority of us have been high-performing over-achievers who can find our own ways to continuously improve our medical knowledge and skills on our own.

Despite the much-criticized art piece’s ironic name, “The Calling,” that title is what’s most important, in my opinion, as it relates to the debate about MOC. I think of my profession as just that, a calling. The drive by the American Board of Medical Specialties (ABMS) and the Federation of State Medical Boards (FSMB) to make it more like a trade union (no disrespect to trade unions, which have fundamentally different goals) by attaching hospital privileging, insurance panel assignment, and medical licensure is not what a profession is about.

Rank-and-file physicians feel like an oppressed group in this struggle, leading to the formation of the website, Change Board Recertification. And, perhaps predictably, the art piece which reminded me of that was “Common Comrades,” by Manu Garay, described as conveying “…the message of inclusion for the poor, oppressed, and outcast.”:

Common Comrades by Manu Garay in MKE


I think the boards are working very hard at excluding doctors from the decision-making process about how to make it easier for us to develop our own efforts at systematic professional development processes. As Iowa Medical Society President, Dr. Jeffrey Maire, DO, says, “No one is in a better position than the individual physician to determine how best to maintain the needed skills.”

I sponsored the resolution to support lifelong learning and oppose Maintenance of Licensure (MOL) in Iowa last year (it was co-sponsored by the Iowa Psychiatric Society) and it was adopted. I’m hopeful that PRS 14-02 will also be adopted by the Policy Forum in September. And if it is, I wonder what the Fonz would say?

Hanging out with the bronze fonz (2)