Iowa Psychiatric Society Moves Lifelong Learning Forward

I just got a message about our American Psychiatric Association (APA) district branch, the Iowa Psychiatric Society (IPS). It took action on the Maintenance of Certification (MOC). I’m rather proud of it because it supports the previous work by me and many other Iowa physicians through the Iowa Medical Society (IMS) to support lifelong learning in this state by opposing MOC and Maintenance of Licensure (MOL) including the following already adopted resolutions in the IMS Policy Compendium:

H-275.019: Licensure and Discipline, Maintenance of Licensure IMS supports the continued lifelong learning by physicians and the improvement to quality of practice; opposes the institution of Maintenance of Licensure for those physicians who are board certified and/or maintaining relevant CME and peer-reviewed quality of practice and/or participating in Maintenance of Certification; and opposes further Maintenance of Licensure implementation for all other physicians without sufficient supportive data demonstrating that the Maintenance of Licensure program supports patient outcomes and improves quality of care. H-2013-Source IMS Policy Compendium 2014

PF-275.020: Licensure and Discipline, Oppose Maintenance of Certification and Support Lifelong Learning IMS opposes mandatory Maintenance of Certification (MOC) for licensure, hospital privileges, and reimbursement from third party payers. IMS supports continuing medical education and the principle of lifelong learning by physicians. PF-9/25/2014-Source IMS Policy Compendium 2014

The Assembly Executive Committee (AEC) “overwhelmingly” passed  the motion copied below about a week ago, which was made by the Speaker of the Assembly and seconded by the Deputy Representative, Area 4 Council:

“I move that the APA Board of Trustees recommend to the ABPN that Part IV of the MOC be eliminated.  I further move that the APA reaffirm its commitment to lifelong learning and quality improvement and support for the highest scientific and ethical standards of medical practice.”

During a conference call of the AEC last Tuesday, there was “strong support” to have the Speaker make the motion at the Board of Trustees Meeting on March 14, 2015.

And of course as many of you already know from reading my blog, Part IV is the controversial Performance in Practice (PIP) requirements including the clinical and patient/peer feedback modules. Recall that the American Academy of Neurology (AAN) wrote to the American Board of Psychiatry and Neurology (ABPN) requesting that they eliminate Part IV of the MOC.

Because the Deputy Representative, Area 4 Council gave permission to post this message on the IPS website (I haven’t seen it yet), I can probably identify him as the Superintendent of the Mental Health Institute at Independence, Iowa, Dr. Bhasker J. Dave, MD, DLFAPA.

Dr. Dave also referenced the Newsweek article on The Ugly Civil War in American Medicine.

I would also like to point out the obvious “ouch” sign in the comment on the article posted on the American Board of Internal Medicine (ABIM) website:

In the statement the ABIM point out that “…internists have a choice among certifying boards that certify physicians in internal medicine and its subspecialties.”

That’s the “ouch” sign. They sound a little defensive. Does that mean the ABIM is acknowledging the legitimacy of competition from the National Board of Physicians And Surgeons (NBPAS)?

I hope the APA leadership listens to the Iowa district branch. And I encourage other district APA branches in other states to support similar motions. That might help rehabilitate the tarnished image of APA as a group that doesn’t represent the interests of its members. It’s pretty clear that psychiatrists are supportive of the principle of lifelong learning but opposed to MOC. There are a few more comments on the Medscape article (registration is free to read and leave comments) indicating dissatisfaction with MOC:

1. I dropped my membership in APA years ago – too expensive and too wrapped up with drug companies. 

2. I am a board certified psychiatrist, technically until 2019.  I cannot find the time nor justify the money to do what is required for MOC.  Luckily, my community mental health job does not require board certification.  Why?  Because there are already so many empty positions; if board certification were required, there would be no psychiatrists, just nurse practitioners working with these extremely medically and psychiatrically ill patients.  ABMS and ABPN claim that the public needs a way to be sure we are competent and current.  I guarantee that not one of my patients has even heard of MOC (or MOL).  They figure out if I am a good or bad psychiatrist by the results they obtain working with me. 

3. ABPN moc is a nightmare. Were I not required to maintain board cert for my current job, I would never again recertify. I can’t wait for NBPAS to add Psychiatry. I will begin boarding there instead, asap.

