Editor’s Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by H.L. Greenberg, MD, a board certified dermatologist . The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.
We are in the midst of a common sense revolution in the house of medicine.
On Sunday, March 6th, I will be presenting a resolution for a vote by the full membership of the American Academy of Dermatology (AAD) to change the bylaws of the AAD to read that the organization is fully opposed to Maintenance of Certification (MOC) and board recertification.
The old guard in the house of medicine put-in-place rules that do not apply to themselves by “grandfathering” in those older physicians who do not need to jump through the same extra hoops as themselves in order to remain board certified.
Having made themselves immune to the unfair and unjust systems of (MOC) and board recertification, the older leadership—which currently maintains a stranglehold on the power structure of medicine—will soon be replaced with a younger generation of physician tired of a system that has long ago sold out its young physicians for their own benefit.
I let my American Board of Internal Medicine (ABIM) certification expire years ago because I did not want to pay the fees or take the time out of my schedule to remain “board certified” since I only practice as a dermatologist.
It is my firm belief that once a person is board certified, they are board certified for life. In the same manner that once I have my high school diploma or college degree, I have that for life—I do not feel the need to cross that bridge every 10 years with another examination or proof of quality, the same goes with medical school and so on.
As a physician who plans on practicing medicine for the next 20 years, I do not want the current group of “leaders” representing me on any front as their efforts though seemingly well intentioned have done nothing but bring about ICD10, Quality Measures, Meaningful Use, Electronic Health Records (EHR), and a whole host of other horrible policies including the ones that I am currently fighting against- MOC and recertification.
There is a vast and growing network of like-minded physicians and lay people across the age and ideological spectrum in the Twitterverse and other social media sites railing against the medical establishment leadership for policies that benefit those on the top of the various medical boards without truly benefitting the real world physicians seeing patients on a daily basis.
The real power struggle in the house of medicine is over who defines quality, and how quality is put into the laws of our nation and ultimately how quality will be used as a barometer through which to pay or penalize physicians.
The American Board of Medical Specialties (ABMS), through its lobbying efforts, has been masterful in somehow equating board certification, MOC and recertification to quality. Although each state determines what it means to be a licensed physician, the ABMS is doing its best to monopolize its definition of quality into something that is universally accepted and the criteria by which the Centers for Medicare & Medicaid Services (CMS) will use to determine payments and participation of physicians in its network.
Because other insurance companies use CMS definitions and criteria as the standard, lobbying efforts by ABMS and the American Medical Association to define quality have extraordinary power.
When I raised the quality issue with my congressman, Dr. Joe Heck, a fellow physician, he said that people want quality of care. I agree with him, but I don’t agree that legislating quality is the appropriate means by which this should be achieved, because I do not believe that government of all places can legislate quality—we are all different and what is quality to me may not be quality to you.
Additionally, equating one organization’s definition of quality (MOC and recertification) to quality across the spectrum is unfair.
My contention is that quality cannot be defined; one only knows quality when one does or does not see and experience it. Additionally, legislating quality is a tricky and impossible business—certainly not within the purview of the ABMS.
The ABMS, ABD or AMA doesn’t come to my clinic and determine the quality of care I provide. The people I treat determine the quality of care they receive—be it through their feedback to my office surveys, Yelp!, other social media sites or their feet.
When I go to Starbucks to get my coffee, I expect a certain level of quality, but there may be a million factors that go into whether I determine that my coffee is quality or not. Alternative boards like The National Board of Physicians and Surgeons (NBPAS) have been set up to take on the stranglehold the ABMS enjoys on recertification and MOC, thereby affecting the definition of quality argument.
My view is that the NBPAS is not much different from the ABMS in terms of charging us to “maintain certification.” What does it mean to, “maintain certification?” In my mind, it means paying an extortion fee to my governing board for no sound reason.
It is the MOC, and the ABMS entities that require physicians to follow a set program benefiting the ABMS specialties alone, which I find so abhorrent as these ABMS entities are stealing time and resources from physicians. My goal, and the goal of many, is to rid us all of the cancer which is MOC and recertification by forcing change.
H.L. Greenberg, MD, (Twitter: @hlgreenberg) is a board certified dermatologist and founder of Las Vegas Dermatology, practicing in Las Vegas since 2006, he specializes in cosmetic, laser, surgical and medical dermatology.