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    Urologist to ABU: ‘I relinquish my certificate’ over MOC (Letter)

    Editor’s note: The following letter was sent to the American Board of Urology (ABU) by Stephen G. Weiss II, MD, who practices in the Deland and Orange City, FL offices of Atlantic Urological Associates. The letter was subsequently sent to Urology Times to “start a meaningful dialogue” between clinicians and the ABU regarding maintenance of certification, Dr. Weiss said. Urology Times welcomes readers’ comments in the “comments” box below or at [email protected].


    Dear ABU,

    As a board-certified urologist for almost fifteen years, I have jumped through every hoop the ABU has placed before me and have remained in good standing; however, I will no longer participate in the meaningless charade known as Maintenance of Certification (MOC). I successfully completed the original certification process and the subsequent recertification process, but enough is enough. The ABU has strayed far beyond its original mandate to ensure excellence in urologic training and has added yet another onerous burden onto the backs of practicing urologists.  

    The 2002 Physician Charter, which served as the foundation of MOC, is a flawed and disingenuous document that has one surreptitious purpose: to give specialty boards more power and control over their diplomates. How dare the ABU question my demonstrated commitment to lifelong learning! How dare the ABU attempt to lecture me on professionalism and ethics! How dare the ABU place the “benefit of the public” above the welfare of its diplomates! The “public” doesn’t pay the ABU’s expenses. The “public” doesn’t struggle under the weight of the ABU’s “evolving” mandates. The “public” doesn’t care a whit about the ABU’s rubber stamp of approval. The ABU should be focused on helping urologists provide “high quality, safe, efficient” care for their patients—the “public” has nothing to do with it.

    NEXT: "The ABU seems to care nothing about the physical and mental health of its diplomates."


