Why the ABIM (and other ABMS MOC programs) Need to Be Reformed

Dr. Wes Fisher has done a great job showing the real problem with the American Board of Internal Medicine (ABIM)and their suspect motivations. Anyone who questions whether the ABIM or any ABMS body like the American Boards of Anesthesiology, Family Practice, Pediatrics, Emergency Medicine, etc. have financial interests to increase testing or buy required educational modules needs only to see how far the ABIM has gone with its offshore accounts, Manhattan real estate to see why physicians need to resist this runaway recertification train. Below is the excerpt from his year in review chronicling the ABIM. Please visit his site to get up to date info too.

ABMS/ABIM MOC Controversy: 2016 Year-in-Review

It’s hard to believe that another year has come and gone since my 2015 update on the ABMS/ABIM Maintenanence of Certification controversy. I thought it would be important to maintain this chronological annual review of the ABIM and their conspiring organizations to keep physicians and the public apprised of the situation unfolding. Here is the timeline of the major developments regarding the ABIM MOC controversy for the past year so far:*

• 12 Jan 2016 – All ABIM archived webpages published after 1 Jan 2014 are removed from the internet archive Wayback Machine at http://www.archive.org

• 13 Jan 2016 – More evidence for improper research practices used at ABIM surface on the ABIM website as physicians are asked to “update their profile” so the ABIM can research ways to “improve health care.” ABIM diplomates are not informed on the research being conducted nor have they been given informed consent about the research activities being conducted.

• 21 Jan 2016 – ABIM Foundation publicly discloses for the first time $56 million in transfers (unverified) from ABIM since 1990.

• 26 January 2016 – Robert Wachter, MD, former Chairman of the Board of the ABIM and its Foundation, publishes a New York Times opinion piece entitled “How Measurement Fails Doctors and Teachers” and suggests “the secret of quality is love.” With the article, Wachter  fails to disclose his own conflicts with the “measurement industry” at the ABIM and ABIM Foundation and the stock earnings he received from IPC Hospitalist Company (later acquired by TeamHealth) that is under federal investigation for overbilling Medicare.

• 16 Feb 2016 – The website DoctorsJustice.com goes live to support the legal defense and countersuit of Jamie Salas-Rushford, MD, a Puerto Rican physician sanctioned and then sued by the ABIM in 2012 for allegedly disclosing ABIM test questions to Rajender Arora, MD, the creator of the now defunct ACGME-accreditied Arora Board Review courses as he studied for his certification examination. Numerous sanction letters and court documents against Dr. Salas Rushford appear online.

• 8 March 2016 – The peer-reviewed journal article, “Medical Specialty Certification in the US – A False Idol?” is published.

• 11 March 2016 – Like the practicing physicians’ anti-MOC activities underway, medical students push back against another unneccessary and expensive testing requirement: the National Board of Medical Examiners’ Step 2 CS requirement.

• 12 March 2016 – The sworn testimony of Rajender Arora, MD of the ABIM’s raid on his home by Federal Marshals appears online and offers remarkable details of the operation ABIM used to gain access to hundreds of review course attendees’ personal information and email accounts.

• 1 April 2016 – Robert Wachter’s industry-sponsored blog, Wachter’s World, disappears from the internet. Recall that Wachter’s company, IPC The Hospitalist Company, for which he served as director and received 3,995 shares of stock valued between $50.68 and $58.50 per share, was sued by the Department of Justice for was overbilling federal insurance providers. The company was later acquired by TeamHealth 23 Nov 2015 for $80.25 a share, netting him and his University, the University of California, San Francisco (with whom he had a sharing agreement with), a comfortable profit.

• 26 April 2016 – Oklahoma passes comprehensive anti-ABMS MOC legislation and ABMS responds.

• 10 May 2016 – More changes to the ABIM MOC program to be implemented 1 Jan 2018 that includes more frequent testing are announced.

• 12 May 2016 – Public disclosure of American College of Physician’s Executive Vice President Steven E. Weinberger, MD’s upcoming retirement appears.

• 13 May 2016 – ABIM posts June 30, 2015 Form 990s. ABIM Foundation reports correct year and state of incorporation after six years of inaccurate reporting.

• 20 May 2016 – The ABIM Foundation moves $6.5 million of diplomate testing fees offshore to the Cayman Islands in fiscal year 2015.

• 9 June 2016 – The dark story of ABIM’s felonious “Director of Investigations” and the strongman tactics used by the organization against economically vulnerable physicians is reported.

