Reflections on the Recent MOC Debate in Philadelphia

Remember that recent post about the Maintenance of Certification (MOC) debate on December 2, 2014? Last night I had the opportunity to view two videos of the debate “Is Maintenance of Certification (MOC) Needed and Appropriately Constructed for Success?”

I’ve also read a blog post about it which contained one of the videos. I’ve included both below and I invite readers to view them.

Obviously they don’t contain the whole of what went on between 7:00-9:00 PM that evening. As I watched, I wondered whether the attendees did what I hoped they would do, which is to try to adopt a sort of perspective-sharing rather than adversarial implacability.

I think they made a valiant effort. It didn’t sound like there was even one physician in the audience who supported MOC.

But they respected Dr. Richard Baron, the President and CEO of the American Board of Internal Medicine (ABIM). And they let him leave with his skin on.

And there was something else I noticed, which was Dr. Baron’s answer to a provocative question from one doctor, which challenged him to explain what evidence there was that could persuade rank and file physicians that they should trust ABIM.

He said simply, “I’m here.” His opponent, Dr. Cutler, then supported Dr. Baron, saying that the previous CEO of ABIM would not have bothered to show up, even admitting that he had signed up for MOC, which was a little surprising. Dr. Cutler defended him, although he’d earlier made it abundantly clear that he thought ABIM had lost its way since the 1980s.

It was a spirited, intense debate, although I would not call it rancorous or bitter. It was a difficult conversation. While I was not persuaded they found common ground (and I didn’t expect them to), they made the attempt and they respected each other.

Where do we go from here? I don’t have the answers although I notice that some physicians formed a union in Oregon. This is an historic event as this has never occurred before that I know of. I’ve always said that doctors will never unionize. And now it looks like it’s been done. I’m not sure if it will promote the evolution of the MOC debate.

I noticed something else about the videos besides the display of intense emotion under tight control. They’re both YouTube shows and when they concluded, I saw the usual selection of other videos.

Among them was one my wife had urged me to view yesterday morning. It has no earthly connection to MOC or any of the debaters or attendees of the event, other than a depiction of how impossible it is to avoid conflict between leaders–and how good it can feel to let the steam off at times.



  1. I just became aware of the other YouTube Video of the middle portion of the debate, which is below.


  2. Jim, I tried your theory of impeccability, by asking him the last question, to which he replied “i’m here”….We knew nothing would be settled that night. But we laid out the facts and made him aware that we were no idiots, and that we would move in a different direction if ABIM does not change its MOC process.


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