A MESSAGE FROM THE PRESIDENT, DAVID J. SIEGLER, M.D.

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Physicians Advancing Health Care

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a newsletter for the medical communityTulsa Medicine»

NOVEMBER 2019

November 8, Noon to 1pm TulsaDecember 6, None to 1pm OKCProper Prescribing ClassApproved for 1 Hour OMB Licensure RequirementNovember 12, TCMS & TCMS FoundationAnnual Meeting6pm Reception ~ 7pm DinnerSpeaker Sean KouplenDoubleTree Tulsa Warren PlaceNovember 12, 5pm to 8pmOSDS RSSTulsa Dermatology Clinic2121 E 21st StDecember 5, 12:00 Noon2019 Holiday Luncheon & Celebration of $25 Million in Recycled MedicationTCMSJanuary 8, 2020 6pmTCMS Board MeetingTCMSJanuary 12, 2020OB-GYN Town Hall MeetingsTed L. Anderson, MD, PhdPresident of ACOG

* 1st Town HallHosted by Drs. Cox & Lakin11am to 1pm Tulsa

* 2nd Town HallHosted by Dr. & Mrs. Stanley3pm to 5pm, Edmond OKrsvp to joetta@tcmsok.orgJanuary 28, 2020 6pmLegislative Update &Opioid CME Program2 AMA PRA Category 1 CreditTM

TCMSFebruary 16, 2020 6pmTCMS & TCMSF President’s InauguralRecognition of Retired PhysiciansOU Schusterman Learning Center4502 E 41st St, Tulsa

IN MEMORIAMJerry Sisler, MD

October 10, 2019

If your college claimed that your bachelor’s degree is now time-limited and you must return every 5 years for a $3000 “MOB” (Maintenance of Bachelor’s degree) course, would you do it? If the National Board of Medical Examiners (NBME) sent you a letter stating that because of the ever-increasing knowledge in medical school, we must “keep up” our degrees and begin retaking Part I, II and III every 5 years at $3000 a test, would you do it?

These hypothetical scenarios are preposterous, right? No one would agree to submitting themselves to such silliness! Or would they? Well, many of us are begrudgingly jumping through similar costly and meaningless “hoops” to be able to say we are “board certified” by the American Board of Medical Specialties (ABMS). Why do we do it? Why do we spend time away from our patients and family, spend hard earned money to prepare for and then take a “high stakes” examination to “market” ourselves as board certified (BC)? If you are the minority of physicians who enjoy and see value to Maintenance Of Certification (MOC), stop reading. For the majority of you, read on for my answers.

1: We are hypocrites;2: We have allowed greedy bastards to monetize our desire to be respected by our peers; and 3: We have allowed those same greedy bastards to establish a monopoly through effective marketing and lobbying.

Before explaining these 3 reasons in detail, I want to review the facts.

Just as other professionals in our society, we sit for a licensing exam following our education. Accountants pass a 5-part test once and become a licensed CPA for life (with a CE requirement). Attorneys pass the Bar exam once and become a licensed attorney for life (with a CE requirement). We pass a 3-part exam once to become a licensed physician. We become boarded by the National Board of Medical Examiners, like our accountant and attorney friends, with an unlimited term (with a CME requirement). These are state requirements. Most of us go on to complete residencies and fellowships.

