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    Letters: Readers comment on Medical Economics stories

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    Good doctors are always updating their knowledge

    I appreciate Medical Economics' willingness to cover the topic of maintenance of certification (MOC) ("Where do you stand?" by Beth Thomas Hertz, December 10 issue).

    Many physicians disagree with MOC and are actively opposing this process. The process is not only "frustrating, time consuming, and expensive," it's also a major moneymaker for the American Board of Medical Specialties (ABMS) and its subsidiary boards. At a time when our medical system is being stretched to the limit by insurance costs, malpractice lawsuits, and government debt, it would have been very useful if Medical Economics would have further looked at the outrageously large amounts of money gathered by the ABMS and its subsidiary boards.

    Not all doctors have a choice with regard to certification, recertification, or MOC because many parts of the country require doctors to be board-certified to maintain hospital privileges and be reimbursed and/or be part of certain managed-care networks.

    Kevin Weiss, MD, MPH, president and chief executive officer of the ABMS, states in the article that an alternative to MOC is "not to take time for professional development." That is insulting. Does he really believe that we make no attempt to further our education, improve our knowledge, and take better care of our patients beyond MOC? Good doctors are constantly updating themselves from a variety of sources, including their colleagues, Internet-based scientific resources, and scientific journals.

    There is no public outcry for MOC. The assertions that board-certified doctors provide better care are not supported by consistent scientific data, and attempts by the ABMS to legitimize MOC do not reveal any real proof that these processes make better doctors.

    MARTIN S. DUBRAVEC, MD
    Cadillac, Michigan

    Why don't lawyers have to be recertified?

    As an obstetrician/gynecologist who finished my residency in 1985, I earned a 10-year certificate when taking my boards. If I had graduated in 1984, I would have been certified for life.

    The American Board of Obstetrics and Gynecology (ABOG) requires a two-part exam. The first part is written, and the second is a 3-hour oral examination, part of which is based on the entire list of all the physician's hospitalized patients plus representative outpatient visits. I passed and was recertified 10 years later. In 2001, my specialty board modified the certificate to be valid for 6 years. In 2008, it changed the rules again to require a yearly exam.

    Why do doctors have to be recertified and maintain certification, but lawyers and accountants do not? The same way the article describes the booming continuing medical education industry, what about MOC?

    Clearly, MOC has evolved into a costly burden to physicians, patients, and healthcare. The boards and their MOC program have become a profiteering juggernaut without any reasonable proof of benefit, efficacy, or patient protection, and compliance is slowly being tied to the privilege of practicing medicine.

    As physicians, we should demand evidence-based analysis of strategies proposed to improve our ability to practice, just as we do our research. We should not give in to potential threats of government mandates.

    Currently, more than 50% of the counties in America do not have one obstetrician who can deliver a baby. I predict that MOC and other external rules and regulations will worsen this public health travesty. Perhaps the lawyers and accountants who only have to pass one exam in their lifetimes can fill the void.

    HOWARD C. MANDEL, MD
    Los Angeles, California

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