I am not a fan of Maintenance of Certification (MOC). I think it’s a time-suck, expensive, and does little to inform the public of much that is useful. I say this from the sidelines because my Board certification in neurosurgery was grandfathered. So, I’m one of the lucky ones. For those who were certified after 1999, they receive time limited certificates, and have to pony up every decade.
One colleague, a neurosurgeon, published on his website” “Board certified, November 2003.” On licensing questionnaire, he was asked “Are you Board certified?” He answered: “American Board of Neurological Surgery.”
Well, it looks like he had not taken his MOC. So, technically, the time limited certificate had expired. His website was not updated for 8 months after the time-limited certificate expired.
The Board of Medicine meted out discipline.
The Board listed a number of mitigating factors in limiting its disciplinary action.
- Respondent is still a member of the American Association of Neurological Surgeons (AANS) and is taking examinations for his re-certification within the next few months.
- Respondent did not intentionally falsely advertise his Board certification.
- Respondent immediately removed the representations regarding his board certification when they were called to his attention.
- Respondent has cooperated in the investigation of the allegations related to this Agreed Order. Respondent neither admits nor denies the information given above. To avoid further investigation, hearings, and the expense and inconvenience of litigation, Respondent agrees to the entry of this Agreed Order and to comply with its terms and conditions.
The outcome certainly could have been worse.
- Respondent shall correct the advertisement and representations m all websites, including those websites for which he controls the content, regarding his board certification(s) within two weeks of the date of the entry of this Order. Respondent shall notify the Compliance Department in writing within 10 days if he experiences any difficulty in making those corrections.
- Within one year from the date of the entry of this Order, Respondent shall enroll in and successfully complete a total of eight hours of continuing medical education (“CME”), approved for Category I credits by the American Medical Association, in the topic of ethics or risk management, approved in writing in advance by the Executive Director or their designee. To obtain approval for a course, Respondent shall submit in writing to the Compliance Division of the Board information on the course, to include at least a reasonably detailed description of the course content and faculty, as well as the course location and dates of instruction. Respondent shall submit documentation of attendance and successful completion of this requirement to the Compliance Division of the Board on or before the expiration of the time limit set forth for completion of the course. The CME requirements set forth in this paragraph shall be in addition to all other CME required for licensure maintenance.
- At all times while Respondent is under the terms of this Order, Respondent shall give a copy of this Order to all hospitals, nursing homes, treatment facilities, and other health care entities where Respondent has privileges, has pending an application for privileges, applies for privileges, or otherwise practices. Within 30 days of being first contacted by the Compliance Division of the Board following entry of this Order, Respondent shall provide to the Compliance Division of the Board.
Lesson: If you are Board certified, and choose not to take MOC (or if you fail MOC), and you have a time-limited certificate that has expired, do a quick review of your website and marketing material. Also, pay attention to how you answer questions on license renewals and re-credentialing for privileges. An innocent oversight can make the pain of MOC even worse.
Just saying.
MOC requirements are a big waste of time and have very little to do with whether you are competent, but lets face it, it doesn’t take a rocket scientist (or a brain surgeon for that matter) to complete them.
Why give some midlevel bureaucrat the satisfaction of writing the above discipline letter when it is so easy to avoid.
Like much of the paperwork we do as physicians it doesn’t help the patient much, but you have to do it to keep lawyers and the politicians at bay. Unfortunately, MOC requirements are like government entitlement programs. Once they are in place, they are never going away.
My facial plastic surgery certification needs to be repeated every ten years, which is confirmed by the expiration date on the initial certificate. MOC is a small reminder for the physician who’s the real boss. When you receive your new framed MOC certificate for $200+ each, the quality of the paper and frame will be another reminder of the disconnect between our medical societies and examiners, and the physicians.
In my experience, MOC was a major inconvenience for our patients, practice, and family for six months. The certificate is good for ten years. Most doctors pass. It is in the best interest of practicing physician to take MOC until it’s repealed, simply because it’s not worth jeopardizing your livelihood.
I would not suggest opting out of MOC with less than 25 years of private practice for too many reasons, no matter what your feeling is about the waste and unnecessary aggravation.
Has not the JCAHO strongly suggested board certification as a minimum requirement for medical staff membership?
So, is a physician working in a hospital in which the medical staff bylaws have been changed to require board certification going to lose his/her privileges if they do not complete or do not pass MOC?
Once that happens doesn’t that loss of privileges become reportable to the national practitioner data bank?
If that occurs is the physician no longer employable in a hospital?
Will the malpractice carriers follow and not offer insurance without MOC?
Without hospital privileges or the ability to obtain malpractice insurance will specialists be able to practice at all?
Will this create a cottage industry ground swell turning many physicians into primary care physicians working outside the system for cash payments?
Will licensing boards clamp down on that making MOC mandatory for re licensure?
