While controversy and serious debate continue to surround the issue of enhanced requirements for maintenance of certification (MOC), the American Board of Pediatrics (ABP) attempted a bit of summertime humor by emailing animated cartoons to its diplomates as reminders to complete their MOC requirements by year’s end. But some pediatricians—including those who say the ABP had threatened them with legal action over their anti-MOC organizing efforts—found the “Nick Jr.”–style cartoons to be, well, juvenile and offensive.
“The cartoons appear to be designed for my youngest patients rather than their pediatrician,” said Joseph Zanga, MD, chief of pediatrics, Columbus Regional Healthcare System, in Columbus, Ga., and a former president of the American Academy of Pediatrics. “It makes me angry that they’d spend our money on demeaning junk such as [this].”
“I’m glad the ABP has a sense of humor, but I was not amused by the videos,” said Victor Strasburger, MD, distinguished professor of pediatrics and chief of adolescent medicine, University of New Mexico School of Medicine, in Albuquerque. “They could be spending their time reviewing how MOC works—or doesn’t work—and make it much more palatable to the average pediatrician.”
In late June, the ABP emailed links to three short musical cartoons to about 15,000 pediatricians who had MOC requirements to fulfill in 2014. “Summer’s here and we’re having some fun!” the ABP explained on its Facebook page. “We’ve created three MOC videos explaining requirements. The content in these videos may not pertain to every diplomate (so be sure to check your ABP Portfolio for YOUR specific requirement needs), but we hope you get a giggle to lighten your day.”
The first animation featured “a friendly bluegrass farmer who can sure play that banjo!” The second video presented a classical motet entitled, “If ye loves being certified …” The third was a rap song, peculiarly titled, “Now this is the story ALL about how my points got flipped, turned upside down … ”
Virginia A. Moyer, MD, MPH, vice president for maintenance of certification and quality at the ABP, said the idea was to remind physicians of the December deadline for completing their Part 4 MOC requirements, which involve quality improvements performance in practice.
“I wanted to send a ‘Harry Potter’–style ‘howler’ but couldn’t figure out a way to do it,” Dr. Moyer explained, referring to the magical letter that screams its written message to the unfortunate recipient. “The videos were one way to get their attention,” she said.
Paul M. Kempen, MD, PhD, an anesthesiologist at the Cleveland Clinic, in Ohio, and an outspoken critic of MOC, said the cartoons are evidence that “the [medical] boards have become so arrogant that they feel they can use any means to force this [MOC] down the throats of physicians.”
Getting Into Trouble Over MOC
In 2010, Dr. Zanga launched an Internet-based anti-MOC petition drive using his email account at Columbus Regional. “The communications director at ABP called expressing concern,” Dr. Zanga said in an interview. “She stated that the information in the petition was blatantly wrong, bordering on libelous. The hospital was not happy and told me to take it down,” he said. After moving the petition to another website, Dr. Zanga said he collected 2,000 signatures opposing ABP’s enhanced MOC requirements. Dr. Moyer said she had “no information” about the matter, but noted that ABP did not have a communications director in 2010.
In the April 2010 issue of Clinical Pediatrics, Dr. Strasburger coauthored a commentary article with Donald E. Greydanus, MD, then at the Kalamazoo Center for Medical Studies, in Kalamazoo, Mich., critical of both ABP and MOC as it was then being developed. In the commentary, titled “Maintenance of Certification: The Elephant in the Room,” they proposed several less burdensome ways by which pediatricians could demonstrate that they were keeping up with developments in the field (Clin Pediatr 2010;49:307-309).
“The ABP threatened to sue me personally and SAGE Publications [the journal publisher] for libel,” said Dr. Strasburger, who was also a member of the journal’s editorial board. “They demanded a retraction. It took SAGE countless hours to review the complaint. Obviously, they were not happy.”
The lawsuit never materialized, and in July 2011, Dr. Strasburger wrote another editorial, “Ain’t Misbehavin’: Is It Possible to Criticize Maintenance of Certification (MOC)?” This time, the editorial was `rsed by 10 members of Clinical Pediatrics’ editorial board.
“The ABP has tried to shut down any disagreement or even discussion about MOC,” Dr. Strasburger’s editorial said. “Several petitions to put a moratorium on the MOC process have generated >2000 signatures; yet the ABP has tried to shut down Web sites and any discussion. Pediatricians initially train within an academic system that prides itself on questioning everything. MOC should be no exception” (Clin Pediatr 2011;50:587-590).
“I do know that the board [of directors] was very unhappy with the two editorials that Dr. Strasburger wrote,” Dr. Moyer said when asked to comment. “If there was any legal action, I know absolutely nothing about it,” she said. Formal legal action would have had to come before the board, which did not happen, she added.
Dr. Moyer said she has “no access” to any informal communications that may have occurred with Dr. Strasburger at the time. “No one should feel threatened about speaking their mind about something,” she said. “We really want the same thing; we all want pediatricians to be keeping up and improving the quality of their care.”
However, according to Dr. Strasburger, “the threatened lawsuit shows that the ABP doesn’t have much of a sense of humor. It needs to look critically at the product it’s producing, like all of the medical boards need to do, and see how to make it more user-friendly. Making half-hearted attempts at funny videos is not going in the right direction. Pediatricians are very upset about this but feel they are powerless,” he said. “What does a single practicing pediatrician do? They feel completely helpless.”
MOC Required for Licensure?
In January, the American Board of Medical Specialties (ABMS), composed of 24 member boards including the American Board of Anesthesiology, approved new MOC standards that emphasize continuous learning and assessments. The new standards are to be adapted and implemented by each specialty board starting Jan. 1, 2015. Backlash in some specialties has been accelerating. For example, an ongoing petition drive protesting new MOC requirements by the American Board of Internal Medicine (ABIM) had collected so many signatures that in April, ABIM President Richard J. Baron, MD, issued a lengthy statement defending the organization’s efforts. As of July 2014, the petition had gathered 17,400 signatures.
Alarmed over escalating MOC requirements, including the apparent melding of MOC with maintenance of licensure (MOL) requirements, the American Medical Association’s House of Delegates approved several resolutions in June. They included opposing mandatory MOC in favor of self-regulation, the establishment of a “critical review” of the effect of MOC on physician practice and patient outcomes, and a resolution opposing mandatory participation in MOC as a condition for licensure. The delegates directed AMA to “oppose mandatory MOC as a condition of medical licensure, and encourage physicians to strive to constantly improve their care of patients by the means they find most effective.”
—Ted Agres
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