ABMS began in 1933 during a time when medical education was inconsistent and unequal across the country. ABMS along with other organizations were successful in addressing the inequality. The initial certifications were meaningful for those efforts. However, after 50 years, the ABMS (a private tax-exempt corporation) devised a new business strategy. Beginning in the 1990s they sought to increase revenues in the name of improved physician quality to protect the public! Their plan copied shampoo executives when attempting to increase sales by using a single word that made people buy more shampoo: Lather-Rinse-R-E-P-E-A-T! Voila, double revenue without much effort. So, it goes, the executives at ABMS created MOC so physicians R-E-P-E-A-T certification. The ABMS faced a problem with the physicians certified before 1990s who held a lifetime certification so the ABMS exempted them from MOC. The ABMS went throughout the US and marketed their new, proprietary product, MOC, and convinced hospital administrators, physician employers, insurance executives AND many physicians, that we must have MOC to be worthy physicians. The ABMS has been successful!!! The ABMS requires its 24 sub-boards to pay an annual membership fee. The American Board of Psychiatry and Neurology, pays a $700,000 annual fee. The physician board presidents make $700,000 to $1 million in yearly compensation with a 40-hour work week without call or concerns about patient-care liability. But what I find more concerning is their tax-exempt profits! The American Board of Psychiatry and Neurology increased its assets (AKA “profit”) from $103 million in 2016 to $120 million in 2017.1 The following is from its 2017 Form 990 (for tax-exempt corporations).1

There are 23 other sub-boards making money. In 2015, I reviewed form 990s for the ABMS and all 24 sub-board and found the accumulated assets (buildings, cash, stocks and bonds) were valued at more than $500 million. THAT IS ½ BILLION DOLLARS!!! I am outraged. You should be too. Remember these are all “non-profit” more accurately described as “tax-exempt” private corporations that practice “pseudo-licensing” of physicians. In fact, the ABMS’ war chest allows it to protect and grow its brand. Its monopolistic branding has caught the suspicions of the Department of Justice regarding the lack of competition in the medical certification industry and recommended the addition of other companies into the marketplace.2 Note that the osteopathic physicians are subject to osteopathic continuing certification (OCC).

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Finally, my answers are as follows:

1. We are hypocrites: We aim to use the best evidence to treat our patients but when it comes to certification we ignore the facts: There is no evidence that certification nor MOC improves outcomes of our patients.3

2. We have allowed the ABMS to monetize our behavior to prove we are worthy: We are good at studying and taking tests. We are motivated life-long learners and have taken an oath to provide the best possible care to our patients. We do not need, nor want, others to tell us how to stay up-to-date on our knowledge and skills. A “high stakes” exam is not ‘real-life medicine.’ When we care for patients, we have access to resources to better their care and improve our knowledge every day! Every patient is a test of our knowledge. Our training provides us a foundation of knowledge but our experience modifies and increases our knowledge every day. Certification does not ensure that a physician is competent. Unfortunately, nothing presently available does. It is far easier to identify poor behavior than incompetence. The vast number (>99%) of actions against physicians by the Oklahoma Board of Medical Licensure and Supervision are due to poor physician behavior (substance abuse, inappropriate interactions with patients, fraudulent billing) than of incompetence.4

3. We have allowed the AMBS to become a monopoly: The ABMS has successfully convinced hospital and insurance administrators (and many physicians who write hospital privilege policy) that MOC/OCC are a gold standard of quality. This is a laughable claim. I have served on a hospital medical executive committee and I learned of board-certified physicians who have behaved unprofessionally. The key here is that most physicians are competent, far more capable than the growing number of non-physicians taking our place. You ponder that we have more important issues to fight than MOC? Well, actually, failing to participate in MOC/OCC or failing the test, results in non-grandfathered physicians being kicked off hospital staffs and insurance networks or even fired by employers.

4. Fighting the Certification Monopoly: We at TCMS initiated the first state law in the U.S. that restricted the use of MOC/OCC. In 2016, TCMS, OSMA, Rep. Mike Ritze, D.O. and Sen. Brian Crain, Esquire, wrote SB1148 which was passed by our state legislators and signed into law by the governor5 and follows the AMA’s Principles of MOC6 outlawing the use of MOC/OCC as a requirement for employment, payment, staff privileges and licensure. It is my opinion that an additional change is needed to bring common sense to certification. We must demand that the Accreditation Council on Graduate Medical Education (ACGME) require its accredited residencies and fellowships to confirm that all trainees are worthy for graduation (which would include procedures, projects, patient care and the ‘in-service’ exams) and certify graduates with a life-long certification. Be aware of conflicts of interest of ACGME member organizations which consists of American Board of Medical Specialties, American Medical Association, American Osteopathic Association, Association of American Medical Colleges, American Hospital Association, American Association of Colleges of Osteopathic Medicine. Who lobbies for physicians’ interests?

