THIRTEEN POINTS to consider during preparations to challenge MOC as a monopoly testing industry in organized state and specialty medical societies.
1. Collect at least a half dozen on-site friends, colleagues, and society members for the local battle. Visit other geographic delegations and caucuses. Speakers and district or caucus leaders who can deliver support (speaking in behalf of my caucus) from their entire geographic region are most valuable. But every personal story and tragedy associated with MOC (< 2 minutes at the microphone) is also helpful. 2. Cover all days of your state society meeting. Collect cell phone numbers and have last minute substitutes, back ups for each meeting or hearing. Dedicated anti MOC doctors will need to answer a well-organized, stacked opposition from ABIM at both the Reference Committee hearing, at the beginning of the state society meeting, AND on the general floor of the House of Delegates, near the end. Remain the entire meeting. Bigger battles may be near the end of the meeting. Don’t let medical society folks distract you to help on other agenda items which might conflict in scheduled time with your MOC Resolution. Don’t volunteer for a Reference Committee position at the meeting where you introduce your Resolutionn against MOC (which will be assigned to another Reference Committee). 3. Use precise wording from other state resolutions as templates in order to state why MOC needs to stop. These are your WHEREAS clauses. Journal references might help legal counsel and their lawyer teams accept your strong language. 4. Use precise language from other state resolutions also in the RESOLVED sentences. Condense to no more than five RESOLVEDS if possible. Fewer the better. Be prepared to defend each and every word. Accept substitutions only if they do not soften or change intent. 5. Have independent legal counsel from physician-friendly organizations like the American Legal Health Foundation (AAPS) proof-read your proposals. Then try to assuage your own state or specialty organization as you work with legal counsel from their societies. Recognize that legal folks from the AMA and many organized medicine groups may work with and receive more generous remuneration from ABMS, ABIM, and the Hospital Associations, hospital and insurance industries. These are huge conflicts of interest which you must manage diplomatically. Know thine enemies. 6. Recognize that your Reference Committee will be lobbied by ABIM. Stay abreast of changes among Reference Committee members, out sick, replacements, etc. Correspond respectfully well ahead of time, as soon as possible. 7. Try to secure a friendly or at least group-elected Speaker or Vice-Speaker of the House at your society to conduct the floor discussions on MOC as in society Bylaws. Investigate newly- introduced leadership or appointees and check for conflicts of interest issues. Be prepared to ask questions if a new substitute moderator is used or introduced for your resolution. If a substitute vice speaker is voted upon at the last minute, ask for clicker votes rather than voice votes. 8. Regardless of written agenda order, be ready to accept assignment of MOC discussions for the least convenient times, after several hours into the meeting or at the end of all other business. ABIM Board folks are patient and prefer to wait until medical students, residents, fellows, and young physicians have left. Explore contracts, administrative exemptions, or other conflicts of interest among younger physicians who speak in behalf of MOC. 9. Testimonies: Have fun and be willing to catch or crack a joke on the test questions and MOC modus operandi. For example, tell what the palm print readers or security folks found upon frisking you as a potential criminal at the test centers. Use personal examples, guffaws about odd test questions, idiosyncrasies about MOC-mandated studies on your practice (I paid $250 to them to show that I was hand washing in my practice?), and contrast what is asked on test questions with the reality of your practice (I would be fired from my hospital/ insurance co/ ACO organization for ordering too many expensive lab tests if I practiced as I am expected to on MOC test questions…MOCs obscure test questions go directly against Dr Christine Cassell’s Choose Wisely recommendations). Anecdotes might be more effective than harsh numbers (30% of internists failed this year, 60% of this New Jersey faculty group would have flunked …) late in the day. 10. In honor of the senior and retired physicians in your group, speak loudly, clearly, and connect with your audience as if you were on TV. Don’t speak beyond allotted time. Come back to the microphone for additional points. Be sure your mike works well before speaking. 11. Know your parliamentary proceedings. Sit near a microphone and stay alert. Recognize ABIM techniques used to remove your popular Resolution off the floor, killers like “Referral to the Board of Trustees”. “Table until…” . Don’t allow. Force a “Call the Question” instead. Don’t allow RESOLUTIONS to deteriorate into recommendations for the AMA alone. We need state society activism directly to the universities, other CME entitities, our legislators, and then appropriate AMA actions might follow. 12. Work with academics and university leaders as speaking delegates, guests, or non delegate Society Members to testify also against MOC. We were fortunate to find our contact through AAPS. His testimony was needed for BOTH days of our two day meeting. He spoke both for the Reference Committee and the General House of Delegates meeting. 13. Thank your team. Get exercise, rest, enough time w family and friends outside of medicine.
