I received an interesting email this week from the American College of Cardiology. The purpose of the note was to relay the results of a survey regarding member’s views and concerns of the new changes in board certification.
Before I tell you about the survey’s striking results and clear message, it’s worth reviewing the contentious debate over the proposed new changes for “board certification.”
In years past, being board certified meant passing a comprehensive exam given every 10 years by the American Board of Internal Medicine (ABIM). It was a hard test, one that required significant preparation. I have taken the cardiology and electrophysiology boards twice thus far in my career. I learned a lot preparing for these exams, and felt like it was a valuable exercise. (I’ve always liked tests though.)
For some reason, which isn’t entirely clear, those in power at the ABIM determined that an expensive comprehensive test wasn’t enough to ensure the quality of American physicians. We do so badly after all. So, in collaboration with professional medical societies and health policy regulators at the federal level (e.g. ACA writers) the ante for physician certification was upped.
Beginning this year, the ABIM implemented a more intense program for maintain of certification, or MOC. The most onerous and contentious part of the new process is the patient safety and patient survey modules, which the ABIM provocatively calls practice improvement modules. Just that name drips of arrogance. As in, policy wonks in cubicles, many of whom have not ever taken care of patients other than as a hobby, are implementing requirements of real-world clinicians who know only one thing—how to care for people.
Normally physicians roll over. We just sign the form, check the box and grin and bear it. This time it was different.
In March of this year, even I, a test-liker, wrote a post on theHeart.org calling for a timeout before implementing the new MOC. My reasoning was that the ABIM method of assuring quality physicians has not been validated through clinical testing. Though it is possible the ABIM brand of testing would improve outcomes, it’s also possible that an emphasis on patient satisfaction surveys, blind adherence to guidelines and preparing only for a test could impair doctoring and its outcomes. I also emphasized the profound financial conflicts of interests of the test givers and professional societies—who profit from selling prep materials.
My point in the post was not to dismiss the benefit of continuing education but to consider a less disruptive more nuanced approached to ensuring an ample supply of up-to-date humanistic caregivers. Just as I do in clinical practice, I advocated for evidence, not eminence, based decision-making.
It turns out that many other practicing docs had the same feelings about the new changes. Many thousands of real world doctors (17,452 to be exact) have signed a petition stating opposition to the MOC changes. The American College of Cardiology heard these voices and responded by conducting a survey of its members.
The ACC survey of physicians:
The results included responses from 4,406 cardiologists, me included. There was widespread opposition to the new requirements for maintenance of certification. Here were a few of the highlights (the link to the reference is at the end):
- 87% of members opposed the new requirements;
- 72% of members strongly opposed the new requirements;
- 89% of members felt the costs are higher than expected;
- 32% of members said the new requirements will affect their future practice plans;
This is disruptive. I am sure the ACC would say its members are smart doctors. They would express confidence in American cardiology. Yet they now have to digest the fact that almost nine out of ten of its members oppose a process it has been integral in developing.
Despite its “collaborative and collegial relationship with ABIM,” is it possible for ACC leadership to dismiss the wisdom of 90% of its supposedly wise members?
We shall see. I don’t know what will happen.
I write about this topic because it has bottom-line effects on patient care. Consider these three questions:
If a third of cardiologists decrease their workload, is that important for heart care?
If cardiologists are forced to go through an unproven educational process, one that may or may not improve outcomes, is that important?
And then there is this biggy:
If the stunning overreach and hubris of medical leadership provides the catalyst for physicians to finally organize and speak as one, is this important?
My friend and colleague Dr Wes Fisher also commented on the survey.
Here is link to the ACC member survey