163 comments

  1. Folks, let me add my story to this. I am a relatively accomplished community hospital interventional radiologist who has voluntarily recertified in my specialty in 1995 and 2005. I’ve never been sued. I have never had a disciplinary action at the hospital or state level, and I have a pristine NPDB record. I’m US born, educated, trained, and boarded. I’ve been successfully licensed without any challenges or suspensions or issues in 10 states and 2 countries. It became obvious to me as I am in my 27th year of practice in a small somewhat backward hospital that I was never going to do much of what my IR MOC was going to examine me on, nor had I done some of the newer more challenging procedures (Y90, BRTO, etc). Not that I am inexperienced; I have 14000 cases including some fairly extensive vascular experience and aggressive stuff – trigeminal nerve balloon compression, complex spine work, etc. Pre-emptively I applied for and got NBPAS certification, and wrote nasty letters to my board asking how they could justify putting my reputation and career at risk by potentially failing me in my chosen demonstrated specialty after being boarded 3x over 27 years. Needless to say, I got a bunch of platitudes and “we’re working on it”. I was due to take MOC exam, which I had not registered for during the first 6 years of this ten year cycle, but the Board badgers you to do so and finally I relented. I completed all the requirements except the exam, which I was scheduled to take in November but I felt unprepared. I rescheduled and took it in March, 2016, and felt fairly prepared after 3 months of fairly intensive preparation. The exam as it turns out was ridiculously easy. Of 220+ questions I left only 20 blank and I know I got most of the ones I answered correct. Then, 6 weeks later, I found I failed. I’m a big boy; I’ve weathered 1 family tragedy and a near miss with another, but I love my chosen specialty and failing it is absolutely devastating. How do I explain this to my colleagues? My children? Licensing boards? Patients? Certification organizations? Malpractice insurers? Plaintiff’s attorneys? Can you imagine having to be deposed after passing yourself off as a competent conscientious sub specialist for 3 decades and having to tell an attorney you’ve failed your F—ing MOC board exam? The professional humiliation is BEYOND description. And I am not soothed by the fact that I can spend another $1000 and take the exam “as often as I want.” So I cannot think of a more important incentive than to get NBPAS accepted as an alternative and ABMS emasculated.
    I have proposed to my Board an alternative MOC which would provide maintenance of certification on a point system, with points being given for years in practice, # of states licensed, lack of disciplinary actions, lack of npdb entries and malpractice cases (points both for lack of settlements, lack of cases, being summarily dismissed, etc), PQRS if you insist, and anything else including the exam. That way, in theory, a newbie may elect to take the exam; someone like me with a pristine record of 30 years would garner enough points to be certified without needing the exam. Someone with 15 malpractice cases, a couple of suspensions for substance abuse, on probation from the state, with only one state license, a couple of entries on his/her NPDB query would have a tough time even if they pass the exam….but the proposal rewards you for having a clean record the longer you practice. Going through state licensure is a torture test these days, and every license you get should be a hurdle that counts towards your recertification. likewise, an isolated suit or NPDB entry wouldn’t decrease your point totals to a material level especially when you factor in length of practice, and so forth. Some practitioners might have to take the exam, some might roll the dice to take it knowing their points are borderline, and others wouldn’t need to take it at all if they had enough points. Here’s hoping. meantime, support the NBPAS, badger your hospitals, and write nasty letters to your Boards.

  2. The Department of Veterans Affairs will accept NBPAS certification! Just switched mine in the VetPro system.

      1. I too would like to know if this is for the national Veterans Affairs system or only individual VAs? If it is national, that is a great precedent.

  3. Thank you Dr. Teirstein for all the urgently needed work. I recently had a get together with several physician friends (of different specialties). None of them is aware of NBPAS. I gave them the link. I will ask their feedback next get together. I think we should have a list of all practicing physicians in US and notify them about NBPAS. Can you and staff do that? That would increase participation

  4. I just got my ABIM recert certificate… sort of…

    I paid all of the “fees”, bought the MKSAP, did all of the “ABIM approved” stuff, took the 10 year irrelevant test. I waited 3 months for the results of the computer test. And another 2 months to tell me that I was ready to get a piece of paper. And then, after 2 more months, that piece of paper came in the mail this week.

    NOWHERE on the “certificate” does it say that I’m a physician. No “Dr”, no “M.D.”, no references to my being a physician, doctor, internist. Not even a lowly health care provider.

    Half of the certificate is taken up with signatures. FORTY SIGNATURES. I counted.

    The “certificate” doesn’t say that I’ve met the requirements for 10 years. I thought that, at least, it would say that I’d survived the 10 year test (as my prior certifications had said).

    My ABIM recertification “certificate” is essentially just a piece of paper with a web address to check certification:
    “Ongoing certification is contingent upon meeting the requirements of Maintenance of Certification. Please visit http://www.abim.org to verify current certification status”

    Oh, yeah. And if you want a copy of this piece of paper, it’ll cost you $65.

    Doctor Ellen, M.D.
    Proud member of the NBPAS
    With my sincerest thanks to Dr. Teirstein, and to all of my brave and hardworking colleagues who have fought so hard and so long

  5. MOC is a complete waste of time, and has no impact on the quality of patient. I wish the American Board of Pediatrics would recognize that fact.

    1. Just completed my CAQH attestation. I tried to upload my NBPAS certificate as board certification, but had to upload it as “other certificate” because the CAQH pull-down doesn’t recognize NBPAS as an entity.

      Is this something you can work on with CAQH??

      1. I emailed them the last time I reattested an heard nothing back. I am doing it again and suggest everyone do the same. They said I should email domainchanges@caqh.org Maybe if they hear from many doctors they will pay more attentions. Below is what I wrote:

        I am board certified by both the American Board of Psychiatry and
        Neurology and the National Board of Physicians and Surgeons (NBPAS).
        I did not see the option of that latter and request that you add NBPAS
        to your option list. To date over 3,000 physicians have been
        certified by NBPAS and 24 hospitals have accepted NBPAS as an
        alternative to ABMS certification.

        I encourage you to explore this certification which requires: previous
        certification by an ABMS member board, a valid license to practice
        medicine, at least 50 hours of ACCME accredited CME within the past 24
        months, for selected specialties, active hospital privileges in that
        specialty and clinical privileges in certified specialty have not been
        permanently revoked

        It is similar to ABMS certification prior to the recent additions of
        MOC. This is important to physicians because there is no evidenced
        based data linking these ABMS MOC activities with improved patient
        care and ABMS MOC activities are experienced by doctors as
        unreasonably complex, having questionable value, and detracting from
        more worthwhile pursuits, including patient care and other educational
        activities.

        Please add this to your menu to your board certification options

  6. Thank you Dr. Teirstein for taking such effective action while most doctors were milling around complaining. After passing four Board of Surgery exams over 30 years I had already decided I would not recertify again, so I am delighted and proud that I will remain NBPAS Board Certified after my ABS certification expires in 2019.

    Not to be pedantic, but as long as we are touting the NBPAS as a learned and scholarly organization, let’s refer to our Board Certified physicians as DIPLOMATES (with an “E”). Diplomats are people like John Kerry who flit around the world burning kerosene, eating at fancy restaurants, spouting inanities, and accomplishing nothing.

    http://www.merriam-webster.com/dictionary/diplomat
    http://www.merriam-webster.com/dictionary/diplomate

    Keep up the great work!

  7. Re: Dr. Rico’s comments and Federal Regulations: It is likely that most hospital credentialing committees do not use Board Certification as the SOLE criterion for hospital privileges. Thus, a lawsuit based on that may not be fruitful.

    Has anyone looked into a class action lawsuit based on restriction of trade? If one does not maintain MOC, most organizations now will find a physician non-compliant with their credentialing requirements. Thus, apart from State Medical Board requirements, a physician can be denied practice in a substantial portion of practice settings these days. See the discussion set forth by Dr. Wes Fisher on his blog, most recently 11-22-15.

  8. I just signed up, and have emailed my physician friends about NBPAS.

    Can you please include Board Specialties from American Board of Physician Specialties as well? The ABPS is just as corrupt and greedy.

    I took my Board exam for Integrative Medicine in 2014, and this year I got an invoice for $904, of which $595 was an “Annual Cert. Maintenance Fee”, and the remainder “Auxilliary dues” and “NIF payments”‘.

    I am also Board certified in Family medicine, and am fed up with their MOC which is a complete and total waste of my time. My certification with them expires in 2018, and I do not plan to renew it. Time to stop playing their monkey game.

    1. I also will like that the NBPAS to open to non ABMS Board certified physicians to become certified by NBPAS. I am also certified by ABPS in Internal Medicine and I am tired of paying 1000 dollars per year fee to maintain my certificate.

  9. I’ve seen a few comments on here regarding Code of Federal Regulations 482.12 that says that medical staff appointment cannot be solely dependent upon board certification or professional society membership.

    Has anyone received an opinion from a lawyer that would support the comments that this law would prevent losing medical staff membership if board certification is not maintained (or switched to NBPAS)?

