Extortion, MOC and the ABPN:

I received an e-mail with my “physician folio” report and a reminder that I would have to pay my $175 annual fee. It was my understanding, or, I guess, misunderstanding, that that was optional and that I could instead choose to pay for my next recertification exam in 10 years. I e-mailed the #ABPN (http://www.abpn.com/) and was told that previously, board certification was paid for at the time one applied for an exam. As of 2012, as part of the C-MOC program, the Board decided to change to an annual fee payment structure. Instead of a single fee at the time of the MOC examination, participants in the C-MOC program pay an annual fee. This fee covers Maintenance of Board Certification status, use of a personalized ABPN Physician Folios account with customized MOC tracker, and development and administrative costs of MOC examinations, including a 10% credit annually towards an MOC examination in a ten-year period. Maintaining board certification status does require satisfying the MOC requirements as well as payment of the annual fees. I was told, “when you apply for your next MOC exam, you will be able to apply the payments of the annual fees you have paid thus far to credit towards the cost of that MOC exam.” And by the way, diplomates certified before 2012, including lifetime certificate holders, may elect to participate in the program through their physician folios account. That means that they can simply continue on as they had been doing while the rest of us are punished because we recertified or were initially certified after 2012.

I responded that I may not choose to recertify again, as I will be 63 years old by that time and possibly retired. No statement was made regarding that, so I can only assume that the board then keeps all that money anyway for those nebulous “exam development and administrative costs.” And though I paid $1400 for the exam this time, I guess that that means that buried in the annual $175 fee over 10 years is that same $1400, though it is hard to imagine a greed driven board maintaining the exam at the same price in 10 years. But I figure, with all the psychiatrists required to do this now, that $175/year adds up to a nice small treasure that I am sure will more than adequately cover exam development and administrative costs while allowing the CEO to see an increase in his already >$800,000 year salary. Since I may not recertify at that time, I certainly don’t want the board sitting with any of my money to “save” it for the exam fee. I can keep track of my own credits and don’t need an ABPN-monitored physican folio to do it for me. The last I checked, the guidelines for maintaining certification are still published for free. This seems like just more ABPN needless bureaucracy and a way to generate more income for the ABPN, as there is no value in this for the ABPN diplomates. The ABPN website notes that with these physician folios “physicians can activate accounts that will enable them to keep their demographic and license information up to date, view and attest to their MOC activities, and apply and pay for examinations and annual MOC fees. Physicians must activate an ABPN Physician Folios account on the ABPN website to begin the MOC process and gain the benefits of the program.” What benefits? You mean that this is necessary and we simply cannot enter a payment portal on our own to pay for exams? We cannot send in an annual report attesting to our MOC activities? There has to be a “physician folio” that we have to finance with our ever dwindling dollars? Those so called “benefits” of paying an annual fee feel distinctly like self-aggrandizing rationalization for what amounts to extortion. Indeed, further down the same page, ABPN again explains/rationalizes the fee in a poor attempt to anesthetize us into a sense of “just business as usual” in much the same way various other organizations pull the proverbial wool over the eyes of their constituents. Just look out how enticing these “benefits” are:

There are several advantages C-MOC program participants gain:

• Annual fee instead of a large fee at the time of application
• Customized list of MOC activities that can be provided to employers, hospitals, licensing boards, etc.
• Reminders from the ABPN regarding MOC requirements that are due to be completed
• Easy-to-use system to track individual requirements
• Personalized ABPN Physician Folios account.

I wrote again to express my concerns and was informed that indeed the MOC requirements and annual fee do need to be satisfied as long as a diplomate wishes to maintain certification. If after 3 years of not keeping up-to-date with the requirements, status will be changed to “Certified – not meeting MOC requirements.” If after 6 years one is not up-to-date with requirements, then that doctor would no longer be board certified (despite having passed the exam 6 years prior!) A diplomate may change his/her status back to “Certified – Meeting MOC requirements” upon successful completion of a block of MOC requirements and payment of all required fees.

This entire process is completely unfair. I have no problem meeting MOC requirements if I have to, though I also think that that is a farce because it does not confer upon any doctor any special status as far as clinical acumen or excellence as a physician. It solely proves that a doctor can find suitable credits to pass to satisfy the requirement. Many of us lead very busy lives, not only in practice but outside of work, and really don’t need more to do. I own and operate a completely solo practice and do all my own administrative work. I don’t need more to do. I earn the requisite number of credits each year to satisfy ABPN and state board requirements. How can the board not only justify more onerous requirements but then make us pay for the “privilege” of such upkeep? This smells like profit mongering on the part of ABPN, just like the ridiculous burden and cost of needing to recertify every 10 years for those of us who graduated after 1993. EVERYONE should need to recertify, or nobody at all. If I choose to recertify in 10 years, I would still rather pay once at that time rather than give the ABPN any of my money annually. The CEO of the ABPN is already paid over $800,000/year, so it is obvious where the money is going. I am not in business to help keep the ABPN afloat and am truly hopeful that soon enough there will be other certifying boards that become accredited. I may have one more certification in my career, but if I have another option I will gladly move away from the ABPN at that time. I would love to continue this discussion with whoever is making these decisions.