The real cost of MOC is stunning

This post was published on kevinmd.com on August 11, 2015.

In the past few years there has been tremendous criticism of the American Board of Internal Medicine’s (ABIM’s) maintenance of certification (MOC) program.  The MOC program was significantly expanded in 2014 and required doctors to get 100 MOC points every 5 years and do at least one MOC activity every 2 years. These requirements also came with increased fees for the MOC program and increased failure rates for the recertification exam.  In the face of criticism, the ABIM changed the program earlier this year and removed activities like “practice assessment” and “patient voice” that many people felt were too arduous.

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Much of the uproar around the MOC has been around the costs for MOC activities such as the fee to enroll in the MOC program, the cost of the recertification exam that doctors have to take every ten years, and the cost of retaking the test in light of increasing failure rates.  But tied to these activities are not just the bills for these activities but also the cost of the time that it takes to do all these activities.  And at a time when doctors feel as if they are expected to work more for less, measuring the costs of the time to do certification activities is tremendously important.

Precision medicine: Getting the right patient to the right doctor

This post was originally posted on kevinmd.com on

In his State of the Union address, President Obama announced a precision medicine initiative “to bring us closer to curing diseases like cancer and diabetes.” The goal of precision medicine is to more accurately identify diagnoses and treatments based on a patient’s genetic information. This information will hopefully lead to better screening, earlier diagnosis, and more personalized treatment.

Photo from istockphoto.com

Photo from istockphoto.com

But it’s hard to imagine that patients will get this kind of medical care if one of the most basic forms of precision medicine — finding the right doctor or team of doctors for each patient — remains one of the most rudimentary processes in health care.

Is there any benefit of duty hour reforms?

This post was originally posted on kevinmd.com on December 22, 2014

Almost every practicing doctor remembers the grueling hours and intense workload of residency.  I recall overnight calls when I ran around from floor to floor, my beeper never stopping. I would collapse at home the next morning exhausted, drained and a little depressed.

Photo from istockphoto.com

Photo from istockphoto.com

 

I would never want to relive residency, but I do look back at it with a sense of accomplishment.  In some ways, it is a badge of honor.

Women in Academic Medicine

In 1849, Elizabeth Blackwell became the first woman doctor in the U.S. She practiced for over forty years both in the U.S. and in England. Given the male dominance in medicine at the time, she faced many challenges including exclusion from lectures and ward round and periods of isolation.

Photo from istockphoto.com

Photo from istockphoto.com

It has been 165 years since Blackwell’s graduation and, not surprisingly, a lot has changed.  Last month, the Association of American Medical Colleges released its annual State of Women in Academic Medicine report .  Women now make up 47% of medical students, 46% of residents, and 36% of medical school faculty.

What can Quality Improvement Learn from Google?

Quality in healthcare is a priority  more than ever before.  There is an explosion of policies and incentives to spur quality improvement.

Photo from istockphoto.com

Photo from istockphoto.com

As a researcher, I often struggle with some of the quality improvement methodologies.  I am a purist and love rigorous designs like randomized trials with clear outcomes and clear interventions.

Defensive Medicine: Is it all in the eye of the beholder?

This week, JAMA Internal Medicine published a study on what doctors order out of fear of malpractice. I was a co-author on this paper with colleagues from the Cleveland Clinic and Baystate Medical Center.

From istockphoto.com

From istockphoto.com

I have been very interested in the problem of defensive medicine for several years because doctors and policymakers often site malpractice fears as a driver of high healthcare costs.

You Can Empower Patients!

Many things that we do as doctors become routine and standard after time. Personally, I have developed algorithms, either written or memorized, that I follow when I care for patients.  I have an algorithm for managing diabetes and one for the work-up of anemia.  In this day and age, shouldn’t we be able to empower our patients to use these algorithms themselves?

Photo from istockphoto.com

Photo from istockphoto.com

In last week’s JAMA, a study came out where patients with high blood pressure were taught how to use an algorithm to self-manage their condition.  The intervention involved self-monitoring with a home blood pressure kit, and, when necessary, self-titrated their medications.

Is Old-Fashioned Care Coordination Missing from Modern-Day Medicine?

Last week, Matt Press – a colleague and friend – wrote a very telling perspective piece in the New England Journal of Medicine where he outlined the complexity of care coordination for a patient with newly diagnosed cancer.

Photo from istockphoto.com

Photo from istockphoto.com

In his piece, Dr. Press – a primary care physician – describes 52 times he communicated with the patient or his physicians over an 80 day period.

How Good is your Doctor?

As a practicing doctor, I often wonder – am I a good doctor?  Good (or great or amazing) – whatever kind of doctor you want to be – is hard to define.  Am I a good doctor if I went to a good school or scored well on my board exams?  Am I a good doctor because I listen and care about my patients? Am I a good doctor because of many, many things that are really hard to capture?

Photo from istockphoto.com

Photo from istockphoto.com

Measuring the quality of a doctor is really difficult – but we are in an age where quality is becoming more and more important.  Quality is now linked to payment, it’s reported on the internet, and it’s likely to become a bigger focus in the future.  As a result, we have to continually to try and define what a good doctor is.

How do you Motivate Doctors?

A few weeks ago I read one of the best articles on motivating doctors to improve healthcare in the Harvard Business Review.  Motivating doctors is an extremely important issue because we are in an era where healthcare is rapidly changing and hospitals, doctors’ practices, and other healthcare entities need to quickly adapt.

Photo from istockphoto.com

Photo from istockphoto.com

But adaptation is difficult – especially if doctors are not behind it.