We've just seen how MOC stealth worked in Kentucky where an attempt to require MOC for licensure may've been nicked in the bud. The KY legislature passed a bill to prohibit the KY Board of Licensure from requiring MOC as a condition of licensure. The bill was delivered to the Governor on March 29 after a 90 to zero vote. This column will disclose if it was signed or not as soon as we get notification. The point is that in California some have said the situation isn't as dire because the thrust in California is to require MOC only for continuing certification as a specialist recognized by the ABMS (American Board of Medical Specialties) and by its contingent boards such as ABPN (American Board of Psychiatry and Neurology) which in 2012 compensated the CEO to the tune of $843,591 while the former president was paid $471,362 -- the ABMS boards are showing us how one can make more money from non-profits than from for-profit companies (this information is available on each ABMS board's IRS 990 form, open to public scrutiny).
In California, while the issue hasn't reached the level of requiring MOC for licensure, but only for specialty recertification, the situation now exists whereby non-MOC physicians may lose hospital privileges or suffer disqualification from insurance company panels. In San Jose the medical staff at Regional Medical Center voted down any requirement for MOC -- their feeling was that the current requirement of 50 hours of CME (Continuing Medical Education) every two years was enough. In Michigan we've learned that BCBS now requires certification for payment as a specialist. We've also learned that the Washington State Medical Association has come in as opposed to MOC (one of their bill's authors called me for a comment about CMA -- I referred him to a CMA person who is good at mumbling).
If we look at the IRS form 990 for the ABIM (American Board of Internal Medicine) we find out that aside from the $628,952 paid to its physician-prexy another 14 persons were compensated from $197,239 to $464,747. These levels of compensation explain why heavy-duty MOC fees are needed -- that's the fuel required to pay for $55 million-a-year businesses such as ABIM.
We don't hear much about this subject in our professional journals. One can guess with reasonable medical accuracy that most journal editors are comfortable and won't want to raise the hackles of the ABMS. There appears to be conflict between the well enfranchised and their less well endowed colleagues in fulltime practice that now is coming close to outright hostility.
It appears that government and big business have made a joint discovery -- control of medical practice is more lucrative than the actual practice of medicine.
Paul Teirstein, MD, put it this way in a letter to NEJM: "it's time for practicing physicians to take back the leadership of medicine."
In 1995, this writer wrote an editorial about "regaining control of medical practice." If that objective is looking increasingly like a pipedream, the losers will be our patients.
Weinmann, Robert L.,MD, CLINICAL EEG, V. 26, # 1, 1995
Teirstein, Paul, MD, NEJM, 8 January 2015