BOSTON – Four-thirty in the afternoon isn’t the time slot most conference presenters covet.
By that point, many attendees are done for the day – loaded up with new knowledge and weighed down with schwag-stuffed tote bags. By 4:30 p.m., the hotel bar is enjoying stronger attendance and better survey-sheet ratings than a closing-time clinical diagnosis session.
But, by 4:30 Thursday at the annual meeting of the American College of Physicians, cavernous room 107 in Boston’s convention center was filling up.
Was it hosting “Atrial Fibrillation 2015”? “Prescribing Chronic Opioids”? “Update in Endocrinology”?
In fact, the session’s topic wasn’t clinical, but its nature was definitely acute. Room 107’s attendees had arrived for a session with the potential for as much action as the weekend’s upcoming Mayweather-Pacquiao megafight: “ABIM: Understanding MOC Requirements.”
There behind the podium stood the subdued president and CEO of the American Board of Internal Medicine, Dr. Richard J. Baron, looking like a Yankees fan about to lecture the Fenway Park faithful on the many merits of Bucky “Bleepin’ ” Dent.
In fact, before him seethed bleachers of angry doctors eager to share their opinions about what they viewed as ABIM’s own Bucky Dent: the Maintenance of Certification program.
With the ABIM board’s chair-elect, Dr. Clarence Braddock III, sitting nearby on the dais, Dr. Baron dutifully outlined the MOC backtracking that came with February’s public apology by ABIM: updates to its internal medicine exam; suspension of the practice assessment, patient voice, and patient safety requirements for at least 2 years; and MOC enrollment fees set at or below the 2014 levels through at least 2017. And if those three requirements did return, ABIM would give physicians a year’s notice before they would have to start meeting them.
By the end of the year, ABIM also will unveil more flexible ways to earn MOC points, Dr. Baron noted. He also offered his listeners assurances that the fall 2015 MOC exam would better reflect doctors’ clinical experiences.
“The most important thing we learned from Feb. 3 is that ABIM needed to change to an organization much more rooted in the community,” Dr. Baron explained.
Then he opened the meeting to questions from the audience – triggering an Airing of Grievances worthy of a “Seinfeld” Festivus.
Terry Rudd/Frontline Medical Communications
Physicians share their concerns.
Beginning with a New Jersey physician who vigorously aired her own grievances at a volume that made a microphone redundant – “Don’t scare us away – we WANT to keep up!” – room 107’s open mics amplified a steady stream of physicians eager to vent their MOC-fueled fury and despair.
What about changing the MOC exam to open-book? “ ‘Consult the gastroenterologist’ is the real-world approach to solving problems!” Why can’t multiple sources of CME credit count toward MOC? Why not dump the recertification exam and simply use the modules to keep physicians fresh?
One physician who spent most of his practice in urgent-care settings and occupational medicine – in which relationships with patients are, by nature, short-lived – worried that a return of the patient voice requirement would make failure certain for him.
“I may be 72, but I will retire before I do one of those Practice Improvement Modules again!” warned another physician.
Attendees also zeroed in on financial allegations made in two recent Newsweek articles about ABIM (“The Ugly Civil War in American Medicine” and “A Certified Medical Controversy”). “Is an independent group going to review reports about ABIM’s finances?” one attendee asked. Another stated that ABIM’s board shouldn’t be paid, a suggestion for which the doctor received a generous round of applause.
Dr. Baron categorically dismissed claims that ABIM was financially troubled and that it manipulated exams to drive down pass rates – and thus boost its revenues with retests. “We had the sixth-largest auditor review our finances, and they found no issue with our finances,” Dr. Baron countered. “Our audited finances are available on our website.”
Although the audience appeared unified in its deep displeasure with ABIM’s approach to the now-postponed MOC changes, the still-active issue of recertification exams revealed fissures between older and younger doctors.
One younger physician questioned the fairness of the dual system: “Why do older doctors not have to recertify? Abolish grandfathering!”
That drove “grandfathered” physicians to the room mics to defend their exclusion from recertification tests. Some stated that no data backed the belief that recertified physicians delivered better care. One grandfathered physician insisted she shouldn’t be “bullied into recertifying.”
Dr. Baron backed recertification by declaring that “we know that knowledge decays over time.” A study of grandfathered physicians vs. recertified physicians showed higher costs associated with grandfathers, he added.