  10. Appreciate Dr tier stein’so efforts to bring the issues in light. For physicians, learning is a life long process, and we learn thru CMEs in area of our practice,but as per ABMS, only learning that is recognized ( if you have paid large sums of fees to them) is what is givenbyABMS and some academic wasted interests. It’s expensive, time consuming and you can not get credit of that learning unless you pay high fees for it. Knowledge can not be kept in jail. Knowledge increases when on shares with others. Why does ABMS not want us to share the knowledge with each other? It only shows that in the name of MOC, this is just extortion to line pockets of few who are not capable of practicing medicine on their own and earn honest living.

    I learn lot more for my practice from courses and meetings organized by industry. I think these meetings should be accredited with CME as I learn lot more than some ACC sponsored course.

  11. First, thank you Dr. Teirstein for investing time and effort (maybe money as well?) in NBPAS.

    In North Carolina, being certified by NBPAS would have to be a secret. The NC Medical Board’s Position Statement on Advertising and Publicity speaks to requirements for certification.
    http://www.ncmedboard.org/resources-information/professional-resources/laws-rules-position-statements/position-statements/advertising_and_publicity

    A licensed physician may only indicate board certification from the following organizations:
    1. ABMS associated board
    2. Bureau of Osteopathic Specialists of the American Osteopathic Association
    3. Royal College of Physicians and Surgeons of Canada
    4. Another board that requires, among other things, recertification at least every 10 years and the recertification must require a written examination.

    So, ABMS boards will have lower requirements than non ABMS board (board of anesthesiology just decided to drop their 10 yr written exam).

    The staff member at NCMB with whom I communicated a request for reconsideration indicated the board would review it, sometime. I would like to encourage others in North Carolina to make a similar request, as well as through your local and the state medical societies.

    1. In South Carolina we might be looking at a similar situation. Four thoughts:

      1) It might not be that difficult to get your state medical board to change the wording on that position statement. Do be aware most boards only meet a few times a year and their agendas are usually quite long. in South Carolina I understand our meetings can last for several days.

      2) I’d check the statute that establishes your state medical board; it’s entirely possible your state Medical Board doesn’t have the authority from the legislature to establish those requirements. A lot of times position statements such as those are simply political wish lists written to keep out competition.

      3) Your hospital might still accept NBPAS for privileges; you simply wouldn’t be able to “advertise” that you’re “board certified” unless you specifically mention that it’s NBPAS.

      4) NBPAS requires recertification every 2 years; all you would need is a “written examination” to meet the letter of the position statement as it stands.

      In the end there’s no science to justify those positions; obviously its all just money and politics. Looks like more and more of us are becoming politicians!

      Best,

      Michael Gilbreath

    2. We have already started addressing and discussing the process of Non ABIM board certification like NBPAS at Wake Medical Center Raleigh. Discussion is still going on. We have been pressing for NBPAS certification. We will see how the process evolves. We need to continue our struggle and I am trying to gather as many signatures as I can. Please contact me on my email address so that I can send you an email to sign up for No MOC with ABIM. We can then collectively express our displeasure to ABIM and other insurers and hospitals.

  12. Have the hospitals that have accepted NBPAS as certification seen it approved as an alternative, or as a replacement of ABIM? If a pure replacement of ABIM, has there been an acceptance by insurers?

  13. I have been an advocate for NBPAS, along with most all of my cardiology associates as well as others. We have requested recognition of NBPAS for “certification” requirements at both the hospital med staff level as well as related to “certification” requirements of our employment agreements with Banner Medical Group. If fact the employment requirement policy does have the forsight to include language leaving the door open for non-ABMS/ABIM certification. I was provided the opportunity to address the Clinical Operations Committee of BMG. They were respectfully interested in our request but unwilling to acknowledge NBPAS at this time. Primary reason given was there feeling and/or the reality that 3rd party, non-governmental payors are mandating ABMS/ABIM certification to be on provider panels.
    I have not seen much comment elswhere about the experience of others with the ” we need to get paid by insurance companies” argurment against NBPAS.
    We will continue to advocate for NBPAS and push this issue.
    Thanks

  14. I submitted the NBPAS letter to my Medical Group/MSO for discussion at our credentialing meeting. It was received well by the members of the committee but we had to table the discussion further until we could find out whether NCQA recognizes the NBPAS Certification. Apparently, as an organization that is NCQA Certified, we follow their guidelines and I am told although Board Certification is not necessary, NCQA currently recognizes all ABS certifications. Has any attempt been made to have NBPAS recognized by NCQA? This would make Credentialing with Health Plans and Hospitals a lot easier.

  15. As per Code of Federal Regulations 482.12 Condition of participation: Governing body (7) “Ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely upon certification, fellowship, or membership in a specialty body or society.”
    First, if the Med. Exec. can’t find another reason to refuse or renew privileges they can’t use board certification as the reason.
    Second, I believe that you just need to show the med exec committee the Federal Code and let them determine if they want to stick to their guns. I’m prepared to sue my hospital if necessary along with naming each member on the med exec committee individually. Of course followed by a press release. The med exec committee is supposed to be representing us, not the hospital exec’s. What’s in it for them to change the rules? On the other hand what are the personal repercussions if they don’t? I think I stated the obvious above. And interestingly in Pennsylvania a large refund on overpayment of prior years malpractice premiums is coming our way and since I don’t really need that money this may be the cause where the money is well spent. And the thought of all those other committee docs having to spend their money lawyering up is oh well, tisk, tisk.

  16. I just read Dr. Edward Rico’s comments from May 26th. I investigated them them further, read the regulations, and he seems to be 100% correct. It seems that hospitals are specifically forbidden by the CMS Conditions of Participation from using board certification as the sole criteria for awarding hospital privileges. This needs to be brought up to any hospital board/governing body that currently requires ABMS certification as a requirement for staff membership.

    Published under Title 42, Chapter IV, Subchapter G, Part 482, Subpart B (482.12) of the Federal Regulations regarding hospital conditions of coverage and participation is the following:

    §482.12 Condition of participation: Governing body.

    There must be an effective governing body that is legally responsible for the conduct of the hospital. If a hospital does not have an organized governing body, the persons legally responsible for the conduct of the hospital must carry out the functions specified in this part that pertain to the governing body.

    (a) Standard: Medical staff. The governing body must:

    (1) Determine, in accordance with State law, which categories of practitioners are eligible candidates for appointment to the medical staff;

    (2) Appoint members of the medical staff after considering the recommendations of the existing members of the medical staff;

    (3) Assure that the medical staff has bylaws;

    (4) Approve medical staff bylaws and other medical staff rules and regulations;

    (5) Ensure that the medical staff is accountable to the governing body for the quality of care provided to patients;

    (6) Ensure the criteria for selection are individual character, competence, training, experience, and judgment; and

    (7) Ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely upon certification, fellowship, or membership in a specialty body or society.

    I found the federal website which I copied the above information from: http://www.ecfr.gov/cgi-bin/text-idx?SID=0abbaacc84884878a128c182045c0c5b&mc=true&node=se42.5.482_112&rgn=div8

    The website was up to date as of July 8, 2015, so this does appear to be current.

    1. The thanks for bringing the above regulations out in the open belong to Dr. Paul Kempen, who has been a tireless advocate for this issue.

    2. My comments posted yesterday appear to have been scrubbed. They were essentially a road map on how to handle our situation. I disagree that the method should be one of groveling to get NBPAS recognized by medical executive committees. What you reference is absolutely correct. In addition medical staffs are supposed to be independent from hospital administration. Therefore my route if necessary will be to sue each member of the medical staff committee individually for violating federal law. This is how Scientology went up against the IRS and won. My standing is being on hospital staff, my employment based on staff privileges and their violation of federal law. Physicians don’t like being sued. If enough are, especially when it has nothing to do with their medical practice, they’ll realize that they are being used by corporate interests and will take matters back into their own hands. Yes, I did join NBPAS as soon as my specialty was included. Every plan A should have a B and C as a fallback.

  17. I just turned in the NBPAS letter to my hospital administrators asking for NBPAS to be accepted as a recertifying board at my hospital.I asked primary care physicians and internal medicine specialists to review and sign the letter and not a single physician declined to sign.Hopefully in the general staff meeting in September we will pass the resolution.I will have an army of doctors ready to respond to physicians who would speak against NBPAS as a viable recertifying board particularly when the ABIM route would still be available to those who desire their stamp of approval.I am now proud to be triple boarded with NBPAS and an avid supporter of this cause locally and using social media(twitter).Not only is ABIM not going away,they will fight to not have to coexist with NBPAS.Please copy the letter to hospitals provided by NBPAS,tweak it to get the administrators names and hospital name correct and print it out and put it in your pocket.Approach your colleagues in the hall and try to briefly educate them and get signatures.I would suggest that you have a few emails ready to send to your colleagues who need more info.The Tierstein video,3 newsweek articles,Dr Wes blog page,the medical economics article are all pretty impressive at making our case.If you need these,just email me and I’ll send them right back to you.MW

      1. I want you to consider having THE EXAM for certification. Exam via nbpas sponsorship. That will put a bigger dent into the abim. That will make this easier for the hospital administration to accept this. BTW I am double boarded with nbpas.

