MOC + MACRA + TJC + CMS = DRexit

I wish I knew who coined the term “DRexit” so I could send flowers or a bottle of whiskey as a thank-you gift. There couldn’t be a more perfect term to describe the growing exodus of physicians from our beloved profession, which is turning into a morass of computer data entry and meaningless regulations thought up by people who never touch a patient.

The one bright note on the horizon for me is that physicians are starting to wake up to the trap of MOC, or mandatory maintenance of certification. It’s surprising that the Federal Trade Commission hasn’t recognized already that this is quite a racket, forcing physicians to do CME activities dictated by monopolistic certification boards which profit handsomely.

No one else knows what I need to read or do to stay current in my specialty better than I do, and I think that over the course of my career I’ve demonstrated the judgment and the sense of responsibility that prompt me to do it. I’ve provided solid evidence of my CME activities to earn recertification from the National Board of Physicians and Surgeons (NPBAS), a far better alternative to the MOC process controlled by the American Board of Medical Specialties.

At the most recent meeting of the CSA (California Society of Anesthesiologists) House of Delegates on June 4, the delegates unanimously passed this resolution:

WHEREAS the American Board of Medical Specialties Maintenance of Certification (MOC) process is costly, time-intensive, and results in significant disruption to the availability of physicians for patient care; and

WHEREAS the professionalism of individual physicians qualifies them to determine the best means and methods for their own lifelong learning and maintenance of their knowledge and skills;


RESOLVED, That CSA supports and encourages the individual physician anesthesiologist’s choice in the pursuit of lifelong learning and ongoing development of up-to-date, evidence-based practice; and be it further

RESOLVED, That CSA affirms that MOC should not be a mandated requirement for state licensure, credentialing, reimbursement, insurance panel participation, medical staff membership, or employment; and be it further

RESOLVED, That CSA opposes any initiative by the California State Department of Consumer Affairs or the Medical Board of California to endorse or require the Federation of State Medical Boards Maintenance of Licensure (MOL) program as a condition of medical licensure; and be it further

RESOLVED, That a copy of this resolution be transmitted to the California Medical Association’s House of Delegates.

I wrote that resolution. As the new President of CSA, I am delighted that it was championed without dissent. If other professional societies stand up against mandatory MOC, there may still be a chance of saving our profession and slowing — if not stopping — the flight of physicians in their prime to careers outside of clinical practice.

Since my son just finished medical school and is starting his internship, I have personal as well as political reasons to cheer for our profession and hope for its survival. Here’s hoping other physicians do their part to fight for it too. None of us should have to choose between MOC and DRexit.


Kate MD

Brava, Dr. Sibert!


Dr. Phil (#thereal)


I mentioned revising the way we do MOCA or board certification to another Sullivan
(Dr. Erin Sullivan – u of Pitt/in the ASA/brilliant dr) a few years back. The next thing I know they (the ABA) changed the way the 10 year recertification was done going from the archaic one time test every 10 years test that cost $2100 to just take. It didn’t factor in cost to prepare, time, travel, etc. If you pass ur ok, but if u didn’t then show up again with your $2100, thanks. Oh, by the way while your preparing for the test can you donate $500-1000 to both your state PAC and the ASA PAC. Oh, can you also get the other state members to donate to the PAC as well. Enjoy your family too!

Bottom line: They (?who) revised it! Great! I guess. Now we have to log on to
The ASA MOCA SITE and answer 120 questions/yr or 30/quarter and get a certain percentage of them right or else??? Oh boy, not sure what else means. This process is a change, a positive change that does life long learning continuously while utilizing the most novel technology to reach the greatest bandwith. It’s ok. But it has to be updated and revised as well.

The real kicker I see is that only Anesthesilogist grads who came out of residencies after 2000 have to do MOCA. What kind of rule is that??? The older ones are grandfathered in??? I think many of them still practice, yes I know they do! What there $2100 is not good? Or they just get their information update by osmosis? Not sure.

Just an idea; revise it too!!! Make the ASA members who graduated earlier than 2000 take the $2100 that they don’t have to spend and give it to the PAC both state and national. (50,000 ASA members total- say half are pre-2000, so 25,000 x $210 for annual MOCA/PAC/????)( if you take all 50,000 x $210 then its double-wow, then you can really really advocate).

Force or tell the more experienced members of the ASA to step up!!! If you use the funds appropriately its $10,500,000 if all 50,000 members gave $210/yr or half that if 25,000 give. We could then really make headway both in our state and federal legislation. Money talks in our country and in most, and you know the rest.

Our business is to take care of people at there most trying time. Our universities and mentors do a great job of it! The prepare us for war with illness. They prepare us to fight the fight so we don’t have to fight! Now, for this one issue we are taking the lead on MOCA. We always take the lead, that’s what we do, quietly, calmly, and professionally!

Now let’s take the lead, get the elders to buck up, get things in order both in our house then lead others as well. Because that is what the ASA and we as anesthesiologist do!

My suggestion is to eradicate MOCA or revise it, keep the life long learning questions quarterly, get the elders to buck up and participate, and get all 50,000 members to give to give $500 each split equally between state and federal pacs and include in you PAC donation access to MOCA. There u go, now life long learning where we are all contributing 360′, so we can fight effectively for our patients!




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