Request ASN to Disassociate KSAP from MOC

Dear fellow Nephrologists,

ASN recently launched KSAP in addition to its NephSAP as another self-assessment study tool. As we appreciate the effort and welcome the new product, it is concerning that KSAP is based on ABIM's "examination blueprints" and have MOC points tied to it. I have asked ASN to untie KSAP to MOC in the following email 3/2015:

"It is great to have a question bank offered by the ASN to help fellows, as well as practicing Nephrologists, for testing our knowledge.  This tool was unavailable when I graduated from my fellowship. The efforts the ASN and the question writers and reviewers have put forth, is very much appreciated. However, I feel strongly that there should be no association between KSAP and MOC.
 

As you are no doubt aware, there have recently been escalating controversies with MOC.  In particular,

·        Newsweek article by Kurt Einchenwald
·        The BMJ blog post by Dr. Elisabeth Loder
·        A debate from the National Board of Physicians and Surgeons by Dr. Teirstein

In addition, ABIM’s financial transparency has continue to be questioned. Needless to say, myself and many others believe that the ABIM and its MOC are in trouble from an ever widening credibility gap.

 

I have written to ASN multiple times expressing my opposition of ASN implementation of MOC. I believe that ASN should stand firm and not solicit points for MOC before it is proven to be beneficial for Nephrologists and our practice. With ABIM’s shady image, I am disappointed to see that the ASN continues to be complacent with ABIM’s grand plan by promoting MOC. It is puzzling to me why the ASN, an organization cherished by Nephrologists for its education value, has not distanced itself from the deeply corrupted and quickly falling ABIM.  Why have we still not been formally polled about our opinion on MOC? Why does the highly anticipated KSAP have to be tied to the ABIM MOC program?

Therefore, I would like to suggest a few things for ASN to consider:

 

1.    Conduction of a poll on Nephrologists’ view on MOC, including each part of the MOC program. I think this is essential and long overdue. Following the poll, the ASN should show members the results, similar to the ACC.  I would acknowledge that other Nephrologists might have very different view from mine, which no matter the result, would prove valuable to the ASN leadership on this important issue.

2.    Disassociation of KSAP from MOC. There is no evidence that MOC equates to competency or quality of care whatsoever. Repeated “studies” conducted by ABIM board members themselves have been unable to demonstrate benefit. KSAP is embraced because of the content -- irrespective of MOC.  Tying it to ABIM MOC  forces Nephrologists to enroll in an onerous program with dubious goals. This stance is now shared by the Dermatology society which has advanced a proposed resolution to stop MOC.

3.    Develop an ASN-based certification program.  ABIM may well become irrelevant sometime in the near future, either due to upcoming investigations and/or losing credibility and faith from physicians. Both Endocrine and Cardiology societies have initiated discussions about alternate certification methods.  Case in point -- ASN already has developed a strong in-training exam for fellows.  It would be logical to partner with organizations such as NBME for the next step and develop a certification examination.  Certification by this exam could be sanctioned by a new board (see below), or ASN itself.

4.    I have sent you the information on the new board, the National Board of Physicians and Surgeons, and would continue to ask if it is possible for the ASN to work with NBPAS to facilitate new certification and MOC goals for nephrologists. "

Help needed! Professional societies, are you in?

It is certainly a sobering process for every physician going from initially hoping that ABIM will listen to us, modify their MOC program, to finally realizing that our wishes are the complete opposite to ABIM's hidden interests. After a few days of "listening", ABIM is not even pretending anymore. The G+ group was shut, and the "Transforming ABIM" blog has deleted every single comment physicians left there, all happened while ABIM sent out a letter claiming that there is "more listening", "really listen" and "keeping-up". Despite support from major media, major journal, several bills with mandatory MOC written in them quietly passed. The war on American's doctors continues.

Will our grassroots effort succeed? Being pessimistic, I doubt it, at least not without the support from our professional societies.

I have urged our professional society to take a stand and help (see the letter below). Not showing in this email are suggestions such as working with alternative board certification entities, which was communicated in previous emails.

ABIM has scheduled an Internal Medicine Summit on Sunday, April 12, 2015. EVERY specialty society will be there. Doctors, please email your specialty leaders and tell them your opinion on MOC. It is time for all professional societies to act on behalf of their members, to say No to MOC, to stop the abuse, to break ABMS/ABIM's monopoly, to restore the sanity, and to fight to give us back the time with patients.   

***********

Dear ASN,

 

I am sure at this point you have read the new report on how the ABIM has been applying creative accounting and deceptive lobbying practices to coerce additional funding by mandating physicians into the yet-to-be-proven-effective MOC.  

I hope the outrage, frustration and helplessness of all physicians in this situation will not be overlooked by the ASN and other societies. The facts uncovered by the Newsweek editorial should put yet another nail in the coffin of the ABIM, further eroding its credibility and trust with physicians.  On this basis, it is imprudent to continue working with ABIM on any MOC activity. 

Therefore, I would suggest that the ASN consider the following actions:

1. Stop any MOC program currently initiated by ABIM.
1. It is a perfect example of “conflict of interest”:  the ABIM is a credentialing organization that is promoting more testing. As the editorial so eloquently describes, MOC is merely a fig leaf to conceal their spending extravaganzas, creative accounting tricks, and deplorable state of their finances.
2. MOC has never been proven to be beneficial, even by ABIM’s own “study”. There is no difference in the care delivered by grandfathered physicians and those with time-limited certificates. At least 10 countries have better healthcare with better outcomes, lower costs, and, yes, no requirements for MOC.  Thus, there is no ground for mandating MOC in the name of “competency”,  and furthermore it is a waste of resources to continue to collect more data on the putative utility of MOC.   I would urge you to stop saying that “more data is needed” and recognize that no further studies are indicated. We must stop MOC NOW.
2. Distance the ASN from ABIM
1. ABIM has become a corrupted organization that might be subject to further investigation.
2. ABIM has been distancing itself from physicians. The fact that they state and they are “listening” while all comments left on their blog has been completely deleted says it all. They lied to physicians about its spending and its intentions behind MOC. As a result they have lost the respect and trust of rank-and-file physicians.
3. ABIM should not be setting standards for quality, value, or professionalism. It is completely inappropriate that only the ABIM has set MOC as the single standard for physician competency, and appalling that the ABIM MOC program has turned physicians into easy targets as an explanation for our dysfunctional health care system. In a sense, ABIM, ACP, and the AMA have all failed physicians as our representatives.
3. ASN should take over the role of certifying and educating Nephrologists.
1. Initial certification plus yearly high quality CME should be sufficient.
2. ASN already has strong education programs available.
3. Patient care is the best all-around way of self-education and improvement
4. CME is a continuous process with wide varieties to meet physician needs. If the same CME works for physicians from other countries, the problem is not CME. There is absolutely no need to “create” a “continuous MOC”.
4. Please work on removing mandatory MOC from every bill or law, the ACA, the Interstate medical licensure compact, HR 2, etc. The national and political encirclement of these legislative bodies by the ABIM is deplorable, and underscores the extents to which the organization has gone to protect its economic interests.