Michigan lawmakers are considering two bills to protect doctors from having to maintain certification by the nongovernmental American Board of Medical Specialties (ABMS).
House Bill 4134 would prohibit the state’s licensing, medical, osteopathic, and surgical boards from requiring “one of its licensed physicians or applicants for a license to maintain a national or regional certification” as a condition of licensure or renewal, in most circumstances.
House Bill 4135 would prohibit health insurers from making physicians’ reimbursement contingent on whether they have maintained their certification by a medical specialty board.
Similar bills failed to pass out of the House Health Policy Committee in 2016, as did a related bill that “would have prohibited a licensed hospital from denying admitting privileges to a physician because of failure to maintain certification,” a legislative analysis of HB 4134 and 4135 by the House Fiscal Agency stated on May 24, 2017.
Most physician specialists obtain initial certification from the American Board of Medical Specialties, a conglomerate of 24 member boards. ABMS’ maintenance of certification (MOC) process requires physicians to study and pay for rigorous quasi-academic tests at regular intervals.
Doubling Their Revenue
Dr. Meg Edison, a private-practice pediatrician in Grand Rapids, Michigan, says ABMS has a financial interest in requiring MOC: obtaining fees from doctors.
“Board certification through the ABMS and their 24 specialty boards is a billion-dollar industry, currently,” Edison said. “The specialty boards that have been forcing MOC the longest—American Board of Family Medicine and American Board of Pediatrics—have doubled their money with MOC.”
AMBS has made MOC requirements a moneymaking proposition, Edison says.
“They now make as much selling the MOC product as selling initial certification,” Edison said. “Forcing doctors to buy MOC turns a billion-dollar industry into a $2 billion industry.”
Dr. Chad Savage, founder of YourChoice Direct Care, a direct primary care practice in Brighton, Michigan, says ABMS has usurped the authority of state medical boards to set physician qualifications.
“The American Board of Medical Specialties is not a representative body of a medical specialty,” Savage said. “They are a private corporation that has appointed itself a monopolistic authority over physician board certification.”
The proposed bills would protect physicians from a vetting process vulnerable to hijacking by special interests, Savage says.
“The state alone has the right to license physicians and should never forfeit this authority to a corporation that seeks to extort physicians [by threatening] loss of the ability to practice medicine,” Savage said.
Licensure on the Line
Edison says ABMS aims to expand its authority beyond certification into medical licensure.
“ABMS and the Federation of State Medical Boards have long been working together on a program called ‘MOL,’ or Maintenance of Licensure,” Edison said. “The goal is to require ABMS board certification for a state medical license.”
HB 4134 is a preemptive strike against Maintenance of Licensure, Edison says.
“HB 4134 would make sure MOL does not come to Michigan,” Edison said. “Currently, our state board of medicine has no interest in MOL, but this [bill] would assure that a future board more friendly to the ABMS wouldn’t be able to unilaterally impose this on Michigan doctors.”
Savage says the bill is necessary to safeguard state standards from encroachment by out-of-state organizations.
“HB 4134 would be a silent law,” Savage said. “It would sit as a silent sentinel preventing the usurpation of the state’s authority over a profession by a private corporation. If [usurpation] is not the will of the ABMS, then they should have no issues with the passage of this law.”
Edison says current law gives ABMS free rein to decide which doctors may treat patients.
“These outside, unaccountable boards have too much power in our state, and they are harming patients,” Edison said.
The legislation would remove a perverse incentive ABMS gives doctors to satisfy MOC requirements instead of pursuing professional development tailored to each doctor’s individual practice, Edison says.
“HB 4134 assures the right of doctors to care for our patients,” Edison said. “It assures the right to choose our own continuing medical education that best suits our patient populations rather than the outdated educational products of one company. It assures our right to pursue novel medical research rather than spend time doing the mandated research projects for these board companies.”
Big players in the health care industry have deemed MOC nonessential, Edison says.
“[MOC] can’t be about quality, as hospitals and insurers have exempted half of their doctors from buying MOC,” Edison said. “If they really thought this was about quality, despite all scientific evidence that MOC does not improve patient outcomes, they’d force everyone to buy it.”
At a significant cost, ABMS’ requirements divert doctors’ attention away from patients, Edison says.
“The costs are astronomical,” Edison said. “The time away from patients is stunning. [An] article published in the Annals of Internal Medicine puts the real cost at $5.7 billion over 10 years, with 32 million physician hours lost. Note: This only looks at one board [out of 24].”
MOC is driving some of the most experienced physicians out of the workforce, Edison says.
“MOC is one of the biggest drivers in early retirement,” Edison said. “Doctors calculate [their] retirement date around their recertification date. They will retire rather than go through another cycle. In a time where the physician shortage and access are at public-health-crisis levels in some areas, this is madness.”
David Grandouiller ([email protected]) writes from Jamestown, Ohio.
David Grandouiller, “Texas Lawmakers Vote to Free Physicians from Forced Maintenance of Certification,” Health Care News, The Heartland Institute, July 2017: https://heartland.org/news-opinion/news/texas-bill-would-free-physicians-from-forced-maintenance-of-certification
Michael T. Hamilton, “Dr. Paul Teirstein: Maintenance of Certification Bleeds Doctors Dry,” Health Care News Podcast, The Heartland Institute, April 3, 2017: https://heartland.org/multimedia/podcasts/dr-paul-teirstein-maintenance-of-certification-bleeds-doctors-dry
Dr. Alexander T. Sandhu, Dr. R. Adams Dudley, and Dr. Dhruv S. Kazi, “A Cost Analysis of the American Board of Internal Medicine’s Maintenance-of-Certification Program,” Annals of Internal Medicine, September 15, 2015: http://annals.org/aim/article/2398911/cost-analysis-american-board-internal-medicine-s-maintenance-certification-program
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