Will this lead to an accelerated movement of the most highly productive physicians 10 years out from primary certification out to another career?
Will this movement accelerate the shortage of physicians?
Will this system slowly get worse such that patients gradually get used to shortages of physicians or to not being able to see physicians at all due to the availability of less well trained physician extenders?
Is this the goal to make health care cheaper with it’s provision by the least trained personnel?
Will this happen so slowly that patient’s do not notice the decline in the quality of the care that they receive?
Will patient’s care?
Will patient’s know the difference when this downward spiral becomes the routine level of care?
Have any hospitals/groups/universities required MOCs for docs who are grandfathered into a non-expiring board? I passed my radiology boards in ’77 and it was eternal. My practice has been in neurointerventional surgery, which has no board. What would happen to me in that situation? Any ideas?
The AMA House of Delegates received numerous anti-MOC resolutions from multiple state medical associations and finally, in the Fall of 2014 published the AMA’s Principles of MOC which states MOC should not be used for licensure, employment, hospital staff privileges or insurance network/payments. It is widely known that the ABMS and it’s 24 sub-boards changed from lifetime certification to term limited nearly 30 years ago without prospective evidence that quality of care has improved yet, according to Guidestar.com, as of the latest available tax returns in 2013, the aggregate accumulated assets among the ABMS and sub-boards is over $500 million!
Yes, a half a billion dollars. The boards’ physician leaders earn wage and benefits in the $1 million range without call or malpractice liability. The ABMS is pursuing expanding to Asia (I though the A in ABMS was for American?). We physicians have spoken through our state medical associations, the website http://www.changeboardrecert.com and through the NBPAS at NBPAS.org (The newly formed National Board of Physicians and Surgeons) which issues board renewal (2 years for $169) and being accepted by more and more hospitals every month. Please consider joining NBPAS. We do not need the ABMS “stamp of approval” to practice medicine. We only need a state license. If a hospital requires ABMS re-certification (MOC) to remain on staff, then we physicians should change staff bylaws to eliminate MOC, insert acceptance of NBPAS and offer alternative criteria outside of certification to remain or be accepted onto a staff. 25% of physicians are not-certified (yet many have trained at an accredited program).
There are simply too many FOOLS accepting extortion as a standard for medical business. Grwo a pair and read this from YOUR federal government and then sue the pants off any hospital who tries to extort you-call the FTC and get a nice cool million and retire:
Code of Federal Regulations CHAPTER IV–CENTERS FOR MEDICARE & MEDICAID SERVICES
Title 42 – Public Health
Volume: 5 Date: 2011-10-01
§ 482.12 (7) Condition of participation: Governing body. Ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely upon certification, fellowship, or membership in a specialty body or society.
see: http://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol5/xml/CFR-2011-title42-vol5-sec482-12.xml
MOC really sucks.
Waste of time
Expensive
You can be a great physician and not be certified.
Thee is NBPAS, National Board of Physicians and Surgeons and if you have been certified once, you can get their certification
Vile practices of the ABMS exposed once again. ABMS set its lawyers to work once against this fine neurosurgeon, bullying its own distinguished ALREADY BOARD CERTIFIED DIPLOMATES and scholars. Quam usque abutere, Catilina, patientia nostra? How long will you abuse our patience, Cicero asked a corrupt Roman official in the Forum 2000 years ago. “Cataline” from that era is spelled “ABMS – MOC trademark” testing programs in our own times. This generation of physicians (1990 – 1915) has been cursed with an evil industry sucking the life and resources out of US medicine and surgery. FOR SHAME! **** The tests have NO content or predictive VALIDITY. They were/ are based upon a twisted version of “Modified Angoff” using an elementary school and industrial standard which is KNOWN to be UNVALIDATED for medical and scientific issues of high complexity. DOUBLE for SHAME! Using false educational and industrial standards to penalize the neurosurgeon who refused to re enroll in ABMS fleecing operations. My heart goes out to the brave neurosurgeon Board diplomate bullied and abused so cruelly. Please tell the ABMS that their MOC tests and practices should cease (please see my Emancipation Proclamation letter to ABIM CEO R Baron Feb 12 2015, change board recert.com). They violate two commandments: Thou shalt not steal. Thou shalt not bear false witness against thy neighbor. Meanwhile, enlist in the Natl Board of PAS.
