Connecting the Connectomes Between MOC and Scholarship: A Rodeo Clown’s Perspective

White-Matter-Fibers-Brainstem-and-above-720x693So I just saw the October announcement from the American Delirium Society (see tweet below) about the National Institute of Health (NIH) research funding opportunity relevant to delirium in the elderly which is connected to the Human Connectome Project:

I’m both a roll-up-your-sleeves practical psychiatric hospitalist and an academician, true to the idea that thinking both/and is always superior to the either/or trap. Academicians as a group are roundly criticized by many who are opposed to the Maintenance of Certification (MOC) process promulgated by the American Board of Medical Specialties (ABMS) and member boards. “Academics” are broadly scapegoated as the creators of MOC and vilified at every turn.

Can you believe it? I’m lumped in with the group of so-called academicians pressing MOC, despite my longstanding public criticism of MOC and Maintenance of Licensure (MOL) and my activism supporting the principle of lifelong learning.

It doesn’t make sense to me either. Most academicians don’t care for MOC any more than I do.

Recently at the October meeting of the American Academy of Psychiatry and the Law (AAPL), Dr. Larry Faulkner, President and CEO of the American Board of Psychiatry and Neurology (ABPN), acknowledged the shortcomings of MOC but warned the audience that “…MOC is not going away, and that physicians should view the process as a way to demonstrate efforts of their ongoing professional learning.”

On the other hand, my message has always been that it’s the pursuit of excellence that counts, not drum-beating about competence. MOC will not help doctors move forward and engage them in the kind of neuroscience that the Human Connectome Project represents.

It figures that, as a clinician-educator in an academic medical center, I’d be painted with the same brush as certain medical board leaders. However, as a clinical track faculty, I’ve never exactly fit the researcher mold either. I guess that’s part of the reason why I became the rodeo clown of both the anti-MOC movement and academic clown bullfighter

I think we should remember that as faculty members, as private practice clinicians and everything in-between that we’re setting an example for the next generation of doctors.

And that reminds me, there are plenty of academics who are doing evidence-based and practical things to help patients heal and doctors engage in lifelong learning. Dr. Igor Galynker, MD, PhD is one of them. You may recall Dr. Galynker as the New York psychiatrist doing research on the Suicide Trigger Scale, which he has recently simplified so as to make it more practical for busy doctors to use in the field. Unfortunately, his kind of work is not approved for MOC credit. By the way, Dr. Galynker is also part of the Family Center for Bipolar at Beth Israel Medical Center in New York. He also sent me Bumpy…awwww.

Bumpy the Firebear

Here comes Bumpy the Bipolar Bear riding with the psychiatry consult service!

Bumpy the Bipolar Bear going to a fire

There goes Bumpy the Bipolar Bear riding with the psychiatry consult service!

I want the next generation of doctors to be both the paragons of scholarship and the paladins for patients. Which role models should they follow? Better yet, how should we model leadership for them?



  1. Hi Jim,

    “…MOC is not going away, and that physicians should view the process as a way to demonstrate efforts of their ongoing professional learning.”

    This is the exact same thing they told us about:

    1. Managed care.

    2. The RVU productivity system.

    3. E & M documentation and coding guidelines.

    4. A system for payment of medical services that is essentially a tax on all Americans that ranks somewhere between their income and property taxes.

    The bottom line is that if you accept what people tell you and don’t question or protest it – it becomes a self fulfilling prophecy. All of the interests who have been pressuring physicians know it.

    A litany of bad ideas.


    Liked by 1 person

    • Amen! Incidentally, I just got my RVU productivity report back. I had a searching discussion with my administrator about this metric and how it underestimates the effort I put into the psychiatry consultation service. One of my colleagues working in the ER has the same issue. And a colleague who is now covering the consult service is probably feeling the disincentive to do so now that RVUs are being factored into the faculty compensation plan.

      RVUs have come and gone in our department and are coming around again. Back in the day, we used to have a multiplier to reflect the level of difficulty. I’m reminding managers about it.


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