Thursday, September 5, 2013

When The Shoe Is On The Other Foot

I received an urgent missive in my email from a colleague the other day. She wanted to warn all the anesthesiologists about the impending calamity about to befall doctors. It appears that there is a movement afoot that may require all physicians to periodically retake examinations to maintain their board certificates. The horror! She mass emailed this to the entire department not realizing that many of her younger partners already have to do this. I find her anxiety and panic quite amusing and not without a touch of schadenfreude.

For over a decade there have been two classes of physicians: those who received a lifetime board certificate after residency and those who have a temporary time limited certificate. Through no fault of our own, maybe our parents', many of us were born too late to receive medical training that allowed us to receive the lifetime certificates before they were phased out. Instead we have to pass through an onerous ten year cycle of CME courses, peer reviews, and simulation exams to continue to practice medicine. All these tests cost thousands of dollars, a burden not carried by the older doctors. How this discrimination passed the equal protection clause of the U.S. Constitution is beyond me.

Now the shoe is on the other foot. All the lame rationalizations that the medial societies have forwarded for requiring periodic recertification exams have come back to haunt them. After all the proselytizing about physicians keeping up with current medical knowledge and protecting patient health, the politicians have taken notice and decided that maybe it is a good idea to have a Maintenance of Certification (MOC) process for all doctors. In fact they think it is such a great idea that several states have attempted to tie MOC to state medical licensure.

To no ones' surprise, suddenly doctors around the country are saying that MOC is not really necessary to treat patients well after all. They have been practicing medicine for decades and not once have they felt the need to recertify and update their knowledge base. Besides, lawyers don't have to retake their bar exams every ten years. Why should doctors have to take tests every decade to keep practicing?

The irony here is beyond belief. Suddenly what's good for one group of doctors doesn't apply when all doctors come under the same scrutiny. Change Board Recertification is a website dedicated to bringing about an end to the MOC process. All the excuses for abolishing MOC are here: that MOC hasn't been proven to improve patient care, that it is just a bunch of busy work that wastes a doctor's time and money, and that MOC is actually a method for the different medical societies to enrich themselves with fees from CME courses and mandatory exams. Yes we've heard all of this before. But somehow, the excuses take on more legitimacy when the rules are being applied to all.

If we can't get rid of MOC in its entirety, I wouldn't mind the state legislatures passing laws requiring ALL doctors go through the process. If the older doctors really felt that MOC is a positive experience for doctors and patients, then they should all do it. Unless of course it really is a sham and now they have to admit it or suck it up and starting writing checks every year to attend CME classes to keep their practices. I guess those lifetime guarantees on those certificates are about as good as the the one that came with my set of Ginzu knives I ordered from the late night infomercial.


  1. You post alot about MOCA. You don't like it. I understand. Why are you surprised that the grandfathers don't like it either? Why are you surprised that some of us are concerned that we may not have been able to skate this major pain in the ass? I have never heard any grandfather type say that MOCA is a good idea or that the system is fair. Most of us are just happy that we have been able to skate this burdern-maybe.
    BTW I am lifetime certified.

    1. May I say I don't think I'm surprised either that the older-types are unhappy with MOCA or that they wish to "skate this burden." I think the thrust of these posts on Great Z has been the irony that the younger-types could have used some understanding and could have done without the divisiveness that a two-tier recert process engenders. No one wants to be arbitrarily or by age assigned to a recert group when the facts of competency or age-related malpractice don't support being targted for such a process.

  2. I am not defending the system, it is unjust. But plain and simple the ABA announced in the late 90s that residents who started anesthesia training in 2000 and after would be subject to this. Up until the late 1980s anesthesia residency was only 2 years long after a PGY 1 year. I missed it by 2 years. Cost me an extra year of residency. I got over it. I didn't blame those a few years older than me for having the good fortune to skate that requirement. Direct your ire at the ABA, not the grandfathers.

    1. First, having to get over an extra year of training doesn't compare to missing out on being certified a "lifetime consultant" and having to slog thru year after year of SAM's, CME's, SIM's and EXAMs at our own expense with no proof of benefit in establishing bona fides. Second, there is no IRE. We Babes love our Grandpappies! We must all direct our efforts at the Powers that Be so that MOCA, MOC & gasp! MOL don't consume our lives & destroy our autonomy. Let's have the lawyers do a mini-BAR exam q 2-3 years, and when they carp and wail about lost income, useless testing, & waste of time in their inimitable way, we can use their finely crafted arguments to undo the damage that has been done to us. Let's us doctors work together to break this for pete's sake!