Harmed by MOC

Letters and emails from doctors who have been harmed by MOC

November 2018

From: Nicholson, Laura MD
Date: Saturday, November 10, 2018 9:23 AM
To: Teirstein, Paul S. MD
Subject: Recert misery

Hi Paul,

I recently gave in and took the recert exam a year late, and wrote the question below after weeks of prep and then post-test PTSD. I thought I must have early dementia during the exam, but my younger colleagues only 10 years out are telling me they are feeling equally terrible, having trouble sleeping, etc. Anyway, I was trying to submit it to an ACP commentary or Medscape or some such, maybe as a joke with a cartoon, maybe as a serious letter, and I can’t seem to find the right forum. Thought I would ask you, as a leader (however unsolicited) in this area, whether or where I should send it. (Feel free to ignore if you’re sick of this chapter in your professional life.)


A 54-year-old female hospitalist prepared for her Maintenance of Certification exam. She received excellent scores in past years by studying MKSAP, so she used the same strategy, completing MKSAP Board Basics and 1400 questions, many of them twice. She learned UpToDate would be available for all exam sessions but continued her intense studying, including 2 weeks of vacation time away from clinical and teaching duties. During the exam, she found the questions long and complex compared to prior years, with surprisingly little use of media such as CXRs, EKGs, or blood smears. As in real life, she decided to check UpToDate on patient scenarios that were uncommon to her practice, assuming that to be the intention of the open book exam. She found UpToDate opened slowly, occasionally not loading at all, and that it could not be left open between individual questions. She developed low grade nausea and tachycardia, which has progressed to anorexia and insomnia.

What is the most important next step in her treatment plan?

  1. Physical therapy referral for cervicalgia
  2. Employee Assistance Program evaluation for burnout and imposter syndrome
  3. Office ergonomics assessment for coccydynia
  4. Application to Mira Costa Community College to teach freshmen biology
  5. Attendance at Southern California ACP to commune with other casualties

Dear ABIM:
I have always enjoyed studying -- quiet hours to fill my mind with the human biology I love so much. I have taken the boards 6 times now if I count medical school, plus 1 specialty board, but this time I witness terrified, exhausted colleagues sending $1000's to ABMS and spending $1000's more on preparation, desperate for the right to continue their own professional livelihoods. My senior colleagues tell me they were there when these recertification requirements were conceived and that "it was always about money." I now feel my own professional societies -- ABIM plus ACP with its expanding collection of expensive study materials -- are willing to break me on behalf of enriching themselves, and that it's an abusive relationship I should end. Their leaders are failing "recertification" in professionalism, respect, and empathy.

Laura Nicholson, MD, PhD

Laura Nicholson, MD, PhD
Scripps Clinic Hospital Medicine Division
Associate Program Director, Internal Medicine Residency
Director, Resident Research
Director of Education, Scripps Research Translational Institute
Clinical Professor, UCSD Volunteer Faculty

December 2017

My MOC Failure

December 3, 2017 by Meg Edison, MD

Today one of my favorite families came for a visit. The kids were behind on their check-ups, but this wasn’t too surprising. Their young mom was recently diagnosed with stage 3 cancer and was working her way through surgeries and chemo. The length of time since our last visit made me worry that mom’s health kept the kids from their routine visits, but upon entering the room she looked well. We chatted for a bit and caught up on her health before moving to talk about the kids.

“Sorry we’re behind. Our insurance company sent a letter saying you were no longer a provider, so we had to transfer out. I couldn’t find a doctor soon enough, so we just went to the ER and Urgent Care for sick visits and the care wasn’t as good. When I called your office to get our records transferred, it turned out that letter was false. I’m glad they asked why we were transferring, we almost left you based on that letter.”

I sat in stunned silence and blinked back tears of frustration and anger as the full weight of her statement hit me. In the middle of cancer treatment, this family was forced to leave and seek care in the ER for one reason and one reason only: MOC.

I’ve hesitated to share the outcome of my failed MOC battle for many months now, but this visit today reminded me why we must fight against the monopoly of forced MOC. MOC doesn’t just harm doctors. It doesn’t just cost money. It harms our patients and it nearly cost me the right to care for one of my very favorite families in their most vulnerable time.

I’ve passed the American Board of Pediatrics board exam twice, I’ve completed countless hours of their proprietary online tests, I’ve completed three of their research projects on my patients. But when the ABP demanded another $1300 or they’d revoke my certification, I had enough. In protest of the shake down, I didn’t pay. The ABP and ABMS advertise their MOC product as “voluntary”, so I took them at their word.