  18. I just applied for certification. My Heme and Med Onc boards do not expire until next year. I just recertified 2 years ago for my Internal medicine boards. My hospice boards do not expire for another 6 years …

    In short, my internal medicine recert (which I did voluntarily because I just wanted to keep my boards current … since I worked so hard for it was a complete wast of time… ). The test was a waste of time, not useful. I paid (my group did) a not a small amount of money to support this corrupt and self-serving industry (plus all those to obtain downstream revenue) called ABMS … I have spoken to so many colleagues that are just not going to take this anymore …

    Practicing docs who actually do useful things with their lives are too busy to fight this so we just go along with it … but I think the time has come for a stop. Thank you, Dr. Tierstein and the rest of the NBPAS board

  19. NBPAS: breaths of fresh air revitalizing medical culture
    And the soul of the physician;
    Freedom from being stuck in a dark oppressive prison.
    Folks say even ABIM leaders want to jump tracks and join.

    “Hello, I’m ‘Johnny Stuck’ in ‘ABIM PRISON’
    Cause just they need some more ‘CASH’.”

    Testing Prison Blues

    I hear that train a comin’.
    She’s rolling round the bend.
    And I ain’t seen the sunshine
    Since I don’t know when.

    I’ve been stuck in ‘Testing Prison’
    And time keeps draggin’ on
    And that test train keeps a rollin’
    Even when I’m dead and gone.

  20. Does CMS have a specific board requirement for payment, or does Blue Cross, or other insurers? If so, How can we get our MEC to approve NBPAS if the institution may not get full payment from payers?

    1. There is actually a specific rule *against* any requirement for certification as a pre-requisite for hospital medical staff membership, see (7) below from the Code of Federal Regulations:

      Title 42 → Chapter IV → Subchapter G → Part 482

      §482.12 Condition of participation: Governing body.
      There must be an effective governing body that is legally responsible for the conduct of the hospital. If a hospital does not have an organized governing body, the persons legally responsible for the conduct of the hospital must carry out the functions specified in this part that pertain to the governing body.

      (a) Standard: Medical staff. The governing body must:

      (1) Determine, in accordance with State law, which categories of practitioners are eligible candidates for appointment to the medical staff;

      (2) Appoint members of the medical staff after considering the recommendations of the existing members of the medical staff;

      (3) Assure that the medical staff has bylaws;

      (4) Approve medical staff bylaws and other medical staff rules and regulations;

      (5) Ensure that the medical staff is accountable to the governing body for the quality of care provided to patients;

      (6) Ensure the criteria for selection are individual character, competence, training, experience, and judgment; and

      (7) Ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely upon certification, fellowship, or membership in a specialty body or society.

      1. That’s pretty interesting Dr. Rico. Did you run this by your hospital MEC or any of your hospitals attorneys? Without knowing the context of the regulation its hard to tell exactly what it means.

        1. I brought this issue up at my hospital Medicine department meeting with mixed response. The impression I received from the physicians in attendance was that the case for accepting alternatives to ABIM certification would be easier to make if a significant number of our physicians participate in NBPAS. So I’m doing what I can to spread the word with my colleagues and will continue to push the credentialing people to accept NBPAS certification.

  21. I sent a letter promoting NBPAS to an an executive officer at my hospital in NYC and received the following response. Can anyone help with a rebuttle?:

    My read this is is that there is potential for many years of litigation.
    As a former chief medical officer I can confidently say that there is no
    way that the credentials process of the 5th largest health system in the
    US will change. Besides that process is governed by the joint commission.
    Unless the JC changes the heath system can¹t. And the NBPAS needs to get
    buy in from the insurance companies that credential us to see their
    patients.

  22. Hello Paul,

    Thank you for your emails and your leadership along with the rest of your colleagues. I have submitted my application to NBPAS, and I serve on the credentialing committee at my institution, and we have already applied to have the bylaws changed to accept NBPAS.

    Warm regards,

    S Ahmed Athar, MD,FACC
    Saint Mary’s Medical Center
    Russellville, AR

  23. How can the VA be approached and convinced to accept NBPAS certification? This can not be done at individual VA medical centers, as such decisions come down from the central office.

  24. I congratulate Dr. Paul Teirstein for a wonderful positive effort to affront a formidable organization that did not pay attention to numerous complaints for so many years. Please note that there were many Organizations that were making a lot of money by providing review courses as well. They were not exactly innocent either. Some of these organizations physicians are in your esteemed Board too! I had always followed your articles in the medical journals and had an opportunity to be with you in Montreal Canada white water rafting in the Lawrence River some 20 years ago. I knew then that you are different. Kudos!

  25. NBPAS is a great service to all physicians and surgeons. If I may, it a breath of fresh air in our current health care changes which has the support of majority of doctors.

  26. I am an internist and an intensivist. Also am certified by ABNM; so multiple ABMS boards; But I am ashamed to tell anyone that my degree and all my 20 years of effort is worth only 10 years and than an organization, which did not train me can take away my certification title just by making a decision based on grabbing more power and greed for money.

    When we were medical students, we learned the basic science of medicine.
    in residency (including the intern year) we learn the art of medicine (which we continue to learn the rest of our lives)
    in fellowship we learn the wisdom of taking care of patients.
    in the years of practice that ensues, we learn the zen of patient care (what Peabody referred to once upon a time, or the aequanimitas of Dr Sir William Osler; ).

    All doctors should be targeting to achive zen/ or the aequanimitas; not keep going back to school and take tests and more tests. No tests at present tests for wisdome, zen, art, aequanimitas or even the current (last two years) science for that matter.

    Sami Akram MD

  27. happy to see all the positive responses to the New Board .
    Dr. Loder’s comments give strength to my feeling that change is necessary .
    I am NOT against MOC , but I object to being pushed around by the process , and spending money on being tested on other areas
    that i do not use . I would rather spend my time at meetings , individual case related study , and learning the barrage f new medicine that i must use .
    thank you pual for your insight and courage

  28. Thank you Dr. Teirstein and the entire board for providing true voice for physicians to continue to provide quality medicine rather than bombarded with time consuming, costly and irrelevant requirements. I do share same sentiment as my peers of isolation within medicine in which our own organizations, unfortunately, not truly support our interests; and it has been difficult to unite other physicians towards this cause even though we all share the same frustrations. I am young physician just started solo practice, and would just love to continue provide good quality medicine. It would be a privilege to volunteer my time to help support this true cause. Please do let me know if I can be any help. Sincere thanks to you and your board for this milestone work.

    Amit

  29. I have been asked to present to the Med Exec Committee of one of the two regional hospitals. They appear to be very receptive. All we need is a critical number of respected physicians to refuse to follow ABIM’s mandates and get behind NBPAS, and the argument will be over. Insurance companies and credentialing bodies can’t afford to lose even 10-20% of us, so they will have to recognize us.

  30. Dear Dr. Teirstein,

    I know you are too respectful to say it but I will say it for you- ABIM fulfills criteria for a corrupt organization. I am surprised they have not been sued to bankruptcy yet. I am on my hospital’s medical executive committee and I would like to bring further legitimacy to your organization. Thank you sir

  31. Thank you Dr. Teirstein for bringing transparency and honesty to the process of recertification. The diligence you’ve applied to researching the facts and then educating your fellow physicians is exemplary. I was literally cheering you on as I watched your APM presentation regarding the Debate on Maintenance of Certification because it was like watching a movie where the truth is told and the villain is exposed. If I were ABIM or ABMS representatives sitting in that audience, I would have been red-faced, and would have considered sneaking out the back door. The facts you presented were jaw dropping. I’m predicting more apologies from ABIM, in the form of real concessions, based on your presentation and the Newsweek article. Thanks again. You are truly inspirational.

  32. As more information comes to light it becomes increasingly difficult to imagine how any credentialing committee, governing body, or licensing board could possibly think the ABIM has any credibility left.

  33. Dr. T,
    Great video debate! I just posted yesterday’s Newsweek article on my social media to spread the word. Keep up the good work!
    Thanks,
    Jim

  34. All:

    1. FYI…ABIM will offer a partial refund of your $2000 MOC “enrollment” fee if you formally ask (minus, of course, a small “penalty” for financially inconveniencing them). This is one way to begin defunding ABIM. Pursuing their wallet is probably the only way to provoke position action on their part.

    2. I have sent a formal letter to the ACP cancelling my membership in that organization (and requesting a full refund of my most recent membership dues) after Dr. Weinberger’s insulting/threatening e-mail to ACP member physicians contemplating NBPAS membership. I would encourage this as another way to defund/deligitimize any medical society that is clearly more interested in their own financial interests instead of the professional and personal well-being of their member physicians.

    The only way to force financially-driven institutions to change…is to threaten their financial well-being. Arguments of science, decency, and ethics have failed repeatedly for many years. Only the threat of financial strain will force action.

    Thank you again Dr. Tierstein!

    Alex

  35. Well done Dr Terstein – we need an alternate mechanism to ABIM. Practicing busy Doc’s cannot do what ABIM is asking for. We need this change. Thanks.