5. Purchase meaningful certification: We must stop buying MOC/OCC and demand that our hospital staffs and the Oklahoma Board of Medical Licensure and Supervision accept other appropriate certifying boards like the National Board of Physicians and Surgeons (NBPAS)7, which renews ABMS & AOA initial certification at $149 every two years with appropriate specialty-specific CME.

Stop equating anecdote with evidence! Speak up! Join NBPAS. Stop supporting ABMS and AOA by purchasing MOC and OCC.

Works Cited

1. Guidestar. https://www.guidestar.org/2. Robert Potter Chief Competition Policy & Advocacy Section Antitrust Division U.S. Department of Justice. Letter to The Honorable Dan K. Morhaim, M.D. The Maryland House of Delegates. September 10, 20183. Daniel J. Gilman, Brian J. Miller, Brian Goldstein. Board Certification: A Dose of Competition. November 29, 20174. Oklahoma Board of Medical Licensure and Supervision actions vs physicians, from 2003 to 2013 (personal review) 5. SB1148: Anti-MOC/OCC law 2016.6. Principles of MOC, AMA, 2014.7. National Board of Physicians and Surgeons (NBPAS) at https://nbpas.org/

David J. Siegler, M.D.President TCMS

2019-2020 TCMS Foundation Scholarship Recipients AnnouncedWe congratulate the accomplished students who were awarded our 2019-2020 TCMS Foundation Scholarships. Each recipient demonstrated outstanding scholastic achievement, leadership, and community service. Since inception, the TCMS Foundation has awarded 1,297 medical students with scholarships totaling $1,348,250. On October 3, 2019, the 2019-2020 TCMS Foundation Scholarship Recipients were recognized at our annual scholarship reception. The recipients are:

Corbit Bayliff, MSII, OSU, OSU Dean’s Award ● Iman Chaudhry, MSIV, OU, Charles James Bate Memorial Award ● Trang Kieu, MSIV, OU, TCMS President’s Award ● Elizabeth Landers, MSII, OSU, The Betty Louise Conrad Memorial Scholarship Award ● Johnathan Nahmias, MSIV, OU Dean’s Award ● Toni Nigro, MSII, OSU, TCMS Foundation Community Service Award ● Kaitlyn Norton, MSIII, OU, TCMS Foundation Community Service ward ● Bishr Swar, MSIV, OU, TCMS President’s Award

Elizabeth Bate Randall, Iman Chaudhry, MSIV, OU, Charles James Bate Memorial Award Recipient,

and Walter Randall

Michael Weisz, MD, and Johnathan Nahmias, MSIV, OU

Elizabeth Landers, MSII, OSU and Robin Dyer, DO, OSU Associate

Dean for Academic Affairs

SARAH R. HAYDEN, DO, Pediatrics, 1589 E. 19th St, Tulsa, OK, 74120. Medical Education: Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, 2011-2016. Residency: Oklahoma State University Medical Center, Tulsa, OK, Pediatric, 2016-2019.

MAITHILI A. FULTON, MD, Family Practice, 16206 S. Lewis Ave, Bixby, OK, 74008. Medical Education: Oral Roberts University School of Medicine, Tulsa Oklahoma, 1986-1990. Internship: University of Oklahoma, College of Medicine, Tulsa, Oklahoma, Family Practice, 1990-1991. Residency: In His Image at Hillcrest Medical Center, Tulsa, Oklahoma, Family Practice, 1991-1993.

