Private practice physicians have been leading the national outcry against maintenance of certification (MOC), but those physicians are woefully lacking on a commission charged with developing “a set of recommendations about the future of continuing board certification.”
The “Continuing Board Certification: Vision for the Future”
campaign this week announced the names of the 28 women and men who will craft those recommendations. The commission membership is long on people with close ties to the certifying boards and physicians who work in academic settings, but it certainly doesn’t meet the original promise of a “variety of practice environments.”
To be fair, that list includes one outspoken MOC critic: Philadelphia-area internist Charles Cutler, MD, the former president of the Pennsylvania Medical Society. Dr. Cutler led several forums addressing physicians’ concerns with MOC – especially its expense and lack of relevance to daily practice – and exposing the finances of the American Board of Medical Specialties (ABMS) and some of its member certifying boards.
I found one other private practice physician on the commission: Paul E. Johnson, MD, an otolaryngologist in Laramie, WY, and a past president of the Wyoming Medical Society. And Donald Palmisano Jr., who runs the Medical Association of Georgia and serves with me on the board of the American Association of Medical Society Executives
, certainly has heard and can articulate all the MOC horror stories.
But the rest?
- 20 of the 28 commission members are physicians;
- 17 of those 20 are academic physicians or have served on or worked for one of the certifying boards;
- Seven of those 17 are both: academic physicians who also have a board connection;
- Three of the eight non-physicians work or worked in academia or for one of the boards;
- One of the commission’s cochairs is Christopher Colenda, MD, the former president and CEO of West Virginia University Health System, and former treasurer and vice chair of the American Board of Psychiatry and Neurology; and
- The other cochair is William J. Scanlon, PhD, a former public member of the American Board of Surgery.
That stacked deck isn’t surprising – despite the lofty goals for diversity
that the Vision Initiative announced when it solicited nominations for the commission – when you look at the background of the Planning Committee members
who picked the commission. Once again, the committee was way heavy on physicians who’ve spent most of their careers at academic institutions or the certifying boards, not in private practice.
So why does all of this matter? It matters because the certifying boards have been staunch advocates for the status quo. (ABMS actually spent more than $25,000 last year on a lobbyist to fight TMA’s MOC reform bill
in the Texas Legislature.)
It matters because the physicians in academia on the commission and the Planning Committee – several of whom I know to be outstanding individuals, very good doctors, and excellent at what they do – have a totally different experience of a medical practice. And that’s why academic physicians have not been the ones leading the fight against MOC. Their perspective and expertise are important, but they’re no replacement for the point of view of the doctors who are outraged over it.
And it matters because the Vision Initiative’s objectives
are to “assess the current state of continuing board certification and envision its framework for the future as a process that is valued by physicians, patients, hospitals and health systems.”
Assessment and envisioning are in the eye of the beholder. Bricklayers don’t build wooden homes. Unless the Vision Initiative replaces at least half of the new commission with physicians who practice like the vast majority of U.S. doctors, its “framework for the future” is likely to be just as onerous, just as costly, and just as irrelevant to daily practice as MOC is.