  36. As physicians we are very strong and dynamic – we adapt to change – and often will do the right or correct thing even thought the path is harder. The ignominious changes over the last decade where the shift of patient care no longer comes from the decision of the physician – but come from the health insurance company or cost saving guideline that they supply. Physician orders have become physician suggestions to be authorized by non physicians.

    I hope that the organized momentum of Physicians can finally be real. Almost two decades in the ‘trenches’ of medical care and I have been all alone. As an Independent solo physician where the patient is my boss – I am so excited to see this type of change happening. I am sure many physicians agree that it is time to get our profession back, become organized, have strength in fighting for accurate patient rights, be a voice that affects real health insurance reform. (example:Billions that go to health insurance corporations that spend it completing administrative tasks while patients have serious disease problems and lack of access to care).

    At an ABIM board review class – “the answer on the boards will never be what you do in clinical practice”

    As a physician who specializes in the prevention of dementia – I would like to suggest a new category. While dementia prevention requires specialized knowledge across a wide number of medical fields – the details in how each interact to cause brain damage and disease are organized. As we have cases of reversal of cognitive dysfunction this field will grow due to the service it provides to patients and families.

    Allen J. Orehek, M.D – Physician of Medicine – Dementia Prevention Center – Internal Medicine/Pediatrics

  37. First of all, thank you! But, please don’t forget about us osteopathic physicians. We are fighting the same battle with our corrupt boards. Is the NBPAS recognized by insurance companies?

  38. I just viewed the video of the debate at the Association of Professors of Medicine. I am more angry than ever! It would seem that with their “apology”, ABIM is merely trying to protect their lucrative business and outrageous salaries.

    1. Thank you Paul for all of your hard work. Now that I have seen this presentation, I am more disgusted by actions of ABIM. As far as I am concern, ABIM has lost its legitimacy. Now it is our turn to help you establish NBPAS as the main entity to certify/re certify doctors.

    2. I feel as though I have been watching Toto expose Oz the Great and Powerful….er….as ABIM says “pay no attention to that man behind the curtain”. Physicians, and especially Internists, are pretty conservative, careful, meticulous sorts. And, as a group, we trust that our physician leaders are the best of the best, and will always have the patient’s best interests at heart. In addition, we expect them to pass on to the younger docs the traits of honesty, responsibility, patient-centered practice (before that became a catch-phrase), and lifetime learning. Unfortunately, it is becoming terribly clear that ABIM is corrupt to the core, and greed has trumped ethics. I suppose I have been pretty smug all these years, thinking that the profession of medicine stood above business (Wall Street) and law in its ethics and decreased focus on money. Now I feel pretty naive…but smarter…and grateful to Dr Teirstein and his cohorts for pulling aside the curtain. I refuse to pay another year of MOC extortion fees and joined NBPAS today. I look forward to seeing what happens when that Newsweek article hits the stands !

  39. Dr. Tierstein, I watched with great interest the available section (yours) of the “debate”.
    I trust you are aware that there is a presidential election coming up in 2016?
    We are all in need of some smarts, some toughness, and some fearless honesty.
    Thank you!

  40. Paul,

    I just reviewed your debate lecture and it was truly outstanding. I am sure there are so many who appreciate the efforts you have selflessly put into this issue – I know I am highly appreciative. I just want to thank you, and the rest of the board members for these important efforts. Steve

  41. Some of us are not constrained by insurnace and hospital regulations on maintaining our board status but do this proudly as part of our profession. In concierge and DPC practices we have more choice. But let this be a call to action for all fellow cash based practices to get behind this movement and stand with Dr Teirstein and colleauges to support the much needed change in medicine and the tieranies that are occuring throughout our profession by for profit corporations hiding under the guise of bettering patinet care.

    I proudly submit my application for NBPA and will let my ABIM certification lapse in 2018. Paul your efforts are starting to be recognized by main stream media and once the consumers understand the drive behind this movement and that doctors still have patient care as their highest goal, ABIM and their affiliates will be crushed. Let me know if I can volunteer in any way.

  42. Dr T–you are the bomb. The presentation TO APM was phenomenal. I have forwarded to all the colleagues.

    One thing was not covered that I would like to bring to light–because ABIM has never allowed their test results or questions to be reviewed, New York City in the 1980’s I believe would not allow the Boards to be given in NYC.

    Q. & A. on ‘Truth in Testing’; An Answer Sheet On ‘Truth in Testing’
    Permissions
    By DAN HULBERT ();
    January 06, 1980,
    , Section Education, Page ED1, Column , words
    [ DISPLAYING ABSTRACT ]
    THE new “truth-in-testing” law, which requires sponsors of col lege and graduate admissions tests to submit copies of tests and the correct answers to students upon request, took effect in New York State New Year’s Day.

    ABIM would not provide the exam and NYC would not allow the test to be given. Not sure if this is still in effect but an interesting historical precendent to the total lack of transparency today.

    Thanks for all your work–it is paying off please don’t stop.

    Linda Lewallen MD

  43. Finally, someone has discovered and publicly recognized that the ABIM is “an emperor with no clothes,” motivated by self interest and not professional excellence. I applaud Dr. Tierstein and the NBPAS Board for taking on the sacrosanct entity for what it has become. The presentation is a superb example of altruism when someone take the extraordinary amount of intestinal fortitude and time in our very busy world to expose the heretofore unassailable truth behind bureaucratic greed and self preservation in the name of societal medical political correctness.

  44. I am happy to submit my application. As I help spread the word, I wonder if any of the board members could comment as to whether or not their institutions have accepted this certification? This would ease some reluctance I have seen, and also help us gain acceptance at our institutions.

    1. Excellent presentation by Dr. Teirstein. It echoes my observation completely plus more such as conflict of interest etc. that I was not aware of. ABIM website is so confusing that I must have exchanged at least a dozen emails with their customer support just trying to figure my way around.

      Here is an interesting anecdote how ABIM test is so irrelevant to my practice. I practice in rural Wyoming. Based on the criteria I diagnosed a woman with rheumatoid arthritis. I put her on steroids. She got better but didn’t want to stay on steroids for very long. I sent her to a rheumatologist in Salt Lake City but they were booked 2.5 months out. So I put her on Methotrexate, lowest dose DMARD and slowly took her off prednisone. She was happy and asymptomatic.

      Four months later the rheumatologist called me and yelled at me. She said that only the rheumatologist should start patients on DMARDs. My diagnosis was incorrect. Or something to that effect. Medicine is a humbling profession. I could be wrong so I kept quiet.

      Fast forward to the present times. Currently I am preparing for my recert due in April 2015. I am doing MKSAP 16 (published by ACP for $1000). MKSAP questions are supposed to resemble what they ask on ABIM recert exams. One of the questions in MKSAP presents a patient on medication called Simponi. The correct answer is Tuberculosis!! It turns out that Simponi is a TNF alpha 1 agent that is notorious to immunosuppress the patient and hence you look for TB.

      Nice trivia. But how much would I use that information?

      In real life I am not even allowed to start patients on a hundred year old medication Methotrexate, but on the ABIM test I am supposed to know the unique problems posed by a modern medication called Simponi. I have practiced medicine for 15 years now and have not started a single patient on any of the TNF agents. In fact I think the insurance companies won’t let me do that since they are so expensive. They want the blessings of a relevant specialist just like we can’t write Procrit anymore. ABIM/ACP questions are completely out of touch with what I practice.

      Last time I did MedStudy but since ACP questions supposedly resemble ABIM, MedStudy did not get my business. Is there unfair advantage at work here?

      I have taken four months off my practice since I am a hospitalist just so that I can sit and prepare for the boards. Otherwise all hospitals were start clamping down on me. My job position has been filled by others. I have taken a chunky financial loss by not earning and hospitals are raising their eyebrows because my case mix index is dropping.

      I could afford to take time off because I am single, no children and have no debts. I wonder how others are able to recert.

      Everything that Dr. Teirstein said is so true which is why I posted my personal experience here.

  45. Thank you so much for doing this. The difference between this nice, simple, easy to understand and manage website is a delightful contrast to the confusing mess that is the ABIM website — they say you need 100 points, but every five years not every 10 so it’s actually 200, but you take the secure exam every 10 years, but you also several practice assessment modules, but hold on they are now temporarily suspended for two years, so check back later… I resent being forced to do busy work, and that there is no way to get enough MOC points without spending $150/module of lots of my specialty society modules since there are only a handful ‘free’ with the $2000 for ten years ABIM fees.

    Can anyone who has brought NBPAS to the attention of their hospital credentialing committee provide feedback about what the committee said when you proposed NBPAS certification as an alternative? I work at an academic medical center and unfortunately ABIM MOC is required for me to keep my faculty appointment, which I resent because it proves that MOC is not optional for many physicians.

    1. Dr. Reed-check on whether your chair/administrators are involved in the ACP. There is a clear conflict of interest when those involved in ACP are deciding on whether ABIM MOC is the only way to get certified. ACP profits immensely from MOC. Get your colleagues together and call them on it!

