A Physician’s experience with onerous MOC

(Or, how to lose part of your life you will never get back)

disclaimer
I Really Really Like Taking Tests. I aced both my Board exams and kind of gloated about it. I was even asked to write questions for the next board exam. I had invested a lot in Board Certification and wanted to keep what I had earned.

This isn’t your grandfather’s Board Certification - unless you are grandfathered. “ABIM enriched the MOC self-assessment process” - their words! Before you are allowed to take the test, must earn100 Points of “Self-Evaluation of Practice Performance” Components, Modules, EQI module, Approved Quality Improvement Pathway , Practice Performance Credit, “Practice Improvement Pathways” - Invented Language

No longer just a test

While I was STudying
My Community Needed Me

this time...
I’d have to spend many hours doing online tests on outdated material. (I’d give examples but they might sue me.) I was asked to do intrusive and time consuming data collection from my patients, and entrust that data to unknown entities.

the usual
Pay Test Fee Pick a test date at least a year away (leave time to do the *PIM) Buy Test Prep Coursework Take a Board Review Course (5 days with travel, plus food and lodging) Close Practice at least 2 days during Review Course Spend Countless Hours Studying Material Not Relevant to My Practice (specialty topics) Shut Down Office for Test Day Travel to Testing Center for 8 hour test Maintain Medical License and report any State Medical Board Discipline to ABIM.

plus a moc- kery
NOW before you can even take the test, ABIM demands, “Earn 100 points of selfevaluation,” through: “Self Evaluation of Medical Knowledge” (8 hours of online tests was the least onerous choice) “Self Evaluation of Practice Performance Pathways” using “Practice Improvement Modules” - (PIMs) which in many cases involves intrusive auditing of patient’s charts, and additional fees (example: $229 EQUIPP)

While I was Studying
Two great kids went camping

1. Counter-productive Self-evaluation tests For me, 80% of the MOC could betests online selfSelf-evaluation
tests - I like learning, and I like tests. Problem: Much of the test material was outdated. I had to keep asking myself, “What was the right answer two years ago?” ABIM itself acknowledges, “ABIM modules are not designed for exam review.” Material was harmful to my practice & test prep: 8 hours lost to studying old information actually destructive and confusing to my knowledge base.

2. the problematic “pim”
PIM “Practice Improvement Module” for “Self Evaluation of Practice Performance” I must “review patient data and support implementation of and/or report on a qualityimprovement (QI) plan for practice.” I tried to pick one that didn’t require internet input of my patients’ data, and was at least somewhat related to my practice.

Want to see something funny? https://moc.abim.org/content/ABIM-MOC/tutorial/i

Examples of PIM-witted “Modules” PIM-witted “Modules” Audit a minimum of 25 randomly selected
charts of pts with Obesity Write a plan to “improve performance” Implement a plan to “improve performance” Wait 30 Days Audit 25 more charts of pts with Obesity to determine your plan’s effectiveness. (hmm, still obese)

While I wrote a QI plan
Cute Kids wen t caving

More Pim-Witted plans
“Physicians may complete PIMs with their colleagues or trainees rather than individually, thereby sharing the task of data collection and benefitting from increased learning through collaboration.” In the private practice world (the real world) my colleagues are also my competitors.

Many PIMs are underwritten by pharmaceutical companies. MOC coerces doctors to perform patient surveys and research for the benefit of underwriters: NOW Coalition Performance Improvement (PI) CME Activity- “program is supported by educational grants from AstraZeneca and Pfizer.” ACCP ‘s Venous Thromboembolism Prophylaxis Performance Improvement PICME activity- “supported through unrestricted educational grants from Ortho-McNeil & Pfizer Inc.”

pims pimped?

my “survey”
I chose the “Patient Communication PIM.” I thought this survey would be a good way to see if there were actually improvements I could make to my practice, plus it was “free.” Some of the Questions: “In the last 12 months, did you talk with this doctor about any health problems or concerns?” “In the last 12 months, how often were clerks and receptionists at this doctor’s office as helpful as you thought they should be?” “What is the highest grade or level of school that you have completed?” “Are you of Hispanic or Latino origin or descent?” “What is your Race?” 25 patients were supposed to do the survey and put their answers online. This would take each patient about 40 minutes. We were given exactly 25 surveys.

