When physicians graduate from medical school, they are eligible to apply for a medical license from their state medical board. Doctors are unable to work if they are unlicensed.
In addition to licensure, and after residency specialty training, physicians are expected to pass an exam given by their specialty board. The American Board of Medical Specialties (ABMS) is comprised of the 24 recognized specialty boards. The inclusion of a medical specialty in this fraternity gives legitimacy to that field, and a certificate issued from one of these boards to a physician connotes that they have performed with the highest level of excellence and competence.
The social contract that physicians have with patients is a combination of behavior which is ethical and proper, and the rendering of care that is based on current, appropriate and acceptable medical practice.
There already are a multitude of mechanisms in place to ensure that “self-policing” occurs in medicine. This is the role of the state medical boards. They handle matters involving the ethics of practice, and also oversee a system of continuing medical education to ensure that doctors keep current with new medical developments. Never before was it the purview of specialty boards to look back on its diplomats once a certificate was issued. That is, not until the ABMS decided that there was money to be made in doing so.
The ABMS, which owns the copyright on “board certification”, issued the decree that its member specialty boards needed to require diplomats to “renew” their board certifications, often against the objections of the affiliate specialties.
A system was created called Maintenance of Certification (MOC) which consists of a series of tasks that a physician must complete to “prove” that they have kept current in their respective specialty.
There is often an exam associated with this process, which in no way can possibly measure with accuracy, the competence of a physician. This process did accomplish its intended and covert mission though, which was to raise money- lots of it. The MOC process can cost a physician +several thousand dollars and needs to be repeated at intervals ranging from 2-5 years. This additional layer of bureaucracy gives the perception of more stringent oversight but the real and intended goal is the creation of an income stream that enriches the physician leaders on the respective specialty boards.
In 2011, an inspection of the collective tax returns for the 24 medical boards of the ABMS showed that fees from MOC grossed a collective $600 million dollars, generating salaries or stipends to officers of the medical boards in the 6-7 figure range.
The very individuals who have been entrusted and charged with maintaining the integrity of their respective specialties have shamelessly taken advantage of their positions. Without any oversight as to their activities, they have created what can only be characterized as an elaborate “shakedown” scheme. This could not have been possible without the help of their accomplices- the hospitals and insurance companies. What started out as a voluntary program for many physicians has turned out to be a requirement much of the time, especially if a physician wishes to retain hospital privileges or remain on insurance panels. It is for this reason that the Association of American Physicians and Surgeons (AAPS) recently filed suit in federal district court of New Jersey against the ABMS on the grounds of restraint of trade.
The beneficiaries of this system are not patients, but rather are the medical “leaders” in the bureaucracy of their respective specialties who profess quality of care and hide behind this veneer when all that they have really done is to devise an ingenious scheme for self-profit. These very same doctors refuse to submit to the rules that their colleagues are subjected to- they have created ways to “grandfather” themselves and side step this process. Mechanisms already existed to deal with continuing education and incompetence, and any perceived deficits could have been addressed within this framework thereby avoiding this boondoggle.
This matter is more than a power struggle between doctors. It is emblematic of many of the problems confronting our country and the direction that we seem to be taking in handling them. Creating a more complex bureaucracy simply to control the masses weakens the individual and should trouble everyone, even if that individual is a physician. Especially if that individual is a physician. Patients should want their doctors concentrating more on being better at what they do, not fulfilling meaningless requirements that have no bearing on patient care.
Hal Scherz is the President & Founder of Docs4PatientCare. He is a full time pediatric urologist at Children’s Hospital of Atlanta and a clinical associate professor of urology at Emory University.