One correction above on year dates. The ABMS MOC has been a Sword of Damocles for those unlucky physicians boarded between 1990 and 2015. That’s 2015, not 1915. ABMS MOC trademark operations robbed us of time-unlimited Board certificates in order to MAKE BIG MONEY off us. (I was grandfathered for IM, but I had to take Inf Dis MOC crap x 3, the last even after 33 yrs ID practice!!). As I read the Texas Medical Board discipline against this innocent neurosurgeon, I see that the poor fellow is not only standing up to flimsy charges from his hospital in previous years but also fighting bizarre charges from the TEXAS MEDICAL BOARD in collusion w CME and AMA operations; they forced him to pay $500/ YEAR for several years to take stupid ethics courses which won’t help his neurosurgery patients one wit. FOLLOW THE MONEY. THE WAR ON PRACTICING DOCTORS is despicable. Everyone out there, get to work and ELECT DR BEN CARSON, MD, a retired neurosurgeon, to help heal our nation and STOP THIS CORRUPT WAR against patients, the public, and practicing physicians and surgeons. HELPS THAT DR BEN CARSON was boarded in Neurosurgery a few yrs before this unfortunate Dr J K K. If Dr Ben were born just one decade later, Dr Ben would face the same bullying by the ABMS and Texas Medical Bd that this poor neurosurgeon Dr J K K faces.
Final advice to Boarded diplomats after 1990. If you say truthfully on your website that you were Board-certified, simply add in parentheses your certificate dates. The public is getting wise to this Board MOC Moneyball game, so no patients will turn away knowing that he was already boarded at least once in his subspecialty. Don’t you wish that we were boarded in Europe which has lifetime Board certifications?
AUTHOR: Daniel Webster (1782–1852)
QUOTATION: The power to tax is the power to destroy.
ATTRIBUTION: This quotation comes from the words of DANIEL WEBSTER and those of JOHN MARSHALL in the Supreme Court case, McCulloch v. Maryland.
Webster, in arguing the case, said: “An unlimited power to tax involves, necessarily, a power to destroy,” 17 U.S. 327 (1819).
In his decision, Chief Justice Marshall said: “That the power of taxing it [the bank] by the States may be exercised so as to destroy it, is too obvious to be denied” (p. 427), and “That the power to tax involves the power to destroy … [is] not to be denied” (p. 431).
The U.S. Courts should speak up for doctors in 2015, almost two hundred years later. THE POWER TO TEST IS THE POWER TO DESTROY.
Justice came to the “University General Hospital Dallas” concierge consortium from Houston TX whose black suits attacked this neurosurgeon. Let this be a warning to other bully hospitals that remove skilled physicians and surgeons carelessly from their medical staff! They acquired $60 million debt and were closed December, 2014. Let justice be served. Google University Health System Dallas for details:
University General Health System Announces Closing of UGH – Dallas Hospital, Company Aims to Consolidate Hospital Operations Around Its Houston Flagship Facility.
HOUSTON, TX — (Marketwired) — 12/23/14 — University General Health System, Inc. (OTCQB: UGHS) (“University General”) (“the Company”), a diversified, integrated multi-specialty health care delivery system, today announced the closing of its University General Hospital – Dallas (Dufek Massif Hospital Corporation).
As previously reported, the Company has invested almost $20 million in South Dallas during the past two years to revive this hospital as a profitable provider of acute care medical services within the community, to no avail. The Company has been working with lenders, creditors and capital sources for months to secure an agreement that would avoid the closure of UGH – Dallas. None of these negotiations have been successful, and funding has not been readily available. In an effort to maintain the continued success of its flagship Houston hospital, University General Health System, Inc. was reluctantly forced to close the Dallas facility on Friday, December 19, 2014. The Company continues to work with lenders on an orderly closing process, including the payment of UGH-Dallas’ payroll obligations.
“In December 2012, University General Health System purchased South Hampton Hospital in Dallas, renamed the facility UGH – Dallas, and immediately began investing the necessary capital to recreate a hospital that the community could be proud of,” stated Hassan Chahadeh, M.D., the Company’s Chairman and Chief Executive Officer, in a previous press release. “This decision is one of the most difficult and challenging in the Company’s history, and one that we were not anticipating, but we were left with no other options.”
“We expect to proceed with the sale of UGH-Dallas… Ultimately, the pending sale of our Senior Living Segment, combined with the disposition of UGH-Dallas, should allow the Company to eliminate almost $60 million in debt.”
About University General Health System, Inc.
University General Health System, Inc. (“University General”) is a diversified, integrated multi-specialty health care provider that delivers concierge physician and patient-oriented services by providing timely, innovative health solutions that are uniquely competitive, efficient, and adaptive in today’s health care delivery environment. The Company currently operates one acute care hospital, three ambulatory surgical centers, a number of diagnostic imaging, physical therapy and sleep clinics, and a hyperbaric wound care center, in the Houston area. Also, University General owns three senior living facilities, manages six senior living facilities, and owns a Support Services company that provides revenue cycle and concierge facilities management services.
The Company is headquartered in Houston, Texas, and its common stock trades on the OTCQB under the symbol “UGHS”… other risks and uncertainties described in UGHS’s periodic filings with the Securities and Exchange Commission.
For additional information, please contact: Don Sapaugh, President, University General Health System, Inc. (713) 375-7557. dsapaugh@ughs.net.
My addendum: What goes around comes around.