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    • Dr. Michael
      Standing ovation to add. Weiss!!! As a urologist, I am embarrassed that I and most other urologists do not have the balls to do this. With your leadership, maybe I will grow a pair. The Mafioso extortion by the ABU/ABMS needs to stop.
    • Dear Colleagues I too would like to congratulate Dr Weiss for his courage in stepping forward and speaking out.I would like to offer my moral ( and financial ) support to his cause and I hope other urologist will feel the same way. I think it is very telling that over half of the comments made in this forum ( all of which have been scathingly critical of the American Board of Urology ) have been made anonymously. This speaks to the fear that this bullying organization has created in this educated group of professionals. That the ABU felt they could treat this group with such disrespect is truly incredible. This forum contributes to the growing body of evidence that the ABU is a dysfunctional organization using intimidation as a part of there power. Prior to this forum I too would have been afraid of retaliation for speaking out against the ABU. Hopefully we can eliminate these fears and work toward a functional board. Sincerely Douglas W Ankrom MD
    • Anonymous
      It's better that the ABU looks after us than the U.S. government!
      We urologists as a group lack the intestinal fortitude of Dr Weiss. If ALL board certified urologists as a group simply refuse to participate in this insane MOC process , it would disappear over night. The nightmare would be over. I recently concluded this ridiculous MOC process for the last time and I promised myself, my family and my colleagues I will never do it again. If the ABU requires any more of my money, time or effort to remain "board certified" I will drop my cystoscopy and never pick it up again. Maybe the ABU can then spend some of the ill gotten money from MOC and send a new board certified urologist to replace me as the only urologist serving the indigent population in this rural Arizona county. I am done. Alfredo Guevara MD JD FACS
    • Anonymous
      Dear colleagues, The purpose of the ABU is to insure that all practicing urologists in the US meet the minimal requirements of competency. These include having a sufficient level of knowledge, adequate operative skills, good bedside manners and adherence to the ethics of medicine. This is easily verified by reviewing the case logs and performance of practicing urologists (e.g. maintenance of state licensure, law suits, disciplinary actions etc...). Once a physician passes the board exam, he/she shouldn't have to recertify as long as he/she continues to practice medicine and meets the minimum standards (certain number of procedures, CME hours...). The ABU are abusing their authority and it's time to step forward and speak up. The ABU's current certification policies have no impact -whatsoever- on improving patient care nor do they insure that the board certified urologist is a better surgeon/doctor than someone who has not recertified or even someone who is board ineligible. Urs Studer is not board eligible. Peter Wiklund is not board eligible. Richard Hautmann is not board eligible...and the list goes on and on. There is no data to prove that the ABU's certification policies have improved patient care and outcomes. It's time to do something. I add my voice to Dr Weiss's in revisiting the entire certification policy. Thank you, Kansas, USA.
    • Anonymous
      Dear Colleagues, It is about time, that we take Dr. Weiss's courageous and insightful advice and "unshackle" ourselves from the onerous and expensive burden imposed by our own "Certifying Boards". Most hospitals indeed require Board Certification or Board eligibility to gain and maintain privileges. From the controversy and notable expense imposed by the current boards, demanding MOC and recertifications, an alternate certifying Board has evolved. The National Board of Physicians and Surgeons (NBPAS.org), an alternative Board providing continuing board certification. The major difference is replacing onerous computer modules and expensive examinations, with ACCME accredited Continuing Medical Education. It behooves us all to seek certification with the NABPS as an alternative to our traditional medical and specialty boards. Our actions will speak louder than words or petitions.
    • Anonymous
      Kudos to Dr. Weiss for starting the long awaited dialogue on the subject of MOC and congratulations to Drs. Terry Moreland and other anonymous writers for stepping forward and make additional contributions. I am sorry to hear about those who have decided or are considering to retire solely because of the requirement of MOC when in fact we need more Urologist because increasing demand from the aging population. I have been extremely lucky to have grandfathered and escaped this unnecessary requirement by virtue of having passed my board certification by just one year before it became mandatory.I agree with all of the suggestions by Dr. Weiss about maintaining certification via designated number of CME credits as well as peer review by the Chairman of the Department of Urology where an individual Urologist is practicing.
    • Anonymous
      BRILLIANT!! Thank You Dr. Stephen Weiss for your voice of reason and your courage. I have felt the same for the past few years dealing with the same threats, hostile deadlines, and absurd bureaucracy for essentially no benefit to my patients and to the financial benefit of the ABU. I have had it with the expense of ALL these parasitic organizations ABU, AUA, local Section. Our compensation has dropped precipitously, yet all these fees only increase? We need to change the by-laws at our local hospitals that state(at least by me) "to remain on staff you must be a Diplomate of your licensing Board." One sham supports the next, ensnaring one's livelihood with the capricious ways of the ABU.
    • Anonymous
      I am also debating whether to take the board exam for the fourth time, or whether to retire. I would argue that I am a much better urologist than when I first took that exam with only a couple of years of independent practice under my belt. The last time I took the exam, I was forced to give up playing in a local orchestra. Giving up practice time to study meant my already limited skills atrophied and I haven't been able to return. I learned a lot of interesting stuff about renal transplantation, but it is mostly irrelevant to my practice in a rural critical access hospital. I am perfectly adapted to do good urology in my health care setting, essentially at the peak of my knowledge and ability, but that assertion can't be measured in any simple, objective way by the board. When I retire, it will be measurable in its absence. Practicing good medicine can't be measured well, which is why the current vogue for "quality measures" is so absurd. Using completely unvalidated measures to determine payment for the work we do is as stupid as using irrelevant examinations to determine our fitness to practice urology. To me, "quality measures" measures the ability to click the right buttons on the EHR, and board recertification measures the ability to study for and take tests well (which I think we all demonstrated by getting into med school in the first place!).
