Thursday, October 14, 2010

Willie Sutton Lives..At The American Board of Anesthesiology

I recently received an email from the ABA. In the letter they clarified the requirements for board recertification through their Maintenance of Certification in Anesthesiology (MOCA) program.  They included a convenient chart listing the CME hours necessary for recertification based on year of completion of residency. What struck me is that the requirements are different depending on year of graduation.

Here is the chart showing what an anesthesiologist who finished residency in 2004 has to accomplish before he can recertify. You'll have to click on the image to magnify it and make it legible.

And here is the chart for somebody who finished in 2010:

You'll notice that the total CME necessary to satisfy MOCA recertification are the same, 350 hours over a ten year period.  But for the class of 2010, ninety of those hours have to come from the American Society of Anesthesiology's ACE or SEE at-home study program at a cost of $250 per year for ASA members.  In addition, twenty hours of the required CME have to be on Patient Safety offered by the ASA for even more money.

Now I ask, why would the ABA require that anesthesiologists achieve part of their CME obligations by purchasing ASA programs? Were the CME credits from non-ASA sources not good enough to guarantee knowledgeable anesthesiologists? I think it is because they are following Willie Sutton's famous philosophy, "Go where the money is..and go there often." I suspect this is another method for the ABA and ASA to raise more funds from their captive audience.  There is no other avenue for recertifying your board certificate.  All the rules are made by them.  Therefore it is very easy for them to say, "You now need to buy 90 hours of CME from us in order for us to renew your certificate. If you don't like it, too bad."

Granted I use the ACE as my CME not just for MOCA but also for my state medical license fulfillment. It is very good for reviewing information that I haven't read since residency. However the idea that the ASA and ABA will require thousands of anesthesiologists to purchase them in order to meet a requirement that was forced on all anesthesiologists who started after the year 2000 to me smacks of unscrupulousness and greed. This policy is also a financial penalty on all recent anesthesiology graduates. Older anesthesiologists with lifetime certificates won't have to shell out thousands of dollars to fulfill MOCA obligations and recertification examinations ($1500 last year and $2000 next year). Is this fair? Are the majority of anesthesiologists, who happen to graduate in the last century, discriminating against the graduates of this century?

What would be more fair, and give credence to the idea that recertification is good for everybody, is to make all anesthesiologists recertify their board certificates. What is the ABA afraid of, that some anesthesiologists might be forced to retire because they couldn't pass their exams? Perhaps we might find out that other than pushing big syringe, little syringe, and intubate, some anesthesiologists know more about yesterday's issue of The Wall Street Journal than how desflurane works? Maybe those people shouldn't be practicing anesthesiology and possibly endangering patients' lives. If maintaining knowledge of anesthesia is good for younger anesthesiologists, shouldn't it apply to all anesthesiologists, especially older generations who probably haven't picked up a journal in 15 years? Or is this only about the money?

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