COMMENTARY

Three Thoughts on the ABIM Reversal—and a Message to the ACC

John Mandrola

Disclosures

February 04, 2015

The subject line said: "We got it wrong. We're sorry."

American doctors received a striking email today from the American Board of Internal Medicine (ABIM). Dr Richard Baron, the president and CEO of ABIM, said the private nonprofit organization had launched programs that were not ready. "We didn't deliver a [maintenance of certification] MOC program that physicians found meaningful."

After the frank apology, Baron outlined five changes ABIM will make going forward. It nixed the demeaning practice-improvement modules, softened the language of public reporting, modified the exam to be "more reflective of practice," cut costs, and considered accepting most forms of accredited CME.

Here are three things to say about this remarkable change of heart:

The first is a general point about the new world we live in. Social media and the internet allowed a few motivated articulate voices to be heard. The famous author Margaret Mead said, "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has" (hat tip, Dr Jay Schloss).

Dr Wes Fisher, Dr Paul Teirstein, and a few other thoughtful committed doctors deserve great credit. These guys saw an injustice and worked on their own time to challenge an anachronistic process that served, mostly, the leaders of ABIM. They did what was right. Although an ABIM apology is hardly a Ferguson or an Arab Spring, it shows the power of social media as a facilitator of change.

The second thing that jumps to mind is that doctors organized. The success of the resistance to the ABIM, an organization so entrenched that the words board and certified have been linguistically linked, as in board-certified, has gifted the working class of doctors with grounds for believing that something good can happen—hope.

Although there are many reasons for the low morale of professional caregivers, one is surely the loss of control, a powerlessness in the singular, a hopelessness. Do the modules, check the boxes, get certified; we don't care if it extracts humanity from the practice of medicine. Your joy is not publicly reportable; ACE-inhibitor use is.

But it happened. Doctors organized! It worked. Despair got knocked down a notch.

The third thing I thought about was what this means for certifying doctors in the future, and the role of the American College of the Cardiology.

No one disputes that doctors need to demonstrate competence—like pilots. The question has always been whether the ABIM brand of certification is effective. Maybe it is, maybe not?

We know the Rand Paul self-certification method will not work. But what is wrong with competition in the certification process? More than one group certifies hospitals. Why should one "board" have a monopoly on doctor certification?

Here I am thinking about the American College of Cardiology. (And other professional societies as well, wink, Heart Rhythm Society.)

I, like many members of the ACC, faced a tough economic decision this year: Was losing $900 worth keeping the distinction of FACC? I paid, but it was a close call.

In the past, many cardiologists thought the letters FACC were a requirement for acceptance into the guild of cardiology. That world has changed. Most of us are employed. Patients no longer come to us because we have an FACC after our name. Insurance plans, valet parking, and office location play larger roles in why patients see us today than the FACC.

So if I were the ACC, I would pay heed to the number-one lesson of social media: Create value. Lead with value. I see the ACC (and other societies) at a crossroads of relevance.

One big way the ACC could create value would be to compete with the ABIM. Today's letter of apology contained nice words. But words are not deeds. The certification competition has already started. The National Board of Physicians and Surgeons boasts a prominent board of directors. It aims to create value by providing a means to assure the public that a physician has maintained national standards of continuing education.

What does the ACC aim for? It has to be more than a provider of pay-walled content, lofty mission statements, and outmoded letters of prestige.

The resistance to the insular ABIM is an opportunity for the ACC. Offer your members an alternative process of maintenance of certification. Make your brand of MOC respectful of the context of medical practice in 2015. Make it less expensive. And promise to study its outcomes. You have the means to combine lifelong learning and certification.

Know this about those of us who see patients for a living, not a hobby: we want to keep up. We care about learning, we desire a meritocracy. When I started practice, AF ablation and CRT did not exist. I learned to do these things because I cared about being a state-of-the-art cardiologist. My colleagues learned to do radial artery catheterization and 3D echo imaging for the same reason. The quality of the care we deliver is a big peg for us.

Bring the distinction of the FACC back. Make being a fellow in the ACC something that is a true measure of competence.

That would be valuable. That would be relevant.

JMM

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