It turns out MOC isn’t voluntary at all. Within weeks of not paying, I received a letter from BCBS of Michigan telling me to buy my board certification by December 31, 2016 or risk being decredentialed. I am board certified through National Board of Physicians and Surgeons, and asked if that was acceptable, and was rejected. Only ABMS boards allowed.

The date came and went, I didn’t pay, and I prepared to defend my case in front of their medical directors at the two appeal hearings guaranteed in my contract. Certainly the medical directors would understand this was a money grab by the boards, that I had passed every academic requirement due until 2023? Certainly the medical directors would see how discriminatory it is to require me to pay and jump hoops unceasingly, while exempting grandfathered doctors from MOC altogether? Certainly the medical directors would see I had fulfilled more board requirements than a grandfathered physician, resident, or medical student but was treated as less qualified?

The date for my hearing was set, and I felt confident the logic of my argument would prevail.

And then the phone calls from panicked patients started.

A full month before my hearing, BCBS started sending letters to my patients telling them I was already a non-participating doctor. Patients started to transfer out, my billers and partners started to panic. I called BCBS, and asked them to stop the letters until my hearings were completed. They refused. I contacted my state attorney general, he couldn’t help. I contacted the state insurance commission, they couldn’t help. I contacted the AMA, and they said to contact my state medical society. I contacted my state medical society and their lawyers for help. Their advice: just pay.

Tired, trapped, and under coercion, I paid $1300 plus a $200 late fee. Within seconds, I had my American Board of Pediatrics certificate in hand, within hours BCBS reinstated me, and never sent out another letter to my patients. It was clearly, all about the money.

I am a diplomate of the American Board of Pediatrics against my will. I find it morally reprehensible to financially support an organization that harms fellow physicians. I find it demoralizing to know my money supports their lobbying efforts against our state MOC legislation. Yet I paid in order to see my patients. I paid so I could still be a doctor. The American Board of Pediatrics could ask for another $1500 next year, and I’d have to pay again. There is no choice.

Is it possible I was targeted for being so outspoken on MOC? Possibly. My initial letter to the ABP has over 100,000 views. My medical society has used me on the cover of their magazine and their website dedicated to fighting forced MOC. The ABMS Senior Vice President knows me by sight, and has watched me testify against forced MOC in our state capitol on multiple occasions.

But I’ve been contacted by countless quiet Michigan physicians threatened and decredentialed for simply refusing to pay for MOC. It doesn’t matter who you are, an outspoken physician with a state medical society behind you…or a solo practitioner quietly trying to stay afloat…you must comply.

I don’t know the solution to this problem. It seems like every legal, logical, and ethical boundary that should prevent a certifying company from gaining such absolute unchecked power has been ignored, and every professional organization that should help us is impotent.

My state medical society has held clear policy opposing board certification, let alone MOC, for insurance plan participation for 20 years. They’ve been negotiating for 20 years, yet aggressive MOC discrimination continues. The AMA has strong policy opposing MOC abuse, but refuses to do anything. The FTC should see this monopoly as a clear anti-trust violation. They are waking up, but still not acting. I am baffled the IRS doesn’t question the million dollar salaries raked in by these “non-profit” organizations. It seems like this would be a slam-dunk class action lawsuit for some smart law firm, but no one is interested in the case. State legislation is likely our best bet, but the lobbying power of insurers, hospitals, the billion dollar ABMS certification industry and their codependent specialty societies is nearly impossible to fight.

If nothing is done, ABMS will win, because their entire coercive business model relies upon our professionalism. As physicians, we take an Oath to “Do No Harm”. We promise this to our patients.

My first emotion when I heard my patients were forced to receive care in the ER was not anger at ABMS. It was gut-wrenching guilt. I dared to speak. I dared to fight. I underestimated their power. I was stupid enough to think MOC was a physician issue. It never crossed my mind that my patients would be harmed. I know better now. The next time they ask for another check, I will comply, and they know that. I just hope something is done before then. Primum non nocere.

January 2018

From: dstorthopedics@aol.com
Date: January 18, 2018 at 2:24:18 PM EST
To: aschlafly@aol.com
Subject: AAPS vs ABMS

Sir, this is long overdue and I support and applaud you and your team in your efforts!

I have a small story to tell you. I have personally been affected by this whole MOC restrictive trade practice. It has affected my life, my family, and my standing in my medical circles.