JENNIFER PETERSON, MD, Adult Reconstruction, 4802 S 109th E. Ave, Tulsa, OK, 74146. Medical Education: University of Virginia School of Medicine, Charlottesville, VA, 2009-2013. Residency: The Cleveland Clinic Foundation, Cleveland, OH, Orthopedic Surgery, 2013-2018. Fellowship: The Cleveland Clinic Foundation, Cleveland, OH, Adult Reconstruction, 2018-2019.

JAMES P. DAVIES, MD, Orthopaedic Surgery Foot & Ankle, 2448 E 81st St, Tulsa, OK, 74137. Medical Education: University of Oklahoma, Oklahoma City, OK, 2009-2013. Internship: University of South Carolina, Charleston, SC, General Surgery, 2013-2014. Residency: University of South Carolina, Palmetto Health Medical Group, Columbia, SC, Orthopaedic Surgery, 2014-2018. Fellowship: Hospital for Special Surgery, New York, NY, Foot & Ankle Orthopaedic Surgery, 2018-2019.

Welcome New Members

CHRIS SUDDUTH, MD, Internal Medicine-Pediatrics, 5014 E 101st St Ste 200, Tulsa, OK, 74137. Medical Education: University of Oklahoma, Oklahoma City, OK, 2007-2012. Residency: University of Oklahoma College of Medicine, Tulsa, OK, Internal Medicine-Pediatrics, 2012-2016.

Welcome Back

CHRISTOPHER N. THOMPSON, MD, Hematopathology & Surgical Pathology, 2738 E 51st St #290, Tulsa, OK 74105. Medical Education: Texas A&M University, College Station, Texas, 2002-2006. Residency: Scott & White Texas A&M, Temple, Texas, Anatomic & Clinical Pathology, 2006-2010. Fellowships: Scott & White Texas A&M, Temple, Texas, Surgical Pathology, 2010-2011 & University of Utah, Salt Lake City, Utah, Hematopathology, 2011-2012.

THOMAS D. BAREFOOT, MD, Anesthesiology, 6839 S Canton Ave. Tulsa, OK, 74136. Medical Education: St. Matthew University, Grand Cayman, 2010-2013. Residency: University of Arkansas for Medical Sciences, Little Rock, AR, Anesthesiology, 2014-2018. Fellowship: St. Elizabeth Medical Center, Boston, MA, Cardiothoracic Anesthesiology, 2018-2019.

RICHARD L. GIBELYOU, MD, Anesthesiology, 6839 S Canton Ave, Tulsa, OK, 74136. Medical Education: University of Oklahoma, Oklahoma City, OK, 2007-2011. Internship: Case Western Reserve University, Cleveland, OH, Anesthesiology, 2011-2012. Residency: Case Western Reserve University, Cleveland, OH, Anesthesiology, 2012-2015.

HEIDI PRINCE, DO, Anesthesiology, 6839 S Canton Ave, Tulsa, OK, 74136. Medical Education: Oklahoma State University, Tulsa, OK, 2008-2012. Residency: University of Arkansas for Medical Sciences, Little Rock, AR, Anesthesiology, 2012-2016

STEPHEN W. SAWYER, MD, Anesthesiology, 6839 S Canton Ave, Tulsa, OK, 74136. Medical Education: University of Oklahoma, Oklahoma City, OK, 2009-2013. Residency: University of Texas Southwestern, Dallas, TX, Anesthsiology, 2014-2018.

Congratulations to Jenny Boyer, MD, who was recently recognized with the American Medical Association’s Women Physicians Section Inspiration Award. This award honors and acknowledges physicians who have offered their time, wisdom and support throughout the professional careers of fellow physicians, residents and students. A long-time advocate of organized medicine, Dr. Boyer has been instrumental in guiding other physicians to become more involved at the county, state and national levels. Congratulations and thank you, Dr. Boyer!

Jenny Boyer, MD, Past President, Receives AMA Inspiration Award

Tulsa County Medical Society5315 South Lewis AvenueTulsa OK 74105-6539

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