  46. I have lobbied our County Medical Society and both hospitals in our city (Saginaw, Michigan). I have applied for certification with NBPAS. I will do anything I can to help this organization succeed. Thanks to all who have worked on this.

    Del DeHart, MD, FIDSA, FACP

  47. I applied for certification by NBPAS because I believe we need to take back control of our profession. THANK YOU FOR YOUR COURAGE!!!!!! PRAISE AND MUCH GRATITUDE TO ALL NBPAS BOARD MEMBERS AND THE RESPECTIVE INSTITUTIONS AND MEDICAL COLLEGES THAT HAVE STARTED THIS ALTERNATIVE PATHWAY TO CERTIFICATION. I AM PRAYING MORE PROFESSIONAL ORGANIZATIONS AND MEDICAL COLLEGES WILL JOIN US. MAY GOD BLESS ALL OF YOU!!!!!!!! YOU ALL ARE THE TRUE LEADERS OF OUR NOBLE PROFESSION EXHIBITING PROFESSIONALISM AND ARE CHOOSING WISELY

  48. Dr. Paul Teirstein, I am proud to know that there are still physcians willing to stand up for what is right and fair. It is time that physicians stand up and speak out together. I will certify with NBPAS. God bless you!!!!!!

  49. The most important question is does the ABIM and or the ABIM Foundation have ANY legitimate role in “re-certifying” or “re-credentialing” or “re-authorizing” or whatever semantics they would like to use. The ABIM is in very murky waters.

    The level of vetting for established physicians is extensive and the sum of the entities scrutinizing our individual behavior is comprehensive and redundant- State Medical Boards, the DEA, Hospital Medical Executive Boards, CMS, Third Party Payers, Individual Sub-Specialty Organizations, County Medical Organizations etc. Couple this with the additional levels of scrutiny from CMS/WSJ/NY Times/ProPublica Big Data access, Claims based data analysis, Google Searches, Yelp Searches available via a smartphone or a laptop. This mix of data and profiling is an unblinking eye at a physician’s behavior and casts a very bright light into our history, our behavior and our reputation. In essence it keeps the field honest and open.

    So the question is if the Federal Government, the State Governments, the Local Governments, the individual Hospitals, the individual sub-specialty societies, the lay press, social media, the Tort System, the Medical Insurance companies, the Medical Liability Insurance companies all direct physician behavior, what exactly is the ABIM trying to regulate that isn’t already being regulated?

    If one asks the question, should the ABIM be the sole arbiter and regulator of “re-certification” when many of us recognize that this role is already filled, and the answer is a resounding “no”, then this debate is over. 

    1. Dr. Koo, Your comments provide the most concise summary I have read to date defining the question of the core issue of the mission of ABIM with regard to certification/re-certification. Certainly, the idea of physician certification would never have gotten off the ground in the early days of ABIM if not for the initiative of physicians to voluntarily submit to testing as objective evidence of achieving a high level of distinction in the discipline of internal medicine. With the current endless stream of heavy-handed behavior as well as history of obscene financial practices over the past 20+ years, ABIM appears to have lost sight of the fact that voluntary participation by physicians is what made ABIM certification a sign of distinction. Now the ABIM principals seem to believe that their credential, like the USDA stamp on meat, is what confers quality or competency on physicians. What significance can such a credential demonstrate if it comes virtually at gunpoint by holding physicians hostage by fear of maintaining employment, hospital privileges, and insurance panel participation? It seems clear to me that the NBPAS concept of continuing certification after the initial exam as demonstrating a measure of training, experience and life-long learning, makes much more sense as compared to ABIM’s implication that continuous certification reflects some marker of quality or competency. I agree, this debate is over.

    2. Exactly so. End MOC. Board certified diplomats should be so honored ONCE and FOR LIFE. Once and done. And alternatives to the ABMS are needed from inside and outside of the country, perhaps exchange certificates by reciprocity, to prevent such abuses as MOC from poisoning US medicine and surgery ever again. Twenty five years (1990 – 2015) of MOC tyranny is too long. End MOC, Stop MOC, No MOC.

  50. This is great, great, great. Thank you so much. I will apply and spread the word. I am ready to donate to get the organization going. I hate what they have done to recertification.

  51. Thank You, Thank You.. I am going to recertify with NBPAS. Enough is enough of this Mockery. I will not give them 1 cent of my hard earned money. What a disgrace ABMS and ABIM and all their supporting cronies ACP ect are. It is time we wake up and take back the future of medicine.

  52. Dear Dr. Teirstein, thank you so much for your effort to bring common sense to board recertification. i will apply right away. i passed recertification exam, however i refused MOC, so in the eyes of ABIM, i am not certified anymore

  53. This is so necessary. The profession is slowly dieing under the current system. Between the reimbursement system that skews everything to the hospitals driving out private practice and now the MOC nonsense. How is anyone going to deliver healthcare if we’re all word processing and studying for exams.

  54. Dear Dr. Teirstein, A short word of thanks for your courage. BRAVO. There is a massive electronic and political campaign to reform the ABIM and the ABIM Foundation. The view of many of practicing clinically active physicians is that the ABIM has lost its way and is too corrupt to stay objective.
    This zillow.com link will show you their level of shaky ethical behavior and their unbelievably poor judgment. The absence of financial stewardship and sense of self entitlement does not reflect those of us who take weekend call and have hectic lives in the office with sick patient.

    http://www.zillow.com/homes/Unit-.num.11NW-210-W.-Washington-Square,-Philadelphia%29_rb/

    Their history of laissez faire, aloof behavior has enraged a vast number of ethical hard working physicians. The ABIM sorely needs to dismantle itself, completely overhaul its leadership structure or accept full and manifest transparency from an outside third party inclusive of clinically practicing physicians. I would add that the next organization in need of a scouring of its operational status is the NQF and Dr. Christine Cassel. Thank you very very much for your leadership and for your hard work. Charles H Koo MD FACC

  55. I applaud the effort and determination it took to establish this board and will support it whole-heartedly. For too long physicians have toiled under the medical mafia hiding behind the “maintenance of certification” mask. The ABIM has demanded money in exchange for protection against losing privileges from clinics, hospitals, and state medical boards, and the eventual recognition of this power has been followed by greed. They provide no value to the care I offer in my practice and I will no longer take part in their recertification ruse.

  56. Paul,
    I’ll save my rant on the abuse by ABIM of hard working physician members for another day. Wanted to ask the following:

    1) Have a set up a fund where disgusted ABIM members might be able to donate (Tax deductible) money to support NBPAS and serve the cause of hard working physicians and contribute to the discredit of ABIM?

    2) Have you considered a national meeting for MDs in general to allow additional interaction with members of NBPAS and with each other to get the caravan moving?

  57. I would copy and paste every comment on this board and send it to ABIM. ABIM needs to have a closer look at reality.

    If you made the $200 fee a lifetime certification–everyone would join immediately!!

    Keep up the great work.

    Linda

    1. I have signed up even though my MOC is valid through 2022. Thank you for providing an alternate route for MOC.

      I was thinking that this board should be compliant with hospitals and insurance companies because they request that we are board certified. For internal medicine, I don’t think they specify that the certification needs to be from the ABIM.

      I had heard that Opthamology has an alternate board created. Would this alternate certification be accepted by potential employers, hospitals,etc? Thoughts?

      1. Thank you for your support! This is a grass roots initiative. We are working hard to gain acceptance by hospitals and payers. We are also relying on physicians like you to spread the word with your colleagues and your hospital medical executive committee. The website has sample letters you can personalize and use to spread the word.

    2. Linda, good to hear from you. ABIM modifies its comments so that any challenging MOC are censored accordingly. It is really wasted time trying to dialog with ABIM. They have not listened to the AMA, state medical societies, specialty societies, hospitals who pay for Board MOC for their staff members, and other stakeholders. They do not bother with individual physicians either. I hope all is well with the electrophysiology work. All the best, Dr Kathy.

  58. Thank you for providing an alternative to the monopoly of board certification. The current system is now becoming a business instead of a service to help Physicians. I hope to sign up before the end of this year if my employer will recognize NBPAS certification. Keep up the good work.

  59. Alas, while ABIM-MOC “got it wrong,” the National Board of Physicians and Surgeons (NBPAS) is righting the wrongs. KUDOS! Let us physicians unite and do the right thing for our noble profession, and uphold our sacred physician-patient relationship. Thanks, NBPAS, for leading this vital charge to effect positive transformation for American Medicine.

  60. Although I signed up for this enthusiastically, I had no choice but to proceed with MOC requirements because my active staff privileges were at risk. I took the written exam in endocrinology in November and passed. I still had to complete the PIM to complete recertification. Until this most recent change.
    I appreciate all the work NBPAS has done and continues to do. I had wanted to apply for certification here instead of ABIM, but Endocrinology is currently not being offered. I suggest that this specialty be added. Regardless of how ABIM will change MOC, I will plan on applying for certification with NBPAS when endocronology is offered.
    Thank you!

