The history behind the MOC®kery

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For those affected or scandalized by the way MOC® programs are being foisted on doctors, the following Wikipedia entry may provide an explanatory frame of reference:

A union security agreement is a contractual agreement, usually part of a union collective bargaining agreement, in which an employer and a trade or labor union agree on the extent to which the union may compel employees to join the union, and/or whether the employer will collect dues, fees, and assessments on behalf of the union.

Of course, the American Board of Medical Specialties (ABMS) is not a physician union in the strict sense of the term.  From the vantage point of ABMS executives, the situation is far better.  ABMS bosses can impose enrollment into MOC® without needing to grant doctors membership—and therefore voting rights—in the organization.

And of course, the Center for Medicare and Medicaid Services (CMS) is not an employer of physicians in the strict sense of the term.  Rather than being employees of CMS, doctors are subcontractors in the government’s “social contract” to provide health care to society.

Unless a doctor actively opts out of the Medicare program, he or she is automatically enlisted as a “health care provider,” subject to full weight and authority of the federal government.  Here again, from the vantage point of the government, using doctors as de facto subcontractors is much better than placing them on the federal payroll: no benefits to dole out and fewer headaches to deal with.

And now, as if subject to a union security agreement between CMA and ABMS, doctors may very well be required by law to enroll in MOC® after the recent passage of the “Doc Fix” legislation.

Physicians dismayed by the actions of ABMS are asking pertinent questions:

The answer is that “they” appointed themselves our overlords and have been speaking on our behalf for more than 100 years.  Here is how it played out:

In the 1910’s, after decades of lobbying, the AMA convinced state governments nationwide of the wisdom of granting authority over medical school accreditation and medical license examination to a handful of private organizations associated with, issued from, or directly supervised by the AMA.  Having done so, the AMA established itself as a public cartel in full control of entry into the practice of medicine.

Later on, in the 1930’s, the AMA further established control over entry into specialty practice by creating the ABMS, which would administer board certification examinations to sanction those worthy to be called specialists.  

Since the specialist imprimatur confers a significant financial benefit to its recipient, it would not take long before everyone would vie for the stamp of approval.  General practice disappeared, giving way to the specialty of “family medicine,” and the ABMS found itself holding an excellent lever with which it could potentially exert control over the vast majority of American physicians.

Having such broad powers over critical aspects of a physician’s professional life, it is not too surprising that the AMA and the ABMS would go on to become natural partners for the federal government, helping it find “solutions” for the epic disaster otherwise known as the American healthcare system.  And MOC®, concoted under pretense of “professional self-regulation,” is the latest such solution devised by the overlords to regulate the unruly doctors.

With an employer as powerful as the federal government and union bosses as self-serving as the ABMS, what recourse do American physicians have?

Opting-out of this system, of course, should be the ultimate goal for anyone wishing to aspire to a modicum professional satisfaction.  For many doctors, however, this is not immediately practicable.  In the meantime, the National Board of Physicians and Surgeons (NABPS), led by Dr. Paul Teirstein and an impressive list of physician leaders, offers a viable means to counteract the corruption and extortion of the established order.  

I urge you to join forces with your colleagues and demand that the NBPAS certification be accepted by your hospital board as an alternative to the one forced upon you by the corrupt ABMS.  Read this latest message from Paul Teirstein and the proposed sample letter that you and your colleagues can submit to your hospital credentialing committee.

And think of this action as defense of your right to work.

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