I saw a couple of articles in Forbes that seemed to be related although maybe it’s only in my own mind. First the article by Larry Husten on the Maintenance of Certification (MOC), which I tweeted:
It’s actually a combination of two articles in which the comments steal the show. In fact, I suppose I should thank Larry for posting his opinion, which left him open to criticism which he acknowledged but still didn’t seem to get. Just as one who commented said, you should probably read the comments first, then read Larry’s story. It’s pretty clear he didn’t do his homework.
My wife suggested I write a counter article to submit to Forbes, but after reading the comments, I can see I really don’t need to do that. Doctors are not opposed to the principle of lifelong learning. We’re just not convinced that the MOC, in its current form, helps us embody the principle. The most frustrating part of it is that most of the modules are not relevant to our practices.
I’m compliant with MOC and just to be fair to the other side, I think it’s important for psychiatrists to be familiar with the MOC process as it is currently structured.
All clear on that? That was just to show that It’s very complicated and that complexity could be part of the reason Larry Husten didn’t do his homework on the MOC issue.
The other Forbes article is on a topic which, at first glance, doesn’t seem to have any connection with MOC.
So, for years, I’ve been using Turbotax Deluxe and we’ve been able to navigate the application fine for our tax situation. This year we felt manipulated into uupgrading to Turbotax Premier for an extra $30. Like many others, we were cornered into either lying on our taxes or upgrading from Deluxe to Premier. We abhor lying and Turbotax probably capitalized on that fear and loathing (especially the fear of lying to tax authorities), betting it could steer us into spending more money on a software upgrade–that it turns out we really didn’t need. It did make navigating the application a lot more difficult, made it unnecessarily confusing, and was filled with obvious mistakes uncharacteristic of the software in the past.
OK, so I’m not going to bore you with all of our tax filing frustrations; you’ve got enough of your own. But here’s the connection between Turbotaxgate and MOC: if Turbotax caught you as well, it probably did so based on what most of us perceive as the money-grabbing, fear-mongering maneuver that looks like it was intentionally conceived and implemented by Turbotax executives. And MOC has been promulgated by corporate boards on the same basis–fear: fear that if doctors aren’t participating in MOC, patients will be exposed to poor or dangerous medical care. The best example is the Bristol heart babies scandal, which led to the revalidation process in the United Kingdom.
The truth is that MOC will never protect patients from incompetent doctors, and it especially won’t protect them from dangerous psychopathic doctors. That’s what state medical boards are for. And by the way, there’s a lot of money in the MOC business for corporate boards.
So the connection between Turbotaxgate and the MOC is that both are based in greed and propelled by manipulation exploiting the natural tendencies of most people to try to live up to higher ethical and moral standards. In my opinion, that is a cynical way to do business.
In all fairness to Larry Husten, I’m aware that there are bad doctors are out there. But I think the best way to protect patients from them is to prevent them from getting into medicine in the first place. I don’t pretend to have all the answers but I’m hopeful that changes now occurring in our medical school curricula will go a lot further in achieving safer and more competent care for patients than the MOC.
We can switch between tax preparation software applications. No doubt some of us will do that next year out of disgust with Turbotaxgate. But doctors can’t just walk away from all of the forces promulgating MOC, which now include the Affordable Care Act (ACA), hospital credentialing committees, the Centers for Medicare and Medicaid Services (CMS), private insurance companies as well as the American Board of Medical Specialties (ABMS) and the specialty boards.
So how do we live with ourselves as doctors under the tyranny of MOC? One way we cope is to fight tooth and nail the MOC, along with a lot of other governmental, administrative, and insurance company intrusions. Blogs, petitions, a Federal Lawsuit, debates, and several state medical society resolutions opposing both MOC and its second cousin Maintenance of Licensure (MOL, in which MOC would be tied to medical licensure) all have done next to nothing to persuade boards to see that MOC in its current form incites fear and loathing from physicians.
How does this translate to safer and better care for patients?
How did making taxpayers afraid help us fare better on our taxes after Turbotaxgate?
At its core these events point to the need for individuals to exercise integrity where the rubber meets the road. If the Turbotax CEO doesn’t have it in him, then taxpayers can rise up and demand better treatment. If corporate boards refuse to treat physicians with respect and keep enforcing empty regulations and piling on busywork MOC modules in a futile effort to impose reflective self-improvement from without rather than trusting doctors to do this the only way it can be done, from the inside out–we’ll continue to do what we’ve always done.
We choose to do anything we can to keep the relationship between patients and physicians important above all other intrusions. We do this in hospitals and clinics every day across America. We write petitions even though there is no authority who could use them to influence policy changes. We write State Medical Society resolutions even though they don’t have the force of law. We try to establish new boards even though they won’t have the legitimacy that older boards have. We call for class action lawsuits even though we can’t get enough physicians together to act as a group with solidarity.
And like Larry Husten’s imperfect analogy between airline pilots and doctors, my analogy between Turbotaxgate and MOC fails. As a large group of taxpayers, we have the potential power to influence a CEO’s market share, quarterly margins, and bottom line–which is really all that matters in the business world.
As doctors our allegiance to our patients and their families makes us individuals, more like paladins than members of a political force. And paladins see themselves as protectors of a higher ethical and moral standard.