  61. The ABIM sent me the following email today, but they still, don’t get it… I believe they are just responding to the formation of NBPAS — WE CAN MAKE A DIFFERENCE IF WE DON’T REMAIN PASSIVE:

    They still want to “Transform MOC”… we need to DEVOLVE/ DISCONTINUE MOC

  62. Congratulations! Just received the “We got it wrong. We’re sorry.” email from ABIM. I’ve already sent in my application to NBPAS, and am not waiting to see whether ABIM can really get it right. Either way, Dr. Tierstein et al deserve an enormous vote of praise and gratitude from the medical world! WELL DONE!

  63. Thank you to all involved. I am checking to see what my chair and chief of staff’s response is to the NBPAS. I am hopeful that they will see the value of this group, such that my colleagues and myself could join. Good luck and thanks again- in the least, if the ABIM at least significantly reforms their process , that would be a mjor win for all of us.

  64. Can you please set up social media presence. Might make it make it easier to spread the word in addition to other channels.

      1. I am chief of medicine and a member of the MEC and so far there seems to be a very positive response as far as accepting this alternative board certification. I have called the ABIM and the MOC is being suspended for 2 years, not eliminated and I got the impression that they still do not seem to get that they represent physicians and have decided to make an onerous, time consuming and expensive recertification process what it takes to continue practicing our profession. No other profession as far as I know has to go through this and if enough of us spread the word then we can at least have some common sense control of our jobs.

  65. This is so welcome. For physicians like myself, an employed specialist in an inner city community health center, the requirements for MOC are so burdensome as to be nearly impossible. Never mind the exorbitant fees, but computer surveys for indigent patients who don’t speak English and who don’t have computers??? Really?

  66. Wonderful idea/ concept – in fact, I just applied for certification!

    As a (previously) ABIM-certified internist (1997-2007), I vigorously resisted, and did not participate in, the onerous process of re-certification through the ABIM when my certificate “expired” in 2007.

    As physicians, we need to begin the process of focusing upon quality of patient care as well as taking back control over our professional lives from the bureaucratic, cumbersome, and inefficient ABIM, an organization that exists primarily for economic benefit, not patient benefit.

  67. I hope you will be adding Preventive Medicine and its subspecialties (Occupational, Aerospace and Public Health).

    1. George:

      I looked it up: It had a sunset . from 2011- 2014. It’s no longer valid:

      SEC. 10327. IMPROVEMENTS TO THE PHYSICIAN QUALITY REPORTING SYSTEM. (a) IN GENERAL.—

      Section 1848(m) of the Social Security Act (42 U.S.C. 1395w–4(m)) is amended by adding at the end the following new paragraph: ‘‘

      (7) ADDITIONAL INCENTIVE PAYMENT.— ‘‘(A) IN GENERAL.—For 2011 through 2014, if an eligible professional meets the requirements described in subparagraph (B), the applicable quality percent for such year, as described in clauses (iii) and (iv) of paragraph (1)(B), shall be increased by 0.5 percentage points. ‘‘(B) REQUIREMENTS DESCRIBED.—In order to qualify for the additional incentive payment described in subparagraph (A), an eligible professional shall meet the following requirements: ‘‘(i) The eligible professional shall— ‘‘(I) satisfactorily submit data on quality measures for purposes of paragraph (1) for a year; and ‘‘(II) have such data submitted on their behalf through a Maintenance of Certification Program (as defined in subparagraph (C)(i)) that meets— ‘‘(aa) the criteria for a registry (as described in subsection (k)(4)); or ‘‘(bb) an alternative form and manner determined appropriate by the Secretary. ‘‘(ii) The eligible professional, more frequently than is required to qualify for or maintain board certification status— ‘‘(I) participates in such a Maintenance of Certification program for a year; and ‘‘(II) successfully completes a qualified Maintenance of Certification Program practice assessment (as defined in subparagraph (C)(ii)) for such year. ‘‘(iii) A Maintenance of Certification program submits to the Secretary, on behalf of the eligible professional, information— ‘‘(I) in a form and manner specified by the Secretary, that the eligible professional has successfully met the requirements of clause (ii) (which may be in the form of a structural measure); ‘‘(II) if requested by the Secretary, on the survey of patient experience with care (as described in subparagraph (C)(ii)(II)); and ‘‘(III) as the Secretary may require, on the methods, measures, and data used under the Maintenance of Certification Program and the Time period. Certification. VerDate Nov 24 2008 13:33 Jun 02, 2010 Jkt 089139 PO 00148 Frm 00844 Fmt 6580 Sfmt 6581 E:\PUBLAW\PUBL148.111 APPS06 PsN: PUBL148 dkrause on GSDDPC29PROD with PUBLIC LAWSPUBLIC LAW 111–148—MAR. 23, 2010 124 STAT. 963

      ABIM is mentioned by its name but the law also gives the options of the alternative pathways. Here is actual language of law>.

      PUBLIC LAW 111–148—MAR. 23, 2010 124 STAT. 963
      qualified Maintenance of Certification Program
      practice assessment.
      ‘‘(C) DEFINITIONS.—For purposes of this paragraph:
      ‘‘(i) The term ‘Maintenance of Certification Program’
      means a continuous assessment program, such
      as qualified American Board of Medical Specialties
      Maintenance of Certification program or an equivalent
      program (as determined by the Secretary), that
      advances quality and the lifelong learning and selfassessment
      of board certified specialty physicians by
      focusing on the competencies of patient care, medical
      knowledge, practice-based learning, interpersonal and
      communication skills and professionalism. Such a program
      shall include the following:
      ‘‘(I) The program requires the physician to
      maintain a valid, unrestricted medical license in
      the United States.
      ‘‘(II) The program requires a physician to
      participate in educational and self-assessment programs
      that require an assessment of what was
      learned.
      ‘‘(III) The program requires a physician to
      demonstrate, through a formalized, secure examination,
      that the physician has the fundamental
      diagnostic skills, medical knowledge, and clinical
      judgment to provide quality care in their respective
      specialty.
      ‘‘(IV) The program requires successful completion
      of a qualified Maintenance of Certification
      Program practice assessment as described in
      clause (ii).
      ‘‘(ii) The term ‘qualified Maintenance of Certification
      Program practice assessment’ means an assessment
      of a physician’s practice that—
      ‘‘(I) includes an initial assessment of an
      eligible professional’s practice that is designed to
      demonstrate the physician’s use of evidence-based
      medicine;
      ‘‘(II) includes a survey of patient experience
      with care; and
      ‘‘(III) requires a physician to implement a
      quality improvement intervention to address a
      practice weakness identified in the initial assessment
      under subclause (I) and then to remeasure
      to assess performance improvement after such
      intervention.’’.

      I think we will be fine.

  68. I urge you to add candidacy for NBPAS certification to Internists currently certified by AOBIM, the osteopathic board.

    I’m a DO internist, certified by ABIM (until now, anyway…). Many, many fine colleagues happen to be AOBIM certified, and have exactly the same problems that we face with ABIM.

    I am deeply supportive of this alternative to the monopoly and hegemony of the ABIM. Thank you and the NBPAS board for going this road.

  69. How and when do you plan to petition State Medical Boards to recognize the certifications granted by this body? If the State Medical Boards recognize the certifying exams from this body, then insurance companies and hospitals will be mandated to accept this certification. Are there any state medical boards you have contacted thus far, I am especially interested in Georgia

  70. Brilliant response to the dictatorial stance of the ABIM. I am in the middle of getting my 50 hours of CME for state licensure renewal but the moment I am done I will be signing up. I also would be happy to contribute to a legal fund to fight the inevitable legal assault that the ABIM will undoubtedly launch.

  71. Regarding section (7)(193) of the Affordable Care Act (ACA), a commentator on NBPAS (http://drwes.blogspot.com/2015/01/some-thoughts-on-national-board-of.html) has questioned the potential loss of a 0.5% additional incentive payment if a physician does not participate in an approved ABMS Maintenance of Certification Program. Such loss would have occurred during the years 2011-2014, but the incentive went out with the sunset on Dec. 31, 2014. I have received email confirmation from CMS/HHS that no further incentives for MoC participation are authorized from now on. Therefore, this particular point about the ACA incentive should not deter hospital systems from accepting NBPAS as an alternative to ABMS board certification.

  72. Thank you so much for taking a stand against ABIM MOC scam. We fully support your efforts in establishing and promoting this alternative pathway

    I know a lot of doctors are a bit nervous about this alternative Board. This is completely understandable. If we all band together and each and everyone of us play his or her to promote the new board and educate our colleagues and hospital administrations, I am confident that NBPAS will gain its recognition by our colleagues, hospitals and Insurers. Dr. Teirstein and his team deserve our support.

    Our immediate goal should be to spread the word and get our colleagues sign up , even if they are already participating in the ABIM MOC. This will help improve our strength and show our support to NBPAS.

    I would suggest following points, which in my opinion will help NBPAS to be recognized as a serious and credible Board.

    1. NBPAS should take its roadshow to the national meetings of all the specialties to promote it self and educate our colleague.
    2. We should work with Residency and Fellowship program directors and try to convince them to join hands with us.
    3. Media campaigns. A few good news articles in NYT or WSJ will definitely help us.
    4. NBPAS should seriously look into starting its own initial certification programs in next a few years. This will definitely establish NBPAS as a credible credentialing entity .

