Civil Debate on Maintenance of Certification

Readers on Twitter want to know what the response is to my letter to Dr. Jeffrey Lyness, MD, FACPsych at the American Board of Psychiatry and Neurology (ABPN) and my letter to Dr. Lois Nora, MD, JD, MBA at the American Board of Medical Specialties (ABMS). I promised I would post if either one replied.

I’m still waiting for an answer from Dr. Nora. Dr. Lyness replied promptly and remarked that the Medscape story could have done a better job of reporting what he actually said at the AAGP meeting.  I’m not going to quote him because the reply was in an email message and I did not have his permission to publish it nor did I request it. He thought that the MOC could become one way for doctors to document what competent physicians are doing and have always done in the pursuit of continuous self-reflective professional development.

He also mentioned that the ABPN shares the feedback it gets from ABPN diplomates with the ABMS, which in his opinion has led to increasing flexibility of the ABMS leading in turn to the increased flexibility of the ABPN in its own Maintenance of Certification (MOC) requirements. He also was very clear that the ABPN needs to maintain a commitment to the ABMS standards so as to avoid jeopardizing the certification status of diplomates.

Dr. Lyness was happy to hear any specific recommendations from physicians on how to improve MOC provided they remain within the ABMS requirement framework.

He also politely thanked me for my efforts to promote self-improvement among physicians.

I thought Dr. Lyness’s reply was courteous and civil, which I think is a breath of fresh air in light of the ongoing shenanigans in the current presidential campaign season.

Here’s an excerpt of what I said to Dr. Lyness in my reply:

You can read my blog post on 3/25/2016 which is  my open letter to Dr. Lois Nora about why I think the ABMS framework is fundamentally flawed and explains why I don’t believe specific suggestions on trying to improve MOC within that framework would be helpful. Most of it is quoted from the letter written by the President of the National Association Medical Staff Services (NAMSS) in 2013 to Dr. Nora about concerns regarding the standards.

I’m more excited about maintaining my clinical competence than worried about jeopardizing my certification status.

I’m not holding my breath for Dr. Nora’s answer. If it appears, I suspect it will be in a similar vein as the one from Dr. Lyness. I direct the attention of my trainees to my efforts in the MOC debate in order to role model the idea that there is still room for civil disagreement on issues central to the mission of physicians everywhere and to implementing the core competencies. I wonder if our honest and respectful debate will provide an example to the presidential candidates…probably not.

Psychiatry Consult Service Team March 2016

Psychiatry Consult Service Team March 2016

I think it’s more helpful to take direct action in the MOC debate, speaking with those who are in a position to do something about the problem rather than waste time commenting in Medscape articles. I have always believed that spinning in our own turmoil about this issue will get us nowhere. When physicians engage in thoughtful discussion, progress is more likely although it may not produce much obvious motion in either direction right away. Change is always coming.

In other words, “Write your congressman.” On second thought, maybe you better not in view of the recent behavior of politicians.

As I approach retirement, I remain hopeful that the good physicians’ way of doing what we have always done to maintain competency and even promote excellence will someday prevail over the current focus on certification status.

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