How the MOC Debate and Aikido Could Be Alike

This post contains a few remarks about petitions and debates about opposing Maintenance of Certification (MOC) and Maintenance of Licensure (MOL). So I’ve closed my petition to oppose Maintenance of Licensure (MOL) in Iowa for a couple of reasons. The main one is that the Iowa Board of Medicine (IBM) has indicated to me that it doesn’t think MOL is needed in Iowa for now. However, the IBM has not guaranteed that it would never pursue MOL in the future. The other reason is that the petition never attained the goal of 100 signatures in the year it was open. See the petition link for the update, which contains the highlight, copied below:

I’ve decided to close this petition. While we never reached the goal of 100 signatures, I received word from the Iowa Board of Medicine (IBM) that it would not be pursuing MOL. This was after I introduced resolutions that were passed by the Iowa Medical Society (IMS) in the last year to support the principle of lifelong learning and oppose both MOC and MOL. While I had the option to call this a “victory” I chose not to do that because, besides my impression that my direct action via the IMS was more effective than the petition, the IBM has not guaranteed that it won’t pick up the issue again in the future.

This reminds me of the disappearance of the two major petitions opposing the recent changes to the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) and the pledge of noncompliance with MOC.

They’re both no longer available and I think it’s because the petitioners simply took them down. Did the American Board of Medical Specialties (ABMS) listen to any of the petitioners?

Which brings me to the second topic, which is the upcoming debate and Town Hall meeting next Tuesday, December 2, 2014 at the Philadelphia County Medical Society (see previous post in which I first announced this event) on the issue of IS MAINTENANCE OF CERTIFICATION (MOC) NEEDED AND APPROPRIATELY CONSTRUCTED FOR SUCCESS?

This is not the first debate on MOC and readers might recall the first one last year, also in Philadelphia:BRSInvitePennApril2013

The forthcoming debate between ABIM President and CEO, Dr. Richard Baron, MD and Charles Cutler, MD, Immediate Past Chair, Board of Regents of the American College of Physicians, will probably cover much of the same ground as last year’s event. The video below might give readers the gist of Dr. Baron’s message next week:

And will this move us forward and to what end? Don’t get me wrong. I’m all for debates, discussion, petitions, whatever it takes–to get us beyond the adversarial positions in which we’re now entrenched. Does anyone seriously believe that Cutler will persuade Baron to agree with his position (which is likely to be the opposite of Baron’s)?

By the way, this reminds me of the Aikido exercise in my Mindfulness-Based Stress Reduction (MBSR) course this summer (which I’m still practicing), which led to a post about the 3 ways in which many approach conflict management:

The Implacable: a tough guy approach, prone to resisting what’s happening and forcing a situation or person to be different.

The Impossible: a belligerent drunk approach, prone to ignoring instead of acknowledging and accepting inner pain, instead flinging it upon others and causing suffering for himself and others.

The Impeccable: a wise elder approach, meeting conflict or whatever is happening with acceptance and kind attention, without passivity or condoning, instead skillfully choosing how to relate.

As a guy who tends to choose the path of implacability, I see the MOC debate as a struggle between opponents both adopting that approach much of the time. This is also something Jon Kabat-Zinn, PhD talks about in his book, Full Catastrophe Living, when he describes the “blending” exercise in aikido. It’s a way of responding to instead of reacting to stress, which in this case would be the attack of a debater, regardless of side. Metaphorically, it involves stepping into the attacker slightly to the side so as to avoid taking the full brunt of the attack. Blending involves turning so that both of you end up facing in the same direction, sort of seeing an issue from each others’ perspective. It allows both to keep their own integrity yet communicate “…that you are not afraid of making contact nor are you willing to let his or her energy overwhelm or harm you. At this moment you become partners rather than adversaries, whether the other person wants to or not.”

Buddha in FallMaybe if we were less implacable and more impeccable, we could move beyond the MOC conflict and work together.

Will it be that kind of debate? Most of us won’t know unless we attend it. I can’t because I’ll be on duty at the hospital. I hope someone will videotape the proceedings.


Kabat-Zinn, J. and University of Massachusetts Medical Center/Worcester. Stress Reduction Clinic. (1991). Full catastrophe living : using the wisdom of your body and mind to face stress, pain, and illness. New York, N.Y., Pub. by Dell Publishing, a division of Bantam Doubleday Dell Pub. Group.