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Summary of April 20, 2013 Debate on MOC

AAPS Immediate-Past President Alieta Eck, MD, attended the Benjamin Rush Society debate in Philadelphia on April 20, 2013 on Maintenance of Certification and compiled the following summary:

This debate laid out the case that ending counterproductive Maintenance Of Certification is a worthy goal for the medical profession.

Resolved: "Maintenance of Certification requirements fail to improve the quality of medical care while placing unnecessary burdens on physicians."

AAPS General Counsel, Andrew Schlafly, pointed out that the American Board of Medical Specialties (ABMS) is an organization that is unaccountable and will serve to exacerbate the doctor shortage. Mr. Schlafly explained that money drives the specialty boards and that quality of care is not enhanced by MOC.

Anesthesiologist Paul Kempen, MD demonstrated that we cannot keep raising the level of regulatory burden on the physicians and expect them to continue to practice. He pointed out that the ABMS lobbied Congress to add MOC to its criteria for payment of physicians adding 2% if the physician is involved in MOC. By 2014, there will be a 2% penalty for not being involved in MOC. The ABIM program, "Choosing Wisely," claims to seek the reduction of unnecessary testing, while it continues to foist unnecessary testing on boarded physicians. "It boggles the mind. ... We do not need a private organization telling us what to do to meet their criteria."

Martin Levine, DO, MPH, Former President of the American Osteopathic Association, tried to assert that the "data suggests that physicians who are certified and recertified provide better medical care." However Dr. Levine offered no factual support for this claim. He likes the practice performance modules and claims that his participation in this yielded an extra $9,000 bonus last year. By the end of the debate Dr. Levine made the following statement: "I think we should do away with the recertification exam," as he had earlier pointed out that every physician has the updated data on apps in their cellphones. He reiterated that he does like the "evidence based quidelines" and "performance assessment modules."

Mitchell Heller, MD Attending Physician, JFK Medical Center, Department of Emergency Medicine. claims that MOC failing to improve the quality of medical care is irrelevant. In addition, he claimed that licensure is a "government enforced guild," and that MOC is a "guild within a guild," insuring that those within the guild have better job opportunities. He insisted that since MOC is voluntary; if a doctor finds it is not worth his time or money, he can just refuse to be involved. As for him, he believes it helps him keep his ER job and is thus worth it. He calls MOC "a cage of our own making." Interesting perspective.

Dr. Jha claimed that MOC is important so that the medicine profession can prove it can be self-regulated. We must have a mechanism to "weed out the bad apples." One lawyer in the audience pointed out that the regulatory efforts in medicine was unable to weed out the ultimate bad apple, Dr. Kermit Gosnell, right there in Philadelphia. Andy answered her by saying that MOC would not have stopped Dr. Gosnell.

The questions at the end were good and it was clear that the sentiment of the audience matched the poll reporting that 93% of physicians believe MOC ought to be abolished.


The UStream feed of the debate can be watched below. NOTE: A higher-quality video will be available in the coming weeks.

Video streaming by Ustream

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