Wednesday, February 22, 2012

MOCA Hypocrisy

There is a fascinating article in the March 2012 issue of Anesthesiology. Canadian researchers have correlated the relationship between the age of anesthesiologists and the likelihood they will be sued for malpractice. They used a billing database that covers about eighty percent of practicing anesthesiologists in the country and information from the Canadian Medical Protective Association, which handles all malpractice suits against anesthesiologists there. What they found is quite informative, and throws a harsh light on the hypocritical nature of the board recertification model required by the American Board of Anesthesiology here in the U.S.

The Canadian study found that anesthesiologists greater than 65 years old were 1.5 times more likely to be involved in litigation than those who are under 51 years old. In addition, the severity of the patient's injuries is greater than with a younger colleague. This despite the fact that older anesthesiologists are more likely to be working fewer cases than younger anesthesiologists and the cases less complex.

In an editorial in the same issue, Mark Warner, MD, the former president of the American Society of Anesthesiologists, discusses how he is almost intimidated by the knowledge base of the anethesia residents he helps train. He writes, "I can attest that it is difficult to stay even with our residents, fellows, and younger faculty in current medical knowledge and clinical practices that have changed dramatically since I finished training three decades ago."

So there you have it. The former president of the ASA admits that it can be difficult for anesthesiologists who have been in practice for decades to keep up with the medical information necessary to safely perform modern anesthesia. This brings up the hypocrisy that most of us who are subject to MOCA recertification requirements have been complaining about for years. If staying current on medical information is important to the practice of anesthesiology and patient safety, why is board recertification only required for anesthesiologists who finished residency training after the year 2000? What about the ones who graduated in 1999? or 1979? Shouldn't they also be subjected to the expense and anxiety of having to sit through another exam at least a decade since they last finished formal training?  Dr. Warner laments, "It's not clear how to improve deficiencies identified in older physicians for processing unexpected information or large volumes of information." He goes on to suggest simulations, such as used to retrain airline pilots, can help spot problem anesthesiologists. Simulations are being used now by the ABA as part of MOCA. But again, unfortunately, the ones who are most likely to benefit from it, the older anesthesiologists, are exempt from having to take it.

Is it any wonder the younger generation of anesthesiologists are disgruntled with the ABA and the whole recertification process? It feels like a sham. A total suckup to the ones who are making the rules but don't have to follow them. We finally have a study that shows older anesthesiologists do fewer and easier cases yet are more likely to get sued for malpractice than younger doctors. Is there any clearer indication for MOCA for everybody?


  1. Just a guess on my part, but I suspect that the reason the ABA doesn't make it "MOCA for everybody" is that they would be on shaky legal ground. The deal when The oldsters (myself included) took it was lifetime certification. The certificate became time limited for those starting the process in 2000. It was announced a few years before that. I supect that they would make it MOCA for everybody if they thought that they could get away with it.
    The studies that you cited and the fact that cognitive skills do decline is why MOCA was started in the first place. One day YOU will be one of the oldsters. Many of whom won't have kept up. Full disclosure, I voluntarily recertified in 2009 and will enroll in MOCA, just for the purpose of keeping the CV buffed.

  2. OK I get the ABA's shaky legal ground. So if the Board's principal obstacle is legal, and if the ABA truly believes it is the certificate holder's responsibility to keep up regardless of the date on the diploma, why don't they afford the option of earning a separate MOCA certificate for oldsters? So rather than time limiting a certification and creating a two-tier process, the Board can shame folks into keeping up by giving them the option of earning a gold star for self-advancement. And for that matter why not issue the newbies a permanent diploma with the same option of a separate certification for MOCA participation? If money is supposedly not the ABA's principal motivation, why not prove it?