He discusses the growing backlash against the "Maintenance of Certification" (MOC) requirements by the American Board of Internal Medicine (ABIM). In theory, a private agency that certifies that doctors are keeping up on important clinical knowledge is good. But his series of articles on the ABIM's process shows serious problem with the specific methods chosen.
From the article:
Dr. Jones can’t manage his practice, care for his family and study for the certification exams administered by the American Board of Internal Medicine. The tests purportedly insure doctors’ competence, but, like many physicians, Dr. Jones says the questions often have nothing to with what he sees in his practice and are little more than a game of medical Trivial Pursuit. Dr. Jones can’t afford the thousands of dollars for study guides and classes to learn obscure, often irrelevant information, and has no time to review the material every night for months. He failed the test, so his hospital will no longer allow him to admit patients because he couldn’t answer questions about diseases he will never encounter....The article also describes how other specialties (such as the anesthesiologists certification board) are adopting other methods to ensure physician quality through tests and quizzes that are more relevant to clinical practice.
This medical protection racket has made millionaires of ABIM top officers, financed a ritzy condominium, limousines and first-class travel, all while sucking huge sums of cash out of the health care system. But now, after decades of unchecked rule by ABIM, cracks are appearing in the organization’s facade of power. Thousands of doctors began a widespread revolt months ago and, in the last few weeks, evidence that their efforts are succeeding has started rolling in...
[A recent study in the Annals of Internal Medicine] concluded that internists incur an average of $23,607 in MOC costs over 10 years—with doctors who specialize in cancers and blood diseases out $40,495. All told, the study concluded, MOC will suck $5.7 billion out of the health care system over 10 years, including $5.1 billion in time costs (resulting from 32.7 million physician-hours spent on MOC) and $561 million in testing costs. And remember—all that time and expense is for a program that has not been proven to accomplish anything.
Let's hope the ABIM learns from their example.
And kudos to Kurt Eichenwald for continuing to report on this developing issue.
(Link via Dr. Megan Edison and Dr. Matthew Bowdish.)