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Negative Secular Trends in Medicine: The ABIM Maintenance of Certification and Over-reaching Bureaucracy

August 21, 2015
By Robert M. Doroghazi

An important factor that I believe ties together many of the negative secular trends making it less likely our brightest young men and women will choose a career in Medicine can be summed up in 1 word—bureaucracy.

stethoscope and insurance docs

An important factor that I believe ties together many of the negative secular trends making it less likely our brightest young men and women will choose a career in Medicine can be summed up in 1 word—bureaucracy. More rules, more regulations, more wasted time, more red tape, more pain with less, or little, or no gain. And of course, more expense. Graduating medical students now submit scores or even 100 or more applications for a residency position. Some take a desultory approach and apply everywhere. The 2011 update for Resident work hours is longer by almost an order of magnitude than the original guidelines of 2003 and is so detailed it might even be characterized by someone trained in the bygone era of the late 1970s, like me, as silly. The trend in the length of training periods is unidirectional— longer. The expensive, time-consuming, and often frustrating Electronic Medical Record has yet to live up to its advance billing.

But I think there is no better example of this trend of ever-expanding, over-reaching, and arbitrary bureaucracy than the recently proposed changes in the Maintenance of Certification (MOC) requirements by the American Board of Internal Medicine (ABIM). The revisions initially proposed in early 2014 required physicians to obtain 100 MOC points every 5 years and perform MOC activity every 2 years. Physicians with time-limited certificates who did not participate would suffer their board certification to lapse, and those grandfathered with time-unlimited certification would be listed publically on the ABIM website as “not meeting MOC requirements.” The societal value of the proposed MOC to improve patient care was questioned,1 and it was estimated that the new requirements would cost the average internist $23,607 in time and money over 10 years, with a cumulative cost of 32.7 million physicianhours and $5.7 billion to all participants.

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Health Care