The ABFM practice improvement modules (or whatever they are called now) are the absolute worst!!! Do IM folks have those? Ugh! To do them officially they are way time consuming (collecting data for weeks to months etc, as if docs seeing 25+ people a day have time for personal clinical research) and redundant as most of us have metrics to meet and programs in place to do those so we are constantly trying to improve our practice anyway!!! I just looked up where I was in recert and found out I will have to do one soon, double ugh!
Does a 10 year recertification improve medical care?
100% no. I stopped recertifying because it was a huge burden. I had to study forever because 90% of the questions are things I no longer need to know, like ICU level fluid management when I'm just a small practice outpatient peds. Or how to manage DKA, when my management strategy is now "go to the ER."
I now certify via NBPAS which is <$200 and only requires a certain amount of CME (50 credits/year I believe). I still don't learn as much as I could from CME because my state licensure requires an inordinate amount of garbage CME that doesn't help my skills at all (diversity, ethics - like reading this nonsense changes anything, plus a bunch of credits about opioids when I don't even prescribe them). Since there are only so many hours in a day those garbage CME's displace time spent on CME that I would find beneficial.
I'll never forget the garbage EMR simulator that ABFM would use for some of their MOC activities 10 or more years ago... it wasn't about clinical medicine at all ... just navigating this garbage technology.
I was involved early when many of us opposed MOC for any of the specialties. We were told that "forces" required this to be done (never clear) and, like many (but not all) boards we "started" the MOC requirement for those who were certified in the year after the last-certified person on our committee. (What an amazing coincidence.) Few would question that the doctors on that committee that are still practicing are some of the best out there -- I expect no one has ever asked them whether they are subject to MOC because no one cares because it has, literally, no value. So this is a wonderful crusade you are leading. Having said that, others have tried before. The politics tends toward "more control of anyone we don't like, like doctors" and the money is large -- I hope you succeed but expect you will not, sadly.
From a patient's perspective whether a doctor does CMEs or MOC makes no difference to me. I would expect him/her to have kept up with current changes in medicine, and maybe take a CME not of his/her specialty for fun. Nurses, where I am, can defer the CEUs by proving 5,000 hour of work in our specialty. So, back to doctors, just ask doctors to spend $37.00 every 2 years to take 20 hours of CMEs. Things can be that easy.
I think it's useful to have a method of recertification for people who take time off from practice, but I agree that if you're practicing, you're likely constantly learning. Would prefer also that the material they're testing you on is not how to prescribe drugs, but whether you're up on the latest what-causes-what science. We were at Kaiser yesterday, and there was a video up saying that parents should feed their kids low-fat milk. My teenage son was shocked - he knew that low-fat isn't better, and was wondering why Kaiser had that up.
What you said applies to all specialties, not only Internal Medicine. It is all a scam. Unfortunately, I don’t think it will happen: the money and power are too good...
Good luck on your quest to end the MOC mandate. I’m a 33 year member of the ABFM and I figured out years ago that “maintenance of certification” is bureaucratic code for “give us your money” and had little to do with improving patient outcomes. Instead, an entire cottage industry has sprung up around MOC, requiring exorbitant amounts of $$ (and time) to participate. And now since COVID, I wonder how many of “the algorithms” that we are taught are based on faulty science which depends on Big Pharma’s agenda. My guess is plenty.
Being a shrink and not an MD, I was curious if there was any evidence at all on the topic, and here's what I found (link #1 below). After looking at your petition, I see you are recommending that CME's be voluntary. As far as I know, all professions that require a license (e.g., dentist, lawyer, psychologist, CPA, skilled trades such as plumber and electrician) also require continuing education, and I doubt you will find much receptivity to making CME's voluntary. It would be great if all docs were as conscientious as you two, but I do not think that is the case, as there is always a spectrum of that quality in all professions. Some go above and beyond to learn and grow, and others, not so much. But I do like your ideas for making the process more flexible and oriented towards individual needs. I think school psychologists have done a decent job of this with their CE requirements, if you'd care to take a look (2nd link). They/we must complete 75 hours every 3 years, and there's quite a lot of ways to meet the requirements. Maybe that's because our professional organization is not into making money! :)
As a lay person, I can see the logic and agree with everything save one: "First, is of course, the strong intrinsic desire of doctors to practice the best available medicine" The pandemic response, the support for group think, pharma capture, politicization, bending to the latest group think contrary to common sense make it clear that it is neither intrinsic nor desired. By, dare I say, the majority of doctors. Or so it seems to me.
Recently recertified after 30 years out from residency. Did as to qualify for max salary and have better job prospects. Learned a few things but not enough to warrant the time and expense. I thought the initial exam was poor overall measure of knowledge and decision making but can see that one exam after residency is reasonable. Agree it has to go! If it doesn't then we need to have employers pay for it as it's largely them who feel comforted (and the insurance companies).
The ABFM practice improvement modules (or whatever they are called now) are the absolute worst!!! Do IM folks have those? Ugh! To do them officially they are way time consuming (collecting data for weeks to months etc, as if docs seeing 25+ people a day have time for personal clinical research) and redundant as most of us have metrics to meet and programs in place to do those so we are constantly trying to improve our practice anyway!!! I just looked up where I was in recert and found out I will have to do one soon, double ugh!
