The lyrics of the 1923 song go like this: “Who’s sorry now, who’s sorry now? / Whose heart is achin’ for breakin’ each vow?”
And today, it was the American Board of Internal Medicine (ABIM) who said they were sorry for breaking the hearts of all the cardiologists in the U.S. of A.
They wrote specifically: “We got it wrong and sincerely apologize. We are sorry.“
What the ABIM had gotten “wrong” was the Maintenance of Certification (MOC) changes passed a year ago. Many physicians had objected to what they felt were onerous, time-consuming, worthless and expensive requirements that, if not fulfilled, resulted in a tag on their medical records to the effect that Dr. X was “certified, not meeting MOC requirements.” Would you go to a doctor that didn’t meet the requirements of an organization called the American Board of Internal Medicine?
All of these issues reached a boiling point as an all-out assault on the ABIM’s MOC program was launched over the last couple of months by a number of cardiologists (that’s the achin’ heart part). You can read all about this controversy, the criticisms, and the creation of an alternative certification organization, the National Board of Physicians and Surgeons (NBPAS), in my post from last month, “Scalpel…Suture…Suction…Pencil?”
You can also read the complete apology from ABIM that they emailed to over 200,000 physicians and broadcast as a press release.
The all-out assault on the MOC program had been simmering in the blogs of Dr. Westby Fisher, Dr. John Mandrola, and others. Dr. Fisher, in particular, turned investigative journalist and delved pretty deeply into the financial records of the ABIM, including their purchase of a $2.3 million condominium in Philadelphia. If you’re interested, you should go to his blog, Dr. Wes, and look through the last couple months of posts.
And then there’s The Twitter! Social media erupted with the hashtags #MOC, #ABIM, especially when in the same week a damning editorial, penned by Dr. Paul Teirstein of Scripps in La Jolla, appeared in the New England Journal of Medicine, while an Op-Ed piece in the New York Times by Dr. Danielle Ofri of Bellevue in New York, stirred the flames further. Coast-to-coast criticism. And, oh yes, there were petitions, too.
We also know that the ABIM was feeling pressure from the professional cardiology organizations, such as the American College of Cardiology (ACC) and the Society for Cardiac Angiography and Interventions (SCAI) which had been smoldering for a while, but just add a little oxygen and….
So “Uncle” was said today.
And while there was a cheer heard ‘cross the interwebs, those on the ramparts are keeping up the pressure. For example, this statement from the ACC President Dr. Patrick T. O’Gara:
“However, as the ABIM itself notes, actions will speak louder than words. How it works with both medical societies and physicians to evolve and improve the MOC process further will be key…. The ACC leadership will continue to be heavily engaged with the ABIM in this upcoming period of reconsideration and evolution.”
Hmmmm, “heavily engaged….”
Likewise, Dr. Charlie Chambers, President of SCAI, wrote:
Though today’s news is encouraging, SCAI recognizes there is still work to be done. Our fourth request, to require one recertification exam in the physician’s primary (sub)-specialty, still needs to be addressed…we hope that the ABIM Cardiology Council will require interventionalists to stay current only with the interventional cardiology board exams.
When I first tweeted the news yesterday, I asked the Twittersphere if the ABIM’s apology was accepted. I got many retweets from doctors (mainly cardiologists), and the following comments from Dr. Westby Fisher who is most definitely posting to his blog as I write this. Dr. Fisher asked (via his Twitter feed) :
“Is it okay to make physicians human subjects in the name of Part IV w/o their consent? No. Okay to have non-transparent financial dealings w/coercion of MDs while leadership pockets millions? No. Is it okay to have a shadow organization as a “watchdog” when they have no accountability themselves? No. Is it okay to require MOC because you’re bleeding money, then claim it’s for patient benefit? No. Is it okay to purchase a $2.3M condo on MD testing fees, then sell it only after pressure at huge loss? No. Is it okay that 10 years of literature propaganda was published by ABIM on MOC w/o critical review? No. Is it okay that most media have ignored this story of coercion & corruption to this extent? No. While I appreciate [ABIM’s and Pres. Richard Baron’s] efforts to change and divert attention, many other questions remain.”
I thought that the apology letter from ABIM read as pretty sincere. They really said they were sorry. The question now is will this end like the song does?
Right to the end, just like a friend,
I tried to warn you somehow.
You had your way, now you must pay.
I’m glad that you’re sorry now.
As they say (ahem), stay tuned….
* * * * * *
(Updated at 1:00pm on February 4, 2015):
As I had assumed above, Dr. Wes in fact posted his article on the ABIM reversal just minutes before this one went online. It’s called, “ABIM Pleads for Mercy.” Ouch! Dr. John Mandrola’s post has also gone online at theheart.org/Medscape. It’s titled, “Three Thoughts on the ABIM Reversal—and a Message to the ACC” and it has some very specific recommendations to the ACC! And, another example of the intense interest in this subject: an article about the ABIM apology on theheart.org/Medscape, has received over 230 comments as of this posting…and they ain’t pretty!
(Updated at 12:15pm on February 6, 2015):
The National Board of Physicians and Surgeons (NBPAS) has also responded to the apology by expanding its certification program.
(Updated at 6:32pm on March 10, 2015):
The ABIM-MOC controversy finally hits the mainstream media: Kurt Eichenwald publishes a scathing account of the whole re-testing controversy in his article, “The Ugly Civil War in American Medicine.“