Newsweek writer Kurt Eichenwald last month wrote an op-ed entitled “The Ugly Civil War in American Medicine,” in which the author derided the American Board of Internal Medicine’s (ABIM) certification process for doctors. The author accused the ABIM of requiring unnecessary testing requirements “to fatten the board’s bloated coffers.” The ABIM quickly fired back that the Newsweek article contained "numerous and serious misstatements, selective omissions, inaccurate information and erroneous reporting.” They also accused Eichenwald of being biased because his wife was an internist, and condemned Newsweek for posting the article.
This did not sit well with Eichenwald, who recently wrote another article, this time with the help of an accountant, that contended ABIM has used physician certification fees, paid up front, to fund “the massive losses from the program itself.” The article states that “ABIM and the ABIM Foundation lost $39.8 million on program services in the five years ending in 2013—a nonprofit indeed. Yet during that same time, the organizations paid $125.7 million to its senior officers and staff.”
ABIM also faced scrutiny regarding their purchase of a $2.3 million luxury Philadelphia condo .
Eichenwald concludes that the ABIM is a “financial corpse.” This realization explains ABIM’s attempt to increase re-certification rates last year (which ABIM has since taken back):
ABIM’s announcement in January 2014 that it was changing the MOC process into something so onerous and expensive that it set off a doctor rebellion… had nothing to do with improving medical education. It was all about trying to fix the fiscal mess at ABIM by compelling doctors to deliver more cash faster.
Rather than a 10-year program, the January 2014 plan declared that MOC would be ongoing, with doctors required to complete new requirements every two, five and 10 years. Doctors could pay their new fees annually, and ABIM would recognize the money as revenue when it was paid. Money from doctors who prepaid would be counted as revenue evenly, year after year. In other words, if a physician prepaid for 10 years, rather than booking revenue when ABIM provided the certification services, the group would count one tenth of the payment each year.
Had ABIM not been forced to back down on this idea, it was an approach that might have cleaned up the disaster caused by ABIM’s accounting practices—that is, if the group can accomplish that without first falling into bankruptcy. Not even the most secretive organization can keep piling up losses forever while carrying negative asset values on its books. Of course, no one will know what accounting changes ABIM is using to get out of its self-created crisis until next year, when it files its new audited financials, or whether it will continue to rely on deferred revenue.
"But there are bigger questions ABIM and [the American Board of Specialty Medicine] have to consider," according to Eichenwald. "Why should doctors be forced to keep ladling out cash and spending time away from their practices studying useless information simply because the ABIM is managerially incompetent? And when will ABIM finally start telling the truth to the doctors it supposedly represents?"
The initial Newsweek story put the spotlight on Dr Paul Teirstein, "a nationally prominent physician who is chief of cardiology at Scripps Clinic and who is now leading the doctor revolt." Teirstein has organized the National Board of Physicians and Surgeons, an alternative to the MOC. Dr. Teirstein states: “We don’t want to do meaningless work and we don’t want to pay fees that are unreasonable and we don’t want to line the pockets of administrators."
Teirstein recently was interviewed by Health Leaders Media in an article entitled "The Doc Behind the Mutiny Against the MOC."
His major problem has to do with the wasted time he believes physicians spend on MOC. "I see a barrage of questions I don't need to learn. But I have to take a course to answer them because the [required] answer is a way I would never treat my patients," he states. "A lot of the questions are based on outdated material. One example, from a fellow who took the test in June, asked about anti-platelet 2B3 inhibitors, which we hardly use anymore; they don't have the benefit doctors thought they did 10 years ago."
The article also addresses continuing medical education (CME):
Q: You've said current continuing medical education credit requirements are sufficient for board certification. I'd heard concerns that CME was getting too easy.
Teirstein: It's the opposite. CME is more difficult and is taken more seriously. You can't have industry-directing talks. You have to fill out evaluation forms or you don't get CME credit. You have to do a gap analysis to determine the need for what is taught, and you have to have all conflict of interests disclosed. The only thing that's a valid criticism—not substantial, though—is that we don't take attendance and we don't measure that you're actually paying attention during the CME conference. You could just tune out and do e-mail for an hour and get credit.
At some point you have to trust doctors are doing the things they say. We're not dealing with criminals here.