    • It has been heartening to receive so much positive feedback from friends and colleagues regarding my act of civil disobedience. I want to personally thank Drs. Moreland and Terry for sharing their personal stories and frustrations with the MOC process. I hesitate to mention by name all the other physicians who have given me support via phone calls, emails, texts and slaps on the back. Dr. Martin K. Dineen challenged me to back up my declaration of independence with meaningful alternatives to the current MOC program. To this end, I have several suggestions for the ABU and for Diplomates suffering under their autocratic rule: 1) If your state requires Maintenance of Licensure (MOL), this process should be sufficient to meet the ABU's MOC requirements. It is redundant to perform both MOL and MOC. 2) If the ABU wants documented proof of "ethical" standards, have diplomates sign the AUA Code of Ethics. If a diplomate has objections to some of the guidelines, then the diplomate can express these concerns in a "comments" section. 3) If the ABU wants proof that diplomates are maintaining a basic urologic fund of knowledge, diplomates can attest that they have reviewed all the AUA guidelines that are relevant to their practice. Once again, diplomates would be able to post comments about the validity and trustworthiness of the guidelines. Perhaps an online forum could be established to help vet these guidelines with feedback from the trenches. 4) It would take a few seconds to click three boxes on this imaginary ABU MOC website: participation in state MOL, sign AUA Code of Ethics, attest to knowledge of relevant AUA guidelines. Since the ABU is unlikely to take this common sense approach, there is an alternative solution. Notify Dr. Gerald Jordan, Executive Secretary of the ABU, that you refuse to participate in the MOC program as it currently exists. I forfeited my certificate in a symbolic protest specifically against MOC. 5) Apply for an alternative board certificate from the National Board of Physicians and Surgeons at NBPAS.org. The President of this organization, Dr. Paul Teirstein, has waged a successful war with the ABIM and has launched a grass roots initiative to replace the current recertifying process with a simple, inexpensive, user friendly option. The NBPAS website even includes sample letters for physicians to send to hospital administrators and colleagues explaining this alternative board certificate. In the past, urologic surgeons like Ruben Flocks, Hardy Hendren and Victor Politano (to name but a few) were giants among men. They blazed a trail of innovation and were undaunted pioneers. Can you imagine any of them performing the MOC requirements? I was attracted to Urology not only for the cool toys, but also because urologists used to have an independent, entrepreneurial spirit and a certain joie de vivre. Now we've degenerated into a bunch of sheepish hoop-jumpers. Let's get back to our roots. Don't tremble at the feet of the ABU; make them tremble at the sound of our unified voice.
      I have been in the private practice of urology in Mercer County, NJ, and Bucks County, Pa., since 1987, after completing my urology residency at the Hospital of the University of Pennsylvania. I initially became board certified in 1989, and recertified for 1999-2009 and 2009-2019. I am in the process of 'committing" MOC III, and I will have to once again take the re-cert exam in 2017, 2018, or 2019. I totally agree with Dr. Weiss and Dr. Terry that the MOC process has absolutely NOTHING to do with the quality of urologic care that I provide to my patients, nor does it enure ANYTHING to the public. Indeed, MOC actually stands for 'Monetarily Over Compensated' because all of the 26 specialty boards, and the ABMS itself, make TONS of money from the re-cert and MOC processes. For proof, just look at what happened recently when the administrators of the ABIM had their salaries and perks made public. All of us who are board-certified in urology should contact Dr. Jordan and let him know what a joke the MOC process is. I have now 'gamed the system'. When I do the PAP for the first time (due by July 1), in the particular topic I have chosen, I purposely get one "patient' answer wrong. Then I review the AUA guidelines for that topic, as I am told to do. When I am contacted by the Board again, to do the PAP again (by October 1), I get all the answers right. Then I am told by the BOARD: "Congratulations, this proves that with further studying and education you have improved your abilities as a urologist, and are now a better urologist for the public!" Really??? All I did was play a game! On a national level, the AMA is working with the ABMS to come up with more reasonable alternatives to the current MOC process. Steven M. Orland, MD President, Mercer County Medical Society
    • Dr. Wiliam J. Terry
      I recently was board certified for the 4th time. I spent $1,000 on a plane ticket to Washington to take the recertification review course that cost $1250. I missed 2 days of work to do this and the hotel cost was $534. I have been paying $200 a year for the last 10 years for the honor of taking the test again. At some point that adds up to real money. The test I took is now different. I am a board certified urologist for 30 years without any hospital staff problems, licensure problems and no malpractice cases against me. Over 80% of my practice is pediatric urology (I did a fellowship in 1984 prior to the pediatric subspecialty designation). I took a 4 hour, 100 question test that did not have one pediatric question on it! How does that make sense and how can you justify that? My partner who is 64 decided not to take the test again and will retire in 2016 when he loses his board certification. He is retiring early partly because of the ABU's requirement for re-certification every 10 years that does not make sense and you cannot justify for any good reason other than politics and it makes you feel good. There are many consequences for the physician that is not board certified that makes practice difficult and has nothing to do with patient care. In my hospital you can't maintain staff privileges if you are not board certified and you also suffer within the malpractice laws in our state. I know that there has to be a better way to do this. Perhaps initial board certification and then just a simple CME requirement with perhaps a certain number of urology specific CME hours every two years to keep certification. Keep it simple and make it easy for physicians to maintain their board certification after that initial one. We don't need to make physicians retire early when they are not ready to do so. I passed my test the 4th time and went through the process because I do not have the testosterone level that Dr. Weiss has.