    Thank you again for all your hard work.

  73. Dr.Teirstein,
    As a fellow Interventional cardiology colleague and more important as a fellow physician I completely support your efforts to “redo” the current system of board certifications. The expenses associated with obtaining and maintaining multiple board certifications is nothing less then atrocious and sometimes can lead to costs of tens of thousands of dollars depending how sub-specialized you are and how many board certifications you choose to maintain. These organizations call themselves “non-profit” while continuing to charge upwards of $2,500 for a single examination fee (now multiply that by the number of board certifications you wish to keep). This has gotten to a point of near ridicule and almost can be considered a “cartel” like mentality by choosing to do as they please and physicians simply mandated to follow. We all know how busy physicians are and many organizations have taken serious advantage of that by simply blind sighting us and taking us for a “ride”. It is time physicians took steps like this to take matters in their own hands and decide what is considered appropriate costs and training requirements for board certifications and to police themselves instead of letting “cartels” do so. I once again commend you and everyone else for taking time out of your busy schedule to get this grass roots effort rolling. I completely support you and wish you immense success !

  74. Thank you all for this alternative board certification ! I signed up immediately. The fax number didnt work when I tried
    to fax in the CME documentation. Perhaps it was busy from all of us trying to fax? I will keep trying ~ As the time draws near
    for me to recertify with ABIM, the flurry of MOC mail and emails has intensified. I appreciate having an affordable and sensible
    alternative

    1. Thank you for your support! I apologize that the fax number did not work. We will look in to that promptly.
      If it would be more convenient for you, please email your CME documentation to: documents@nbpas.org.

  75. I encourage all physicians to sign up for this alternative method of certification. This method of certification is based upon the time-honored practice of using CME credits as a way of documenting one’s continued commitment to enhancing one’s post residency/fellowship medical knowledge. Using CME credits allows the physician to take courses that hone their individual skill set instead of being forced to participate in mandated MOC which has little, if any, relevancy in individual practice. For someone who has opted out of the charade of MOC and time-limited certification exams in 2014, this gives me a vehicle for documenting what I have been doing all along, staying current, during my 21 year plus years of private practice. For once, we physicians must unite against the forces which are interfering with our ability to deliver care. Once this monkey is off our backs, let’s unite around other issues ( ICD-10, EHR, ACO’s, etc. ) and see if we can get our profession back.

  76. We have been bullied enough. I boarded in Internal Medicine in 1997 and again in 2007. Here I am again working on my MOC requirements for 2017. This in addition to the many CMEs I already complete for my own education, or as required by the states I am licensed in. The “modules” do not make me a better doctor. They are expensive busy work. I am impressed that you require board certification already in the ABIM. Your board is an impressive group. Thank you for being the leaders in this much needed momentum. It’s about time we doctors started fighting back. I only hope the roar gets louder. I’m in!

  77. Dear Dr. Teirstein,
    Thank you so much for all your efforts and taking stand against MOC scam . I support this and I am in.

  78. Thank you Dr. Teirstein for this. I just got off the phone with a representative from my speciality to understand MOC requirements. They are even more infuriating than I realized (investigate Part 4 — the quality improvement nonsense).

    I would urge those who have any time to go and call the MOC representative from their specialty to find out more. Having a free moment, I spent about 15 minutes irritating my representative by asking question after question — “what does X mean? what exactly is a sponsor? how many points do I need for X, Y or Z?” to the point of the representative becoming clearly frustrated at their time being wasted by ridiculous questions “The answer to that is on the website, if you would just read it!”). At that point, I said — now you understand how we all feel. It made me feel a bit better.

  79. Sign up! Why? It’s an investment in the future of the medical profession, a real opportunity for change. It’s also a cheap insurance policy (only $169 for two years). What if you lose your ABMS status for some reason (e.g., not enough time to study, personal hardship like a divorce or sick child in close proximity to a recertification exam, or some careless bureaucratic SNAFU at ABMS that prevents you from sitting for the exam). You’ll still be certified by NBPAS, but only if you sign up now. If you wait until you lose your board-certified status, you’ll be ineligible. If you sign up, you’ll enable NBPAS to outcompete ABMS and force ABMS to try to catch up by lowering its prices and starting to really listen to its diplomates. Competition is better than monopoly. You know it, so sign up. You’ve got nothing to lose and a lot to gain.

  80. Thank you Dr. Tierstein and NBPAS board members. I realize that this organization is in its infancy, but first impressions matter! This website needs to rival the ABIM in its design and “flashiness”. I urge you to accept contributions, above and beyond the fee you are charging for board accreditation. You will need to hire staff, to advertise, to market to state medical boards, health plans, etc. All this requires funds! Please let me know if I can be of any assistance to your organization.

  81. Can you please add Pediatrics and all its sub specialty boards like Neonatal Perinatal Medicine ? You will gain more members real fast. Whoever has the membership strength in numbers will prevail. If most members will switch then recognition by all other entities will follow.

  82. I am glad we are raising the level of our opposition. Our society should create more doctors who are not just clerical data scientist who keep looking that laptop screen inside a patients room, but are compassionate human beings in the patient room providing patient care and not “laptop care”. What has happened to American Board certification is deplorable and I wish we could mount a stronger presence of defectors.

  83. Is there currently a route to meet CME requirements available for ABIM-certified internists that are currently in a fellowship. The ABIM MOC provides credit during fellowship training since fellows do not collect CME. I would apply for this certification, but do not currently have CME…yet, I do attend required and non-required educational conferences daily as a part of fellowship.

    Could you either direct me to or create a pathway for those of us still in subspecialty training?

    Thanks,

    Joe

  84. Like most of my colleagues in Internal Medicine, I am very much in favor of continued learning and staying on top of my game. The ABIM, in the interest of “protecting the unsuspecting public” from incompetent doctors, does not foster and encourage continued learning in a benevolent way, but rather they create a series of ridiculous and ever-increasing series of hoops to jump — ending in a very high-stakes secure exam that if not passed, results in the loss of hospital privileges, insurance contracts and the ultimate inability to earn a living practicing as a physician.
    The MOC process as it stands now is punitive. That needs to change! Never mind all the MOC activities we do- if we fail to pass that stupid esoteric secure exam, then we lose EVERYTHING! That, for me, is the big deal killer. I passed my initial board certification in 1994, have been recertified twice over the years, and have been in practice for nearly 22 years. I feel that I have proven my competency time after time. If patients want to find out if I’m any good, they can Google my name on Healthy Grades, Vitals.com, Angie’s List, or one of the many sites out there. Enough is enough!!!

    1. Less than a year ago, I took the ABFP recert exam. The whole process was demeaning, inconvenient, we were all treated like prisoners at Gitmo. They even wanded me (as in the airport) whenever I entered the exam room! I guess they thought I might smuggle an AK47 in and start firing away if I got frustrated answereing the inane test questions. Also had to show ID, sign in, sign out, utter nonsense. I did pass the exam, as I’ve done several times before, won’t have to take the stupid thing again for another ten years. Have already sent in my app for this new board, hopefully, we can avoid this kind of rude treatment and constant demand for more and more fees with this idiotic MOC process, I applaud your efforts. It’s about time we physicians stood up for ourselves, banded together, and tell these racketeers ENOUGH!

  85. Will you expand to allow those certified by AOBIM?
    Part of a large group – 30+ – mostly Internist, few FP, all Hospitalist, many are DO’s, all MD and DO are interested in this.

  86. Are you planning to add Geriatric Psychiatry? I have been training fellows, and they will be very happy to know there is an alternative for them. The whole thing of MOC seems like a scam. Rules been imposed without clinical evidence. There is too much money changing hands without accountability.

  87. I couldn’t agree more with the problems with board certification MOC. I will join just for solidarity and to provide financial support, but I am looking forward to this effort being extended to my current board certification area of pediatric hematology-oncology. The recertification and ongoing training process has become a Tower of Babel, with numerous, duplicative efforts distracting to the practice of medicine. Disproportionate attention is being directed to esoteric and bureaucratic aspects of medicine that attention to core competency is becoming lost. The “open book” approach is a fact of medical practice, and that fact is becoming lost to regulators and usually excluded as a component of examination. There still is an overreliance on factoid recollection rather than patient management approaches.

  88. Thank you so much for doing this!!! With such a trustworthy board, I really hope this organization gets the appreciation it deserves. I am practicing cardiologist, and I am in full support of this alternative to ABIM.

    Dr. Vladimir Fridman, MD
    vfridman1@gmail.com

  89. I’m in. But you ought to try being a DO interventional cardiologist in a state like Oklahoma. I can spend a week at TCT or a couple of days at a CTO meeting and none of it matters for licensing for me here in Oklahoma. I have to go to a local meeting to learn about things like gynecologic emergencies in the office to keep my license to be an interventional cardiologists. They are all just a racket to get our money.

