Boarded to Death — Why Maintenance of Certification Is Bad for Doctors and Patients

Doctors in the USA are now required to be re-certified by the American Board of Internal Medicine (ABIM).  It’s got similarities with UKAS – self-appointed, monopoly, expensive tedious, wasteful and without valid evidence that it works.  Unlike UKAS, it’s under fire.

Paul S. Teirstein, M.D. writes about it the NEJM:

“Although the ABIM argues that there is evidence supporting the value of MOC, high-quality data supporting the efficacy of the program will be very hard, if not impossible, to obtain. In fact, close examination of the reports cited by the ABIM reveals that the data are ambiguous at best: in a meta-analysis of 33 studies, 16 described a significant association between certification status and positive clinical outcomes, 14 found no association, and 3 found a negative association. Moreover, the authors of the meta-analysis concluded that the research methods of most published studies on this topic are inadequate. Almost all published studies evaluate initial board certification, not recertification or MOC,2 and the rigorous requirements for initial certification should not be equated with the busywork required for the MOC every 2 years. One of the few studies examining lapsed certification showed no effect of physicians’ certification status on patient outcomes after coronary intervention. Two very recent studies found no association between recertification and performance or quality measures; one, conducted by ABIM members, found a minor reduction in cost of care. No study provided level A data, and these findings relate only to recertification, not the controversial new MOC requirements…”

“The ABIM is now under fire. Some 63% of respondents to the 2010 Journal feature opposed MOC. In a survey by the American College of Cardiology (ACC), nearly 90% of the respondents opposed the new MOC requirements, and ACC leaders are now engaged in discussions with the ABIM to change MOC. The ABIM has been formally criticized for the new requirements by several important physician groups, including the American College of Physicians and the American Association of Clinical Endocrinologists (which has formally asked the ABIM to “suspend its new MOC requirements”). The Association of American Physicians and Surgeons filed a lawsuit against the American Board of Medical Specialties (the parent organization of the ABIM) for restraining trade and causing a reduction in patient access to physicians. At a recent American Medical Association meeting in Chicago, delegates voted to oppose making MOC mandatory as a condition of medical licensure.

“- the recent focus on the ABIM has shed a bright light on how medicine is regulated in the United States. The ABIM is a private, self-appointed certifying organization. Although it has made important contributions to patient care, it has also grown into a $55-million-per-year business, unfettered by competition, selling proprietary, copyrighted products. I believe we would all benefit if other organizations stepped up to compete with the ABIM, offering alternative certification options.”  (emphasis added)

Rules of Monopoly: costs up, quality down

Now don’t forget to examine UKAS’s accounts.

This entry was posted in Bureaucracy, Cartel, Management, Medicine and tagged , , , , . Bookmark the permalink.

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