I grew up in small town West Virginia. I stayed local in the state of West Virginia for my education. I obtained my undergraduate and medical degrees from WVU and was accepted into my general surgery internship at The Mercy Hospital of Pittsburgh and then returned to WVU where I continued and completed my excellent Orthopedic Surgery training. After a two year stint as an active duty Air Force Orthopedic surgeon, I returned to my home state of West Virginia and settled in at the largest level one trauma center in the state. No one really wanted to do orthopedic trauma back then as it is now. I have spent most of my career in the state that I love and taking care of the people of this state despite all of the bad press this state gets. It is extremely difficult to recruit to the state of WV and I always felt proud to be a part of the small number of Orthopedic surgeons who call this state home. I have had a great career spending time in private practice, faculty of West Virginia University and faculty of Marshall University. I served as the Chief of Orthopedic trauma at Western Maryland Health System for 3 years before returning to a faculty position at the eastern campus of WVU in Martinsburg, WV at Berkeley Medical Center.

I have been fortunate through the 22 years of my practice by taking great care of people and having never paid out a single dollar in a malpractice claim. Not many Orthopedic trauma surgeons can say that let alone most physicians. I have received numerous awards for great care through the years and have prided myself in always trying to do the right thing. I taught orthopedic residents for 14 years of my career and was always held in high esteem by my residents and colleagues as a "go to guy for issues, questions, or tough cases".

I am a very busy person, husband, father, surgeon, and athlete. At the age of 54, I still race bicycles all over the country. Over the past several years, life has been hectic and crazy and fun. I maintain all of my CME's as required and read incessantly to stay on top of technology and teach and lecture often.

I made a personal decision several years ago. I decided to stop participating in MOC knowing that it could bite me one day. My outspoken logic was that I am an excellent technician who has a near perfect tract record, I'll let this speak for itself. My patients do very well, I am liked by my colleagues and I produce a consistent quality product. Besides, how rediculous is it to have to recertify just for the sake of taking a test. It takes a great deal of time and time away from my family and practice and my life to do such a thing let alone all of the stuff I already to to maintain all of my licenses and CME for hospital credentials. How many times do attorneys have to pass the bar exam? How many times to Dentists have to pass their boards? How many times to CPA's have to pass the exam? How about all of those nursing administrators....how many times to pass your nursing boards?? There is no improved patient outcome with recertifications. I am completely on board with initial certification as I believe all of us are.

As my certification time was ticking down, I joined the NBPAS and whole heartedly believe and support their mission. I am an active certified Orthopedic Surgeon with NBPAS.

Well, anyway, to the meat and potatoes of this email. I was warned by the CMO and the chief of surgery that in order to remain on staff, I must recertify and that the bylaws do not accept the NBPAS certification. Ok, so, I am without a doubt the best technical surgeon with a huge practice and I am now being threatened of being terminated and losing my academic position. I go from being the "go to guy" to the guy who is given an ultimatum. I chose to hold my ground and I was asked to resign or I would be terminated! If I was terminated, it is a reportable issue to the NPDB. So, now the shame and loss of income and stress of "now what". So, all of the above....great guy, great hands, super surgeon means nothing anymore because of the stigmata of the MOC and my "loss" of board certification. Hell, even the locums companies turn their noses up at me. I have gone from being the golden boy to being unemployable due to non participation in MOC.

If this isn't the poster for restriction of trade, I don't know what is? I have now become virtually unemployable in a state that can barely recruit anyone.

Please let me know how I can help and would be more than happy to help in any way. I would be happy to testify or participate in any activity. The ABMS has created a monster. Let me help you bring is down.

Douglas Tice, MD
11801 Knob Road
Cumberland, MD 21502
304 816-1278

January 2018

From: J Graham Dickerson <john.graham.dickerson@gmail.com>
Date: January 4, 2018 at 4:50:58 PM PST
To: info@nbpas.org
Subject: Teladoc termination

Here is another story about the extortion of the ABFM i.e ABMS

To whom it may concern:

