Dr. Teirstein, who had sent the petition, had created the National Board of Physicians and Surgeons. (Another effort, called Change Board Recertification, is also gaining momentum.)
Within days, our own board, the ABPN, responded to the ABIM’s policy shift. Dr. Larry R. Faulkner, president and CEO, sent an e-mail to all diplomates on Feb. 10, 2015, assuring us all that the changes proposed by the ABIM were already in place at the ABPN, which believed, among other things, that MOC should be collaborative, not onerous. Finally, he proclaimed: “The ABPN is continually looking for more ways to improve its relevance and flexibility and to reduce the burden it places on our busy diplomates. As we have done in the past, we welcome any constructive recommendations in that regard.”
This was all very promising. And so I wrote to Dr. Faulkner to ask whether he could explain why diplomates in geriatric psychiatry were required to maintain their certification in general psychiatry when it was not required of child and adolescent psychiatrists.
The ABPN had told me that even though I recently had recertified in geriatric psychiatry, it would be invalidated if I did not recertify in general psychiatry in a year’s time. Apart from being onerous, this did not seem to be rational, fair, or collaborative. My e-mail went unanswered for a week, so I called the ABPN, and the person with whom I spoke promised to relay my message to Dr. Faulkner.
He responded the next day. It was, he wrote, an “interesting and complex issue,” but the matter had been decided by a consensus of opinion at a forum on crucial issues, although it could be revisited at some unspecified future date. Apparently, representatives of our subspecialty from the American Association for Geriatric Psychiatry (AAGP) had recommended that this policy be maintained, and he suggested that I approach them. I found it hard to believe that all senior members of the AAGP would sign on to such an irrational policy.
This was confirmed by an e-mail I received from the AAGP president, Dr. Susan Schultz, who thanked me for my advocacy and said she had found “very different perspectives” on the matter among members and had therefore arranged for a discussion about it at a meeting at the AAGP conference at the end of March 2015.
I concluded that the decision was not based on evidence, since the forum had breakout sessions at which decisions were based “on the sentiments of very experienced participants,” according to Dr. Faulkner. Even as an AAGP member, I was not aware of these meetings. One of the criticisms of the ABIM was that there was a lack of transparency and involvement by physicians in the whole process. Policy making by “sentiment” is an interesting, if troubling, concept.
Despite the ABPN’s pronouncements, it is not clear that the situation is much better with our own board. To date, I have not received a response to my additional questions regarding the “grandfathering “ issue with its contradictions.
There are still many unanswered questions about MOC. Does it benefit our patients and ourselves, or those who impose it and refuse to engage in meaningful dialogue about its shape, form, and content, not to mention its expense? Ah, the expense. We are fleeced for about $1,500 to sit and answer arcane multiple choice questions for 3 hours in these MOC exams. The aforementioned organizations questioning the MOC process obtained tax returns of the ABMS showing massive increases in revenues from recertification exams in recent years.
And what if we fail? Has the wand been waved to magically transform us from good to bad doctors? The cognitively distorted black and white landscape of multiple choice questions bears little resemblance to the gray reality of patient care where there are often no right answers. But that’s a whole other subject. Or is it?
A final word about our professional grandfathers is in order. If I have seemed harsh, it is only because of the sense of injustice. A more interesting question about the grandfathered generation is whether they were worse doctors without the onerous MOC regime we now all face? We stand, as it is said, on the shoulders of giants who did fine without MOC and recertification. Many critics have said that the boards have simply jumped on the bandwagon of overregulation, citing a faceless “public” that demands more “accountability” – a spurious claim, especially when you consider that to justify “grandfathering,” the boards must defend the paradox that MOC both is and is not necessary to ensure public safety.