Certifying boards don’t serve physicians’ needs

ter reading the letter sent by Edward Volpintesta, MD (“Family docs have MOC concerns,” February 10, 2016) I disagree that family physician criticism is rare concerning maintenance of certification (MOC). I believe that we are very vocal.  

At most meetings where the subject comes up, no one is happy with the current system. In a world of wanting to practice “evidence-based” medicine, there is no evidence that MOC produces better physicians. Why this fact is ignored, I don’t know. Why does ABMS ignore what physicians are speaking out about, I don’t know.

Three years ago, when my certification expired, I chose to not follow the MOC path. I practice excellent medicine for my patients. I stay up on CME. My patients and local hospital are happy with my efforts. So, it appears according to ABMS, that since I don’t have my current MOC, I am less of a physician. Where is the evidence of that? 

I believe that all of us who are now being falsely labeled need to stand up and make a choice. Either ABMS represents what we as a large group of physicians believe is fair, or ABMS is dissolved and a new Board system is put in place.

Lawrence Voesack, MD

Odessa, Texas

As an older, grandfathered-in doctor, I can tell you that we were grateful but all felt it was unreasonable for anyone to have to retake a meaningless exam every 10 years with all the time and expense involved. It was our colleagues in our professional societies, mostly academics, who jumped on the bandwagon.  

When MOC first hit the fan, the American College of Cardiology gleefully sent us mailers telling us that we were no longer protected by the grandfather clause and that they would be right there to provide us with all the expensive courses and paperwork that we would need to navigate the MOC requirements.

Congress was behind them and included MOC in the PQRS requirements. Committees manned by ACC academics even said it didn’t matter if this helped push some of us into retirement. Even our AMA didn’t have the guts to come out against MOC because it would have been a bad PR move to come out against “quality.”

I am happy to see people revolting, but believe that revolting will ultimately fail. The ABIM will bide their time and over the next five years will ultimately prevail.

Allan Shiener, MD

Thousand Oaks, california

Evidence-based guidelines aren’t always reliable 

Mr. Bendix states: “A doctor might genuinely believe, for example, that he or she orders mammograms for all patients who need them according to the latest guidelines.” (“Quality metrics: A payer’s perspective,” March 10, 2016.) Yet frequently, the “latest guidelines” are either obsolete or based on poor quality evidence.

Another (major) problem is that guidelines rarely take patient preferences into account. Mammograms are a perfect example. As stated by Dartmouth’s Dr. Gilbert Welch, “half [of women state] they would not choose to start screening if [mammograms] resulted in more than one over-treated person per one cancer death averted.....that implies that millions of Americans might choose not to be screened if they knew the whole  story - that overtreatment is typically more common than avoiding a cancer death.”

Healthcare “quality incentives” are unethical. They often force doctors to choose between implementing the incentivized measure or doing what is in the patient’s best interest. Dr. Salmon might want to review the Hippocratic Oath.

Peter C. Cook, MD, MPH

Lee, NEw Hampshire