I have been in practice for 17 years and provide quality care to all patients. I have been tested through medical school residency and even recertified several times with the American Board of family medicine. I did so not because it improved quality of care but because I felt forced to by insurance companies and organizations who put an undeserved status of recognition for these organizations that extort money and time from physicians. I have spent thousands if not tens of thousands of dollars in maintaining a title that has no significant meaning.Therefore this year I decided to let my board certification expire with the American Board of family medicine. I am now board-certified with another entity called National board of physicians and surgeons that has reasonable and meaningful criteria for the title "board certification"I can only hope that this organization does not go down the path of extortion that the American Board of family medicine has. I have faithfully serve Teladoc in the pioneer industry of virtual medicine and the care I provide has not changed. I understand that there Is most likely a desire by your company to appear to have exceptional physicians, however I ask you to reevaluate why you place so much importance on board certification by the American Board of family medicine when it has essentially no correlation to quality care. Therefore the requirement by any organization to force their employees to pay money and go through time consuming activities unrelated to the care of their patients to get a title that has no clinical significance is participating in a criminal enterprise called ABFM. To imply that I am no longer "as good" as the other physicians who have taken long tests and spent thousands of dollars on a title that even the AMA considers unrelated to quality of care. I suggest you look into the history of how these for profit companies came into existence. Interestingly the physicians who decided on "recertification" every 7-10 years where grandfathered in to be lifetime certified with no further recertification. You might want to check and see if you are employing some of these older physicians, they might no be a "qualified" physicians as I am now to Teladoc

Thank you,
Dr.John Graham Dickerson

January 2018

From: Anonymous
Date: January 2, 2018 at 11:56:38 AM PST
To: info@nbpas.org


A bit about me
I sat IM and Peds in 2008 - passed both,
so am up for both recerts 2018.
Meanwhile in 2010, I completed a year long Fellowship and passed Hospice & Palliative Care Boards.

End of 2016 I started work for a Federally Qualified Health Clinic.
so I get paid crap,
but at least it wasn't performance driven.
Of 17 sites,
1/3 of a million patients, we serve ALL public schools of this Capital City.
I am 1 of 2 Pediatricians.
I round at the State/County Hospital in NewBorn Nursery.
I got Certified in 2017 as a Medical Specialist in HIV since I head up that program,
and am the ONLY emplyed MD seeing HIV patients.

My CME Benefit account is $1500.
That won't even scratch ONE Conference, never mind re-sitting boards and MOC and...

AAP won't credit the New HIV Specialist toward MOC recert, since it's "adult"
(as if anyone else is dealing with Maternal-Fetal transmission screening).
And they want me to prove I am doing Quality Improvement in Peds.
Seriously - what do they think I do all day?

So, I love seeing my patients, but I am already burning the candle at 5 ends and
I do not have time, energy or money to go around trying to get other over-worked, under-paid people to help me "prove" I am doing quality improvement!

Anonymous, RN MD

December 2017

From: Catherine Landers <momadoc@aol.com>
Date: Wed, Dec 27, 2017 at 8:17 PM
To: pteirstein@nbpas.org
Subject: Moc

Dear Dr or Mr Teirstein,

I accumulated so many hours of mksap study to recertify my abim status and passed.
In order to maintain my status I needed to complete an MOC activity and connected to a link provided by the abim.
The link took me to a John's Hopkins cme page offering 6 hours of credit until 8-2018. This was submitted to the accme website. I was directed to that website to check if cme was recorded.

The certificates of completion show an expiration date of 11/29/2017 even though the link states the course is offered until later in 2018.

Abim has not updated my completion of these courses. I was directed to the accme website that does not let me sign on. I wrote to abim and sent my certificates but was told that I have to choose an approved course that I have already done provided by their link on a secure sign in.
I finally wrote to John Hopkins cme department and have reached someone who is turning my request over to someone else who is supposed to be in charge of the department.

So I paid $1600. For maintenance of certification, about $500 for board testing, another $1000 for a board prep course, $500 for acp membership, $500 for each of 2 mksap 2016 and 2017, completed all of the mksap and have to do an Moc activity which is done.

I do have many words I could use here but because I want to keep this reprintable I will just say that it is no wonder that doctors are leaving in droves.

Count me in.

Catherine R Landers, MD
BOARD CERTIFIED 1995,2005,2015

January 2018


I'm more than willing to send you the threats that I have gotten, if it can be of assistance to you, NBPAS or practicing physicians.

  • ABOG notified ACOG and ACOG reached out to me telling me to comply or they would kick me out of ACOG
  • I had both an extended telephone conversation with the ACOG EVP as well as I sent an extremely polite but forceful letter to ACOG about why it would not be in ACOG's best interest to kick me out for not MOCing and they said "that they would get back to me..."-----that was a couple of years ago
  • I am sometimes a medical legal expert [both for the defense as well as the plaintiff] and I historically have donated all such revenue to charity. ABOG has spoken to attorneys in two cases who have attempted to use this against me. Several other attorneys have also attempted to do so but I do not have evidence that they had spoken to ABOG. It is possible that they learned of the issue from reading one of the prior depositions where opposing counsel tried to beat me up over MOC.
  • The State of Alabama mandates that all medical experts be ABMS Board Certified. Opposing counsel once tried to have my testimony thrown out in an Alabama case but the attorney that hired me argued to the Court that "as I was ABMS Board Certified and maintaining MOC at the time of the event" that the fact that I now refused to comply with ABOG-MOC and that ABOG says that I am no longer entitled to say that I am board certified was not relevant to that case. The Court ruled in our favor, but that attorney will no longer hire me for any case originating in Alabama. So theoretically, I have been economically harmed. This gets complicated as mentioned above, I donate my medical-legal revenues to charity, so in actuality the charities were harmed. Legally I do not have to donate these revenues but these technical issues always cloud legal arguments...

