If Only We Knew Then What We Know Now

Comply and Oppose

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I left a comment on the March 17, 2015 Psychiatric Times article “ABIM Finally Gets It Right” by Sidney Weissman, MD, and it should make us all wonder what is the real worth of board certification, let alone Maintenance of Certification (MOC). You can get the same message from Dr. Wes in his post “Money for Nothing.”

I also doubt ABIM has finally got it right and after years of inaction on MOC, the APA sent a letter to the ABPN recommending that it drop Part IV of the MOC, which includes the PIP, a time-wasting endeavor which has no support in the literature for improving patient outcomes.

You know, this morning I’m looking at both of them and notice this ad right below each one. I’m sure we’ve viewed it so many times it’s probably invisible. Ironically it’s an ad for “ABIM Certification Review. Peace of Mind: Pass Your Internal Medicine Board Exam–Guaranteed!”

Just for fun, I clicked to remove the ad. It gave me a little survey asking what’s wrong with it. I had only 3 choices:

  • Irrelevant
  • Inappropriate
  • Repetitive

The list should include another option, maybe “Ironic” or “Misleading.” I’m sure you can think of others. While we’re on the subject of irony, I should mention the message I got from a colleague asking me if I wanted to be nominated to “Distinguished Fellow” rank in the American Psychiatric Association (APA). This is ironic because, as all my readers know, I decided not to renew my APA membership this year because I don’t think the organization represents my interests, especially regarding MOC, and because it’s very expensive–$981.

I doubt APA sees me as a distinguished fellow. The APA letter I never got (probably because I failed to renew my membership), which was sent to the American Board of Psychiatry and Neurology (ABPN) suggesting Part IV of the MOC be eliminated was too little, too late. I doubt the ABPN will pay any attention.

So how’s the National Board of Physicians and Surgeons Survey going? Like most surveys, responses are in the handful range, but so far it’s unanimous in favor of having an alternative board and supportive of the NBPAS. Comments are representative of what we’d see from physicians:

NBPAS Survey Comments1

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NBPAS Survey Comments2

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I’ve been talking with my hospital and departmental and administrative leaders as well about considering the acceptance of the new alternative certification board, the National Board of Physicians and Surgeons, launched by Dr. Paul Teirstein, MD, Chief of Cardiology and Director of Interventional Cardiology for the Scripps Clinic in San Diego.

You could consider doing the same. You might discover you could keep your money in your pocket either way. If I had known then what I know now, would I have campaigned so vigorously for the past several years in opposing MOC? I probably would have because I’m also campaigning in support of the principle of lifelong learning.

Of course, if you doubt I believe in the principle of lifelong learning, you can visit my blog site any time and find free access to our psychiatry consultation service’s Clinical Problems in Consultation Psychiatry (CPCP) educational presentations. They’re relevant to my practice, which I can’t say about most of the expensive MOC products available through the ABPN.

I engage in daily professional development in my clinical work because I want to do it and if I didn’t I wouldn’t be able to perform at the top of my game as a doctor caring for my patients. I don’t have time for MOC busywork.

Dr. Jim Amos, Medal of IronyYou know, I see irony in a lot of different places, which is probably another reason why I was the logical choice for winning the coveted Medal of Irony Award. I was thinking about way back when in the late 1970s when psychiatrists were raising many of the same objections to mandatory CME as we are now about the MOC. I wonder how I’m supposed to make sense of that. Maybe it’s that if we had known back then what we know now, we might not have raised so many alarms about CME–especially since we now defend it as being far superior to MOC. Then again–maybe not.


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