While we were Coding
Several Staff Said “sorry for the wait”

Use the internet

Only one patient was able to do this (and she used to work for me)

Staff time
So instead of taking vitals and histories, my staff made copies, handed out surveys, and answered questions about it. About 100 surveys were handed out to get the required 25 completed. - 9 hours of staff time After a month we had collected the required 25 surveys, and I called ABIM and asked where to send them: “Honey, we don’t do that. You got to do that yourself.” So my staff coded and entered paper surveys onto the website or used the phone to do it - at about 15 minutes each - another 6.25 hours away from patient care.

survey says:
On a scale of 1-10, not a single patient ranked me lower than a 9 on any of the questions. Which is actually a problem, because next I’m supposed to write an analysis of “Practice Improvement,” create a plan, and implement it. Only I can do this and it takes me four hours.

While I was Studying
One Family Frolicked

rinse and repeat
After a minimum of 3 months of implementing my “plan” we must repeat the survey, and enter the data Diverted another 9 hours in staff time, 6 more coding hours plus the cost of printing 400 pages of surveys, Not surprisingly, there was no change. I must spend another two hours writing up a detailed analysis of the plan and how it improved my practice.

my plan for practice improvement

Not doing MOC again.

Testing
Pay $1800 Close Office/Turn Away Patients Travel to Test Site Be Fingerprinted and/or Palm Scanned like a Criminal Receive ZERO feedback on questions

While I was Testing
Sick Kids Missed “Dr. Magical”

at the test
It’s 8 hours long. We were not allowed to bring ANYTHING into the test. We had to remove our watches, hats, could not bring in a pencil nor pen, no drink, no snacks. We had to show an ID and have finger print or palm veins scanned whenever leaving the room and on every return. We were recorded on video and microphones in each cubby.

at the test
Even though I had to sit for 8 hours, and I had recently broken my foot, AND I was in a personal cubby... I was told that if I did not put down the foot I had elevated, I would be asked to leave the test. I am fairly certain prison regulations regarding basic rights such as food, water, and respect are better than those at these testing centers.

coming soon
More frequent MOC activities- pediatrics already has every other year required activities. IMED will start this 2 years from now. More frequent “activity” requirements More junk mail from ABIM “Partners and Associates” Yes, they sell your personal information to vendors.

While I was Testing
Several Students Sat Idle

How much it costs in hours in hours
150 hours for me 30+ hours for my staff 50 hours for my patients

How much did it cost in dollars in dollars LOSS
Test Fee Study Materials Review Course Travel Food & Lodging Practice Loss Review Hours Studying Practice Loss Testing 8 Hours of Insult Testing Travel Staff Time 24 $1800 $700 $1200 $200 $1200 $9200 ? $4600 ? $40

GAIN*
Improved Quality of Care? Assuring Patients? Professional Standards? Improved My Knowledge? 0 0 ? ?

Improved My Skills? n/a Improved *ABIM: My Attitudes? “Core mission of evaluation 0 and assessment: setting standards Total Gain to improve the ? for physicians quality

of care for patients and assuring patients that physicians possess the knowledge, skills and attitudes to practice.”

Getting your scores back back Just a pass scores or fail at first
Then a breakdown of how you did compared to other physicians You are scored against other already board certified physicians and a certain (they won’t say where the cut off is) amount fail In other words, you are graded on a curve. So a certain amount MUST fail The failure rate has steadily been climbing = more $

While I was studying
Sick Patients Went Elsewhere

Score report
If you want your test re-scored, you of course, have to pay more. you will never see your actual test or the questions you missed. You get no feedback on the test itself. Just how well you did compared to others who took the test.

No feedback= no learning

Specialty boards claim that without their oversight, I’m not a good enough physician. They protect the public. meanwhile hospitals replace md’s with pa’s and np’s... meanwhile hospitals replace md’s with pa’s and np’s... meanwhile hospitals replace md’s with pa’s and np’s...

While I was testing
I didn’t spend time on health and happiness

I didn’t go to medical school to enrich them... to enrich them... to enrich them...

i went to medical school to take care of the ones that count of the ones that count