4. It is unfortunate that the APA has remained silent on this issue.  This is a reflection on the APA, rather than the practicing psychiatrists.  In many areas, including MOC, the APA over the years has been reactive or inactive rather than proactive in representing the best of interest of practicing psychiatric physicians.

5. I am a psychiatrist, member of the APA and board certified, and I AM THOROUGHLY DISGUSTED WITH ABPN. This has evolved into one big scam – clearly ABPN is doing it to line their pockets with a lifetime of fees from MDs too meek to speak up or challenge them on their nonsense. Maybe we should be asking for more transparency into ABPN’s finances? I know several colleagues who are letting their board certification lapse because they feel MOC is burdensome and arbitrary. Even the CME requirements feel meaningless to me. And I think it’s really suspect that they are sending out “seasoned” (read: old) psychiatrists who are GRANDFATHERED IN and have no “skin in the game” to talk up their terrible MOC system. EVERYONE certified before 1994 is grandfathered in and does not have to do MOC. What a sham.

6. Early on I spoke with ABPN representatives at the APA Annual Meetings.  When I tried to explain to them that as a forensic psychiatrist dealing solely in litigation of felony crimes and appointed by the Department of Defense for each case I have no “patients”.  I work solely for the court and the attorneys detailed to the cases.  It was like talking to my Labrador Retriever about stock trading strategies.  

There are two reasons the leadership doesn’t get it.  

1.  The former medical director was in bed with ABPN and pushed FOR the requirement

2.  About 90% of the governance is old enough to never recertify, so they don’t even understand it.

From taking the board recert exam for Forensic Psychiatry a couple of years ago I realized that over 90% of the exam was in areas not at all related to my practice setting.

Frankly, most private sector employers don’t seem to require certification and many of my colleagues have indicated to me that they were not going to recertify.  

ABPN has been quite successful in demonstrating their own irrelevance.  

7. I have to wonder just how many psychiatrists are left out there, and how many of them are APA members…

I haven’t heard even ONE psychiatrist speak out in favor of this atrocity called “MOC” (other than the members of the ABPN, who profit from this “enterprise”).

8. I am a board certified psychiatrist.   Huge problem with MOC.  Not in APA for years.  Why should I belong?  It is exuberantly irrelevant and self-justifying with a roll-over-and-take-it-from-all-angles attitude.

I’ll sign any petition against MOC.

I agree with all of the above, but especially identify with number 6. I’m a consulting psychiatrist exclusively. Technically, I don’t have any patients of my own either, so the PIP is not relevant to my practice. Ironically, when I asked the Academy of Psychosomatic Medicine (APM), the main U.S. organization supporting consulting psychiatrists, to oppose MOC they declined to do so. This is mainly because of the delicate political position they’re in. The APM is beholden to the APA for supporting it as a subspecialty of psychiatry. In fact the APM will be receiving the APA’s 2015 Distinguished Service Award in May.

Dr. Jim Amos, Medal of IronyI’m also a 2013 winner of the Medal of Irony Award. What’s that, what’s the incongruity here and how does it apply to MOC? Well, one of the other many layers of regulation over physicians is the Joint Commission’s Ongoing Professional Practice Evaluation (OPPE). Under my hospital’s metrics, because I’m a consulting psychiatrist, I’m essentially invisible to the OPPE and so it would be difficult to renew my hospital privileges–unless we count MOC. Then I’m probably fine. Assessments of physicians are geared toward those who staff inpatient units or outpatient clinics. A colleague commented on this and remarked that there should be an exception on the OPPE requirements for physician consultants like me. That’s why I’m a winner of a 2013 Medal of Irony Award and that’s one more reason why the PIP module should be eliminated.

I doubt that APA will go along with the Iowa district branch motion, not unless many other district branches follow suit. Iowa leads the way but Iowa can’t do it alone.

Further, I think grass roots support for the NBPAS should grow and it should be supported by groups like the Joint Commission. We probably should have an alternative to the ABPN no matter what it does about Part IV of the MOC.

I commend the Iowa Psychiatric Society for the action they’ve taken on MOC. It’s too soon to call it a victory but it’s a step in the right direction. Let’s hope the APA and the ABPN are listening.

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