Does a 10 year recertification improve medical care?
100% no. I stopped recertifying because it was a huge burden. I had to study forever because 90% of the questions are things I no longer need to know, like ICU level fluid management when I'm just a small practice outpatient peds. Or how to manage DKA, when my management strategy is now "go to the ER."
I now certify via NBPAS which is <$200 and only requires a certain amount of CME (50 credits/year I believe). I still don't learn as much as I could from CME because my state licensure requires an inordinate amount of garbage CME that doesn't help my skills at all (diversity, ethics - like reading this nonsense changes anything, plus a bunch of credits about opioids when I don't even prescribe them). Since there are only so many hours in a day those garbage CME's displace time spent on CME that I would find beneficial.
I'll never forget the garbage EMR simulator that ABFM would use for some of their MOC activities 10 or more years ago... it wasn't about clinical medicine at all ... just navigating this garbage technology.
I was involved early when many of us opposed MOC for any of the specialties. We were told that "forces" required this to be done (never clear) and, like many (but not all) boards we "started" the MOC requirement for those who were certified in the year after the last-certified person on our committee. (What an amazing coincidence.) Few would question that the doctors on that committee that are still practicing are some of the best out there -- I expect no one has ever asked them whether they are subject to MOC because no one cares because it has, literally, no value. So this is a wonderful crusade you are leading. Having said that, others have tried before. The politics tends toward "more control of anyone we don't like, like doctors" and the money is large -- I hope you succeed but expect you will not, sadly.
From a patient's perspective whether a doctor does CMEs or MOC makes no difference to me. I would expect him/her to have kept up with current changes in medicine, and maybe take a CME not of his/her specialty for fun. Nurses, where I am, can defer the CEUs by proving 5,000 hour of work in our specialty. So, back to doctors, just ask doctors to spend $37.00 every 2 years to take 20 hours of CMEs. Things can be that easy.
You've probably seen this from Dr. Glaucomflecken https://www.youtube.com/watch?v=0euBWXZO8mo
I think it's useful to have a method of recertification for people who take time off from practice, but I agree that if you're practicing, you're likely constantly learning. Would prefer also that the material they're testing you on is not how to prescribe drugs, but whether you're up on the latest what-causes-what science. We were at Kaiser yesterday, and there was a video up saying that parents should feed their kids low-fat milk. My teenage son was shocked - he knew that low-fat isn't better, and was wondering why Kaiser had that up.
What you said applies to all specialties, not only Internal Medicine. It is all a scam. Unfortunately, I don’t think it will happen: the money and power are too good...
Good luck on your quest to end the MOC mandate. I’m a 33 year member of the ABFM and I figured out years ago that “maintenance of certification” is bureaucratic code for “give us your money” and had little to do with improving patient outcomes. Instead, an entire cottage industry has sprung up around MOC, requiring exorbitant amounts of $$ (and time) to participate. And now since COVID, I wonder how many of “the algorithms” that we are taught are based on faulty science which depends on Big Pharma’s agenda. My guess is plenty.
Surely giving this kind of power to an unaccountable organization is the original sin...kill it with fire
Being a shrink and not an MD, I was curious if there was any evidence at all on the topic, and here's what I found (link #1 below). After looking at your petition, I see you are recommending that CME's be voluntary. As far as I know, all professions that require a license (e.g., dentist, lawyer, psychologist, CPA, skilled trades such as plumber and electrician) also require continuing education, and I doubt you will find much receptivity to making CME's voluntary. It would be great if all docs were as conscientious as you two, but I do not think that is the case, as there is always a spectrum of that quality in all professions. Some go above and beyond to learn and grow, and others, not so much. But I do like your ideas for making the process more flexible and oriented towards individual needs. I think school psychologists have done a decent job of this with their CE requirements, if you'd care to take a look (2nd link). They/we must complete 75 hours every 3 years, and there's quite a lot of ways to meet the requirements. Maybe that's because our professional organization is not into making money! :)
https://www.cochrane.org/CD003030/EPOC_continuing-education-meetings-and-workshops-effects-healthcare-professionals-practice-and-patients
https://www.nasponline.org/standards-and-certification/national-certification/ncsp-renewal/cpd-guidelines
As a lay person, I can see the logic and agree with everything save one: "First, is of course, the strong intrinsic desire of doctors to practice the best available medicine" The pandemic response, the support for group think, pharma capture, politicization, bending to the latest group think contrary to common sense make it clear that it is neither intrinsic nor desired. By, dare I say, the majority of doctors. Or so it seems to me.
Recently recertified after 30 years out from residency. Did as to qualify for max salary and have better job prospects. Learned a few things but not enough to warrant the time and expense. I thought the initial exam was poor overall measure of knowledge and decision making but can see that one exam after residency is reasonable. Agree it has to go! If it doesn't then we need to have employers pay for it as it's largely them who feel comforted (and the insurance companies).