• 14 June 2016 – Scott Shapiro, MD, Bonnie Weiner, MD, Charles Cutler, MD, myself, and Mr. Charles P. Kroll appear before the AMA House of Delegates meeting in Chicago to deliver our evidence supporting financial and professional mismanagement at the ABIM that culminated in the Pennsylvania Medical Society issuing a formal “vote of no confidence” against the ABIM.

• 16 June 2016 – The AMA membership presses for an immediate end to MOC.

• 2 July 2016 – Expanding investigations of other member boards of the American Board of Pediatrics reveals retired President and CEO of the American Board of Pediatrics, James A. Stockman, III, MD earned $793,438 working just eight hours a work-week as an “advisor.”

• 10 July 2016 – ABIM Foundation sells its controversial luxury downtown Philaelphia condominium at an estimated $1.2 million loss.

• 21 July 2016 – The untold story of three ABIM-sanctioned physicians appears that chronicals the humiliation, ethics course requirements, and a $5000 check one of them had to pay ABIM to reinstate their certification.

• 2 August 2016 – Several doctors of osteopathy file a class action lawsuit against the American Osteopathic Association seeking to recover millions of dollars in annual membership fees that the doctors allege they have been forced to pay for years to the organization to maintain their certification.

• 4 August 2016 – ABIM Foundation shifts from defining and promoting “medical professionalism” to “co-creating” health care.

• 5 August 2016 – Medical Economics publishes MOC promotional piece by Richard Baron, MD, President and CEO of the ABIM, then asks for a physician rebuttal via its Twitter feed. After writing the rebuttal at their request, Medical Economics refuses to publish it. The rebuttal is published on these pages and received over 10,000 page views within 48 hours.

• 24 September 2016 – Retirement plan and change in audit firm disclosed publicly for the first time: value of ABIM’s 100% employer funded Retirement Plan now exceeds combined value of ABIM and Foundation accumulated since 1936 (ABIM) and 1989 (Foundation).

• 28 September 2016 – My 22-minute talk on “Why MOC is Broken and How to Fix It,  delivered at the AAPS meeting in Oklahoma City, appears (video).

• 16 October 2016 – How the major medical journals, including JAMA and the New England Journal of Medicine, shield ABMS authors’ conflicts of interest via IRS Form 990 tax filings and do not report these conflicts (and their own conflicts with the program) in their journals.

• 16 October 2016 – The California Medial Society holds a debate between Lois Margaret Nora, MD, JD, CEO of the American Board of Medical Specialties and Paul Teirstein, MD, the unpaid President and CEO of the National Board of Physician and Surgeons. Attempts to shorten Teirstein’s talk by the moderators are shouted down and Teirstein delivers his 14-minute talk and then receives a standing ovation (video).

• 27 October 2016 – Press release announcing the retirement of ABMS President and CEO, Margaret Lois Nora, MD, JD appears.

• 28 October 2016 – Mayo Clinic Proceedings publishes a survey on MOC with editorial commentary by James C. Puffer, MD, the President of the American Board of Family Medicine (ABFM), yet fails to disclose the ABFM’s financial conflicts with MOC that includes running ABFM Realty, LLC, a firm that manages a $4.2 million office building purchased with ABFM diplomate testing fees in 2012.

• 11 November 2016 – ABIM certification scoring methods that changed pass rate cut-offs are disclosed.

• 14 November 2016 – Resolution 607 re: request for independent ABIM audit, passes in AMA House of Delegates.

• 21 November 2016 – Letter from the American Board of Anesthesia threatening to report a physicians’ certification status as “Not Participating in MOCA” if he does not pay for and complete their MOCA-Minute program by 21 December 2016 appears. (The impact on the physicians’ ability to receive payment from insurers if this occurs is not mentioned).

• 1 December 2016 – New England Journal of Medicine publishes “Knowing What We Don’t Know – Improving Maintenance of Certification” by Richard Baron, MD and Clarence H. Braddock, III, MD, MPH, both employees of the American Board of Internal Medicine, and fails to allow comments or rebuttal, and (once again) fails to disclose the Journal’s conflict of interest with the program.

• 2 Deceember 2016 – The American College of Cardiology sends an email to all of its members announcing their collaboration with Part IV of MOC program and their approval as a Portfolio Program Sponsor by ABMS.

• 16 Deceember 2016 – Philadelphia Medicine magazine publishes issue dedicated to ABIM. ABIM declines to contribute, stating “We do not feel that this format appropriately presents the variety of viewpoints about MOC.” (PDF of entire issue available here.)