I don't want to fill up your inbox with documents but if you think that any of this information would be assistance to you or NBPAS feel free to let me know and I'll send it all along.

On principal, it does bother me that Alabama specifically excludes any other board other than ABMS partners. I'm not sure that it is that easy to change a law in that state however if the AAPS suit was victorious in Federal Court I do believe that NBPAS could use that ruling to trump the Alabama law. My understanding is that Federal law has supremacy over state law when they are in opposition.

The Medical Board of California's website and application/re-application also only accepts ABMS; this is something that I think NBPAS should oppose. As a California based organization the NBPAS Board could

  • write to the MBC requesting equality,
  • complain to your local state member of the Assembly and state Senate
  • seek intervention with the AG, the Governor, Dev GnanaDev MD [President of the MBC], Dean Grafilo [Director of the Department of Consumer Affairs] or Alexis Podestor [Secretary of the Business, Consumer and Housing Agency]
  • file suit against MBC

Dev GnanaDev, M.D. - President

Dev GnanaDev, M.D., of Upland, has been appointed to the Medical Board. He serves as chair of the Department of Surgery at Arrowhead Regional Medical Center, a position he has held since 1989. He is a clinical professor of surgery at Western University for Health Sciences and an associate professor of surgery at Loma Linda University. He served as president of the California Medical Association from 2008 to 2009. Dr. GnanaDev has received a multitude of honors and recognition for his outstanding work and commitment to those who utilize public health programs, including the Medical Board's Physician Recognition Award in February 2005. He earned his medical degree from the Kurnool Medical College in Kurnool, Andhra Pradesh, India.

Classification: Physician | Appointing Authority: Governor | Appointment Date: 12/21/11 | Term Expiration: 06/01/19

June 2017

From: Remenchik, MD, Ellen
Date: Monday, June 5, 2017 2:26 PM
To: info@nbpas.org
Subject: board certification with your organization.


I am an almost 64 yr old physician, previously board certified by ABIM and ABPM - but at my age I don't want to take another 8 hour test.

I am credentialed with insurance companies...but to enhance my credentials (as I want to find a new job position in primary care), I was strongly considering board certification thru your organization.

I have to complete 100 hours of CME as my boards expired in 2015- I have completed around 50 hours, as required by the state of Texas.

Is your board gaining much acceptance from insurance companies...or employers?

I need to work at least 3 more years and would like to change jobs. Of course, having let my boards lapse disadvantages me.

My 20 years of academic experience no longer seems to impress anyone! Neither does my 32 years of medical experience...

I look forward to hearing from you,


Dr Ellen Remenchik
Former Asst Professor, Mayo COM, Baylor COM, UT Tyler Health Center.
Previously Board Certified by ABIM and ABPM, Internal and Occupational Medicine
San Antonio TX

May 2017

From: MH <mitchocon@aol.com>
Date: May 23, 2017 at 6:30:43 AM PDT
To: ablommaert@nbpas.org, info@nbpas.org
Subject: Re: NBPAS Certification

I have a problem with ABIM, maybe u can help me. They're so corrupt.

My BIM certification was expiring 12/2016. I wasn't aware of if I payed earlier for the re-certification test, I get an additional year for my pulmonary board certification. Anyway, I missed the deadline by a few days but they wouldn't accept my payment to give me certification for another year.

That's a crime and almost a bribe to give me an extra year of certification if I paid early. Would that make me a better or smarter doctor? No, it would just put $$ into the pocket of the ABIM because thats all they care about.

Thanks so Much!

Mitchell L. Horowitz, MD
Medical Evaluations

April 2017

From: Kim Grafton <kimgraftonmd@gmail.com>
Date: Tue, Apr 11, 2017 at 8:07 AM
To: kcollins@nbpas.org
Subject: Re: Anti-MOC: Important, time sensitive news from NBPAS

I will be forced into early retirement if I don't take the boards and participate in MOC this year. No budging on this topic in my town (Santa Barbara). Kim