November 15, 2015
To the Governing members of the AOA and AOBIM:
I am no one to you. I am a regular working physician, a hospitalist. I work the typical 7 days for 12 hours and then I am off for 7 days. On average, I see about 18-22 patients a day. My typical day begins around 4:30am, getting up and ready for the day. I arrive to work around 6am, get my census in line and get checkout from our night coverage. I then begin my rounds about 6:15am in the ICU and work my way from the sickest patients to the least sick patients. All of this occurs while juggling phone calls from nurses, pharmacists, and other doctors. I sometimes have to stop rounds to go to the ER to admit a patient. Sometimes, the rounding is interrupted by a rapid response or a code blue. Nonetheless, this goes on until around 6pm, when I get to go home for the evening. It’s what I do, and I love it. I chose this life.
I remember being in medical school and learning all of the new information. I was overwhelmed most of the time. I felt dumb the majority of the time. But, I survived. I completed all of the requirements set forth by the governing bodies. I completed the many steps of the COMLEX exams, including the physical exam portion that required travel to Pennsylvania as this was the only location where it could be completed. I remember feeling very aggravated that the cost of these exams was so incredibly ridiculous. I remember feeling like it seemed the AOA and the NBOME were in cahoots to just extort money from poor, hard-working medical students trying to fight their way through medical school. We were all just jumping through the hoops. I was aggravated. But I paid the money. I had to. And, I passed.
Then, I graduated medical school and residency. The next hoop was the AOBIM board certification. The cycle started again, and I started the journey, paying the fees. I passed and was excited. I didn’t want to pay the money, but it was a hoop I had to obediently jump through, and I did. Then I learned that, lo and behold, the AOA and AOBIM have now created this new entity - the OCC - that is a requirement for board certification. Basically, I now have to pay a fee to join the OCC. The OCC requires me to “earn” points in certain fields of study through modules every 3 years during my 10 year certification time, before I have to (wait for it) pay another exam fee to take the recertification AOBIM exam. But this is the great (dripping with sarcasm) part…each module to “earn” these points that are required costs money (a lot). So not only do I have to pay to join this great entity – the OCC – I also have to pay to “earn” the points required! AND, this is in addition to the exam fee that has to be paid every 10 years in order to take the required recertification AOBIM exam.
Now, the geniuses in the AOA and the AOBIM state that the theory behind the OCC is to maintain continuous, lifelong process for certification in the osteopathic profession. And these same geniuses think that the way to do that is to nickel and dime every physician that has graduated from an osteopathic school. These geniuses think that the continuous, lifelong process of learning is going to arise from physicians paying absurd amounts of money for computer-based modules that require clicking and pointing, AFTER entering credit card information. That is the basic gist of this theory. All of these modules are computer-based. They have to be purchased and then are valid for a length of time to be completed. Once completed, you have “earned” the points and have met the requirements. In my honest and humble opinion, the requirement from the AOA and AOBIM standpoint is Visa, mastercard, or discover. The requirement is money to continue to deepen their pockets, cleverly disguised in computer-based modules that are for sale to physicians, required to complete them to maintain certification.
The real, true lifelong, continuous process for certification in the osteopathic profession, or the allopathic profession for that matter, is the everyday nature of seeing and caring for patients. Every day, I see patients and speak with them and their families. I listen to them and learn from them. I laugh and cry with them. I teach them about their illnesses and diseases. They teach me about humanity. I speak with nurses, pharmacists, and other doctors about patients on a daily basis. I learn from each of these groups of people, again, on a daily basis. This is practical knowledge and practical learning.
I am a hospitalist. I do not have an outpatient clinic. I treat patients with acute illness, and then I get to discharge them home to follow-up with their primary care providers. There is something great about being able to watch someone come into this hospital in their worst condition and leave feeling wonderful. I play an active role in impacting patients’ lives. Sometimes, there are bad outcomes. Sometimes, I do my absolute best and do everything I possibly can for the patient. Sometimes, that isn’t enough. Sometimes, patients don’t leave here alive. Unfortunately, that is the nature of humanity. However, this, too, is another aspect of learning that occurs. You can read about dealing with death on a computer based module all day long, but until death is staring you in the face, and those families are right in front of you looking for answers, you don’t know how to deal with it. Each specialist has a great perspective on why their specialty provides them with lifelong learning. Patient care is the epitome of lifelong, continuous learning. It is not in a money-seeking scheme you call OCC.
Every physician in the United States has great CME opportunities every single day. These are offered in hospitals, in conferences, in seminars, etc. Just as you all love computer-based modules, CMEs can be found infinitely on the internet on very highly acclaimed websites from educational institutions. Physicians are not looking for ways to earn CMEs. These opportunities are abundant and do not cost a lot of money. The AOA and the AOBIM are looking for a means to make money. That is the simple reason behind the creation of the OCC, in my opinion.
I am disgusted and ashamed of the governing bodies of the AOA and the AOBIM. I find it repulsive that you would purposely make this entity mandatory and require the physicians you certify to partake. It seems to me that this money racketing starts all the way in the beginning of medical school with COMLEX testing and snowballs from there. The big conglomerate of the AOA, NBOME, AOBIM, and ACOI seem to all take part and enjoy in the money raining down. Is it not enough for you that we go to school for 21 years and then complete a residency of 3-12 years? Is it not enough that most of us owe upwards of $200,000 in federal student loans? Is it not enough that we spent, and sometimes still do, so much time away from our families and friends? Is it not enough that we missed, and sometimes still do, out on birthdays, holidays, births, deaths, etc? Is it not enough that we sleep sometimes only a few hours at night? Is it not enough that we actually enjoy seeing our patients and taking care of them? Is it not enough that we chose medicine for the fact that we want to help people? Are all of those things not enough for you? You still feel compelled to take our hard-earned and well-deserved money???
You should all be ashamed of yourselves. I honestly do not know how you sleep at night. Even though I do not feel that my letter will make a difference, I hope that at least one of you that can make a difference will consider my thoughts and opinions and consider changing this ridiculous mandatory requirement.
Sincerely,
Jennifer M. Everett, D.O.
