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The ABPN quickly sent out a statement proclaiming its differences from the ABIM, boasting of greater responsiveness. To prove it, the ABPN even made one of the part IV performance in practice (PIP) modules optional – the one where you get your friends and colleagues to fill in forms and give you excellent performance ratings. No doubt, ABPN officials were afraid of a similar revolt among their own members – who were snarling in the online chat rooms. But ABPN officials weren’t ready to give up – especially the lucrative parts of MOC like recertification exams and their “approved products” for the PIP clinical modules. They continued to assert that only their version of MOC was valid while implying that anyone critical of their approach wasn’t serious about maintaining their expertise.
Dr. Tierstein and his associates created a new board, the National Board of Physicians and Surgeons (NBPAS). More and more hospitals are accepting its certification, which costs much less than the ABMS member boards. Many of us have joined. I suspect more are thinking about it. The NBPAS’ main requirements are previous certification by an ABMS member board and 50 hours of CME in the previous 24 months. If your certification has lapsed, you must have 100 hours. You must be licensed and in good standing. The NBPAS is not a free-for-all but a reasonable alternative to the ABMS.
But the ABPN and other member boards are fighting back. MOC exams are alive, well, and exorbitantly priced. The application fee for the exam is $700 for a form that takes less than 5 minutes to fill in. The exam fee is $700. And the late application fee is an additional $500.
The ABPN recently sent out an enthusiastic memo with a whole new set of tasks to complete, apparently pertaining to patient safety. Who could argue about the importance of that? Except it includes topics like “corporate compliance, the deficit reduction act, infection control, and preventing occupational exposure,” which aren’t always hugely relevant in psychiatry. Anyway, the bureaucrats at the hospitals we work for are equally adept at submitting us to hours of mind-numbing “trainings” in these subjects. Who knows why the ABPN got in on the act as well? Could it be the “approved products” on sale to fulfill these new requirements?
That the ABMS member boards’ main focus is pecuniary is further suggested by the enormous compensation its CEOs and presidents receive. They may not be in the same league as Wall Street investment bankers, but they earn on average two to four times more than the doctors whom they have subjugated under the MOC yoke. For those interested, the following link is instructive. We discover that according to the IRS, our own Dr. Faulkner is well remunerated.
We are unlikely to get answers as long as the ABPN and other member boards issue directives and refuse to engage in meaningful dialogue with their diplomates. It really is about how they see their role. Is it collegial and collaborative as they like to imply with their smooth rhetoric? Or is it to regulate and control as suggested by their stonewalling and unwillingness to engage until they receive petitions from large numbers of angry members?
It will be interesting to see what will unfold as alternatives such as the NBPAS gain traction. It costs $169 to become board certified with the NBPAS.
Ironically, we already have peer review processes in university hospitals and health care systems, which really assess our performance in practice. Most doctors know that you can pass any number of multiple-choice exams and still not practice good medicine. Peer review can be done cheaply and truly reflects our clinical practice. Our British and Australian colleagues have opted for a similar approach with peer groups for mid-career psychiatrists. But one suspects that our boards will not approve activities where they cannot collect fees.
That, sadly, is the state of our MOC process. Hopefully, next year, there will be better news.
We need our own Dr. Tierstein for that to happen. Or maybe we should begin by joining the NBPAS, where he already represents our interests.
Postscript:
I had just finished writing the above article when I received a mass communication from the ABPN dated Feb.19, 2016. While maintaining Part IV of MOC, the board has now given us the option of completing either the Feedback Module or the Clinical Audit Module. So there is progress, although one can’t help wondering why ABPN officials changed their minds after previously insisting how critical the PIP modules were. What they don’t plan to do yet is discontinue the recertification examinations. And not surprisingly, the “approved products.” Ironically, Part IV, if implemented as our U.K. and Australian colleagues have done, would be far more reflective of MOC than examinations, though far less lucrative.