  90. This is an interesting alternative, although not the only one available aside from ABIM; the American Board of Physician Specialties exists. The issues that must be addressed before I believe this to be a viable option include, (a) will certification through the NBPAS be recognized and accepted by the public, hospital credentialing offices, and insurers? It must be done by all three lest it be irrelevant. Even if the hospital accepts it, without insurers willing to include one on their panel, it would not achieve its ultimate goal of parity; (b) why is the CME threshold for certification less than the actual number needed for relicensure? What was the raionale, derivation, or evidence behind 50 hours? (c) $169 for 2 years of certification is still $845 for the 10 year window that ABIM certification encompasses. Again, how was this number calculated? (d) Since the finances of the ABIM’s Board has come under some scrutiny, how much does this Board get paid?

    1. 1) We agree, we must get acceptance by hospitals and insurers and public. BUT…you can help! On this website is a sample letter to send to your hospital Chief of Staff. You can also spread the word through your medstaff and through social media

      2) 50 hours of CME every two years was selected because it is the average among states. A few states require more. This can be re-examined but the 50 hour number has not be questioned by others

      3) The cost is targeted initially to be a lot less then ABMS (it is about 23% of ABIM costs). Ultimately we will adjust the cost as required (hopefully lowered) There are no salaries at this time

  91. Please, don’t forget about the Osteopathic Physicians & Surgeons, as we too are facing all the controlled non-sense of re-certifications and osteopathic continuing certification OCC=MOC, regulations, financial hardships, and mandated membership to the American Osteopathic Association (AOA).

    The AOA threatens that they will revoke current, valid board certifications if membership isn’t paid yearly.

    I just re-certified once again and for the last time. My time-dated certification expires in 2022, sooner if I drop out of AOA mandated membership.

    Our Constitutional Rights are being seriously violated; it must stop. What happened to America?

    Thanks for all of your help and hard work. Looks like it is paying off and soon, together we will take back our profession of Medicine and be able to do our job and put patients first.

  92. I’m so happy this is going forward! My ABIM certification doesn’t expire until 2017, but I would like to support the effort now. If I apply now will it certify me from 2015 for 2 years, or from my ABIM expiration date?

  93. I own a very specialized solo medical practice and haven’t performed traditional family medicine in years. However to see some of the patients that want to see me, it requires me to get certified for some insurances which require board certification. Not only I’m being forced to be tested on medical conditions that I will never see, I also have to spend money and time away from my practice, of which is getting less and less. It’s hard enough trying to keep a solo practice up and running in 2015. MOC is hurting doctors like me, as well as preventing us from reaching the patients we could help.

  94. Thank you very much for facilitating this. I signed up today. Thank you for your continued efforts against MOC and ABIM scam

  95. Can you make the system remember what someone one puts in towards the application and leaves the rest for later.
    Everyone may not have all the documents at the time they start to fill in the application.

  96. Dr. Teirstein,

    We appreciate all of your great efforts recently regarding the MOC scam. I’m currently a cardiology fellow and I was wondering whether the NBPAS has considered waiving the fees for fellows in medical subspecialties (ie: for our internal medicine certs) so that you might increase adoption amongst the younger physician population? Please let me know if I can help in any way.

  97. Very interested in ridding myself of the American Board of Radiology (Radiation Oncology) and this may be it.
    It will be helpful if a sample certificate is posted on-line so we can see it’s presentation and content in order to judge its authoritativeness.
    Who is accepting or is anticipated to accept this certification now, next year, etc. re: hospitals, insurers etc.? For example, for those physicians on your board, what are the administrative and medical staff privileging committee discussions in their hospitals?
    What is the critical mass of physicians needed for this concept to remain viable? What is your projection?

  98. Thank you for your efforts. I just applied for NBPAS certification. I also contacted ABIM for a refund of my MOC money. Before I accept their refund offer, would you be able to answer a few questions:
    – As far as you know, are hospitals/insurers accepting the NBPAS certification in lieu of “maintaining cetification” by ABIM?
    – I still intend to take the ABIM recertification exams every 10 years. Do you know if not participating in MOC will prevent me from being able to take these exams?
    Thank you again for spearheading this initiative.

  99. Please extend to Psychiatry as soon as possible. I am beyond irritated at the MOC requirements and the money required per year just to “be in good standing.” I am 100% behind NBPAS

  100. Please extend this re-certification to pathology as soon as you can! Our certificates are in the process of being hijacked as well.

  101. MOC was supposedly designed to make it easier for clinicians to become recertified every ten years or so depending upon their specialty. It was hijacked and mandated by insurance companies and hospitals, not for the reason of maintaining competence, but for regulatory issues. If an MD does not want to become recertified by MOC or otherwise, he may be dropped by an insurance carrier. MOCs and CME take valuable time away from clinical practice and effect income when the M..D. is not present because of CME requirements for state lilcensure as well. There is no evidence that physicians who have an MOC or a recertification are more or less competent than others in their field.

  102. What specialties are covered, and what specialties are being developed?

    Is there any activity/discussion with specialty societies and insurance carriers?

    Of the various nations ranked ahead of the United States in health outcomes, how many require similar MOC and recertification exams, and how many do not?

    1. In the next few weeks we will focus on ABIM specialties. We will expand soon. We need your help. If you believe in this project, please apply for board certification. On the website, click on the “WHY NBPAS” tab for a summary you can use to educate your hospital’s Chief of Staff, Medical Executive Committee, administrators, colleagues, and patients, about the controversy and why NBPAS certification is important. At this time we are not asking for contributions. Instead, we believe it will be more effective if many physicians apply for certification. We are counting on physicians like yourself to “jump start” this organization so we have funds to hire staff and get our message out to other physicians, hospital administrators, payers and patients.

      1. Paul, I’d like to help but can’t apply as you suggest . Would you/your board consider creating a page where individuals can log their name, specialt(ies) and reason for interest in this certification pathway?

        If the ABIM were non profit, then why not impose one fee regardless of number of training completions being maintained. .. the fees become outrageous. I maintain 4 ABIM certificates; none obviates another fee based exam: pediatrics, anesthesia, pediatric anesthesia and critical care medicine. None of the exams test what I practice-pediatric cardiac anesthesia and critical care. It is absoluteley insane, with ABIM vague promise of future coordination, when some subspecialty exams (critical care) have been around over a decade!!

      2. Dear Dr. Teirstein,

        Thank you for you strong efforts in this important matter. I sincerely hope that you will soon accept Family Physicians.
        I feel that ABMS has entirely failed us and I no longer have any trust in their organization and those affiliates who continue to follow them like sheep.

      3. Bravo! Congratulations, Dr. Teirstein, well done! I support your cause 100%. ABIM requires me to recertify IM yet again in 2017 (status post 1997 and 2007). My plan is to dual-certify with NBPAS now, so that my 2017 recertification with ABIM can be my last. By the year 2027 NBPAS will probably have equal status with ABIM, if our colleagues seize their professional prerogative and vote with their feet. Frankly, if I were not so risk-averse, I would fly solo with NBPAS now, but I am a belt-and-suspenders guy and I’m too old to change that.

        Coca-cola tastes great because of Pepsi-cola. Without competition, all enterprises degenerate (e.g. USPS). By creating a choice, you are ensuring that the overall board recertification process will improve for all stakeholders, guided by the invisible hand of the free market.

        Best Wishes for Success!

      4. Paul, Thank you for this brilliant move to help all of your colleagues to remain certified and to be able to focus on patient care, instead of being exploited by the self-serving ABMS. You have no idea how much this solution has brought peace to me.

        I have been outraged at how intimidating and demeaning it has become for us physicians, because of the constraints put on us by these self-appointed colleagues of ours, to determine if we are worthy to continue in our practice of medicine.

        I have re-certified several times. I have finally come to the conclusion that it is a racket and I decided no more, I had had enough of this having to prove worthiness to these strangers. Continuing medical education and low cost renewal respects us all as the hard working physicians that we are. Thankyou, Paul, for bringing respect for one another back to our medical profession.

      5. Hello Paul, I joined right away (next day) after getting this exciting news.

        Is there any way I might gain appointment to some committee or such so as to participate in spreading the word?

        any opportunities for volunteerism available?

        I am already telling colleagues, many are as steamed as I am at the madness of ABIM.

        G-dspeed,

        Jeff

    2. As to the specialty societies piece you mention, beyond endorsing reform of ABIM, I’d like to see this organization pressure these societies to develop a reduced rate for members who belong to multiple affiliates. For example as a teaching academic pediatric anesthesiologist practicing congenital cardiac anesthesia/critical care, I belong to a minimum of 6 “core” societies. Their aggregate dues empty my professional expense account. (AAP-pediatrics, ASA-anesthesia, SPA-pediatric anesthesia , SEA- education in anesthesia, CCAS-congenital cardiac anesthesia , SCCM-critical care medicine)

    1. Sharing my experience.

      My ABPN certification ends this December 2016, during the process of credentialing I informed VA that I do not want to recertify and I applied for NBPAS certification. They are threatening to cut my pay $8000. Same time physicians who were not ABPN certified getting higher salary than me. They say I was hired based on that qualification. I belong to VA Gainesville FL. Where to go for justice?
      Rajasekhar K Valmiki M.D.,

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