APA Meeting Updates from Toronto: The Good and the Bad and No I’m Not There

Jim Amos MD 7OK, so even though I’ve not renewed my membership with the American Psychiatric Association (APA) for various reasons, I’m getting updates about this year’s annual meeting in Toronto. This contains news both good and bad.

First the bad; the announcement by American Board of Medical Specialties (ABMS) President and CEO, Dr. Lois Nora, MD, JD, MBA about the decision not to lose the controversial Performance in Practice (PIP) component of Part IV of the Maintenance of Certification (MOC) program.

This does not come as a surprise, of course. The ABMS has not been listening to rank-and-file physicians who know there’s no good evidence supporting the effectiveness of MOC programs and the infamous PIP modules are the bane of our working life. Even though the American Board of Psychiatry and Neurology (ABPN) makes a big production about making the feedback module optional, I’m not impressed.

“News

MOC Part IV Feedback Module Optional as of 2016
The ABPN Board of Directors has decided to make the Feedback Module an OPTIONAL component of Part IV in its Maintenance of Certification Program. As of January 1, 2016, the Feedback Module (patient or peer surveys) will become a highly recommended yet optional component for all ABPN diplomates enrolled in Maintenance of Certification. The Part IV Clinical Module component (chart review) will remain a requirement, with additional approved activities now available on our website. This change is in compliance with current MOC Standards as mandated by the American Board of Medical Specialties.”

Furthermore, I’ve taken a quick look at the so-called new approved PIP clinical products and I’m not excited about them. They are still not relevant to my practice. Now, the list is still hard to read and I may have missed something, but in my opinion the ABPN has a long way to go.

And what did Dr. Nora mean by “relaxation” referring to the requirements and expansion of activities in the PIP clinical component? It is the height of presumption to say that front-line doctors will “embrace” this time waster which hobbles the creativity of clinicians who search for ways to improve that will be relevant, engaging, and which will cultivate self-reflection and practical practice improvement from the inside out.

Even President and CEO of the ABPN, Larry Faulkner, MD acknowledges the PIP clinical module is “…controversial and difficult…” and there doesn’t seem to be any clear movement toward an alternative method for helping busy doctors engage in an improvement process that will convincingly improve patient outcomes in easily measurable ways.

I’m also not impressed with the APA implication that they are representing psychiatrists interests in this controversy by mentioning the letter they sent to the ABPN recommending that Part IV be eliminated. It’s too little, too late and one of the reasons I decided not to renew my membership, at a cost of $981 which does not include the hefty price tag on the main player in the MOC product line, the Focus Journal of Life-Long Learning in Psychiatry, which picks my pocket of nearly $400 for just 4 issues a year (nearly $700 for a two year subscription).

I wonder how many psychiatrists in private practice are members of APA, and how they meet these MOC requirements. After all, I have access to a lot of research literature through our university library. Can they afford the expensive MOC “products” and do they have access to the medical literature? Hey, I search the literature every day here and a simple check of PubMed is something I could almost take for granted because it’s so handy. I also use that literature to make sure I’m up to speed on what I’m doing for patients and colleagues in my role as a psychiatric consultant.

It’s more useful than the Focus journal and it doesn’t cost me hundreds of dollars a year. What if private practice psychiatrists had access to something like that? Could the boards cover the cost of something like it instead of sucking money out of us to cover the whopping salaries of their executives. Look and wonder at the ABPN Form 990 for Dr. Faulkner’s salary of $843,591.

Larry, could you spot me $10,000 until next Tuesday? I’m a little short on cash for MOC products.

What do most private practice psychiatrists make annually? And would they advise current residents in training to pursue private practice? Incredibly, one psychiatrist does just that in a recent issue of Current Psychiatry, despite the evidence from other quarters that private practitioners are a rapidly vanishing species. I still get notices from the American Medical Association (AMA), an organization to which I also chose not to renew my membership:

Number of independent physicians on the decline.
The Orlando (FL) Sentinel (5/17, Miller) reported that in today’s “rapidly changing health-care landscape, solo practitioners” are becoming an “endangered species.” The reasons, according to the Sentinel, are due in large part to health systems buying physician practices to “improve their market share,” and commercial insurance companies having less of an incentive to “negotiate reimbursement rates with some small practices.” The story adds that for small independent practices the challenges are numerous, including the complexity in dealing with new government regulations and standards, evolving practice and payment models, and the cost of implementing electronic health records. The Sentinel says recent data by consulting company Accenture show the number of independent physicians declining to 33 percent in 2016, down from 57 percent from 15 years ago.

Nevertheless, Dr. Ken Braslow, MD, has some pointers for those who want to enter private practice…without mentioning the perilous state of affairs in that arena. The advice includes general guidance without a warning that the devil’s in the details:

  • Establish a business model
  • Run the numbers carefully
  • Build your brand
  • Proceed thoughtfully; seek advice [1]

Braslow enthusiastically suggests that you: “Start blogging. If you enjoy writing, use a blog to showcase your talent and expertise. It is free advertising and makes you seem like a trusted authority. However, don’t start a blog unless you can commit to posting regularly.”

Thanks, Ken; I think I got that part covered, at least.

The leaders of the boards need a little “relaxation”–and so do I.

So here’s the good news at the APA meeting. Dr. Richard Kogan, a Julliard-trained pianist and psychiatrist, gives a very interesting presentation on Chopin.

 Reference:

1. Braslow, K., MD (2015) Some essentials to consider when opening a private psychiatric practice. Current Psychiatry 14, 54-55. URL http://www.currentpsychiatry.com/the-publication/issue-single-view/some-essentials-to-consider-when-opening-a-private-psychiatric-practice/0eb6f6262b6a86309c05b93b5c51d66e.html Date accessed May 20, 2015.

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