Urologist to ABU: ‘I relinquish my certificate’ over MOC (Letter)

Editor’s note: The following letter was sent to the American Board of Urology (ABU) by Stephen G. Weiss II, MD, who practices in the Deland and Orange City, FL offices of Atlantic Urological Associates. The letter was subsequently sent to Urology Times to “start a meaningful dialogue” between clinicians and the ABU regarding maintenance of certification, Dr. Weiss said. Urology Times welcomes readers’ comments in the “comments” box below or at ut@advanstar.com.

Dear ABU,

As a board-certified urologist for almost fifteen years, I have jumped through every hoop the ABU has placed before me and have remained in good standing; however, I will no longer participate in the meaningless charade known as Maintenance of Certification (MOC). I successfully completed the original certification process and the subsequent recertification process, but enough is enough. The ABU has strayed far beyond its original mandate to ensure excellence in urologic training and has added yet another onerous burden onto the backs of practicing urologists.  

The 2002 Physician Charter, which served as the foundation of MOC, is a flawed and disingenuous document that has one surreptitious purpose: to give specialty boards more power and control over their diplomates. How dare the ABU question my demonstrated commitment to lifelong learning! How dare the ABU attempt to lecture me on professionalism and ethics! How dare the ABU place the “benefit of the public” above the welfare of its diplomates! The “public” doesn’t pay the ABU’s expenses. The “public” doesn’t struggle under the weight of the ABU’s “evolving” mandates. The “public” doesn’t care a whit about the ABU’s rubber stamp of approval. The ABU should be focused on helping urologists provide “high quality, safe, efficient” care for their patients-the “public” has nothing to do with it.

NEXT: "The ABU seems to care nothing about the physical and mental health of its diplomates."

The ABU is a champion of evidence-based medicine, yet there is no proof that the MOC requirements will accomplish any of the stated goals. In fact, I’d wager that these costly and time-consuming tasks not only distract urologists from providing care to their patients but also prevent them from spending time with their families. I bet regular exercise, good sleep habits, and interesting hobbies would have a better correlation with a urologist’s skill and compassion than the ABU’s MOC program. It is very telling that the ACGME has enacted rigorous work restrictions on resident training, yet the ABU seems to care nothing about the physical and mental health of its diplomates. Physician burnout is a far greater public health concern than continuing medical education, but the ABU treats its diplomates like impervious automatons.

No more! I withdraw my neck and hands from the ABU’s public stockade and voluntarily relinquish my board certificate. The ABU has abused its authority and I will no longer suffer under its capricious and arbitrary dictates. I want my life back. My patients deserve a healthy, happy urologist; my wife deserves a healthy, happy husband; my daughter deserves a healthy, happy father. Please remove my information from your omniscient database. Do not contact me. Do not threaten me with fines. If the ABU fails to abide with these requests, I will be forced to take legal action for harassment.

Sincerely,

Stephen G. Weiss II, MD, FACS

NEXT: Dr. Weiss offers alternatives to ABU certification

Editor's Note: Dr. Weiss submitted the below comment after receiving feedback from colleagues on his letter.

It has been heartening to receive so much positive feedback from friends and colleagues regarding my act of civil disobedience. I want to personally thank Drs. Moreland and Terry (see Comments section below) for sharing their personal stories and frustrations with the MOC process. I hesitate to mention by name all the other physicians who have given me support via phone calls, emails, texts and slaps on the back. Dr. Martin K. Dineen challenged me to back up my declaration of independence with meaningful alternatives to the current MOC program. To this end, I have several suggestions for the ABU and for diplomates suffering under their autocratic rule:

• If your state requires Maintenance of Licensure (MOL), this process should be sufficient to meet the ABU's MOC requirements. It is redundant to perform both MOL and MOC.

• If the ABU wants documented proof of "ethical" standards, have diplomates sign the AUA Code of Ethics. If a diplomate has objections to some of the guidelines, then the diplomate can express these concerns in a "comments" section.

• If the ABU wants proof that diplomats are maintaining a basic urologic fund of knowledge, diplomates can attest that they have reviewed all the AUA guidelines that are relevant to their practice. Once again, diplomates would be able to post comments about the validity and trustworthiness of the guidelines. Perhaps an online forum could be established to help vet these guidelines with feedback from the trenches.

• It would take a few seconds to click three boxes on this imaginary ABU MOC website: participation in state MOL, sign AUA Code of Ethics, attest to knowledge of relevant AUA guidelines. Since the ABU is unlikely to take this common sense approach, there is an alternative solution. Notify Dr. Gerald Jordan, Executive Secretary of the ABU, that you refuse to participate in the MOC program as it currently exists. I forfeited my certificate in a symbolic protest specifically against MOC.

• Apply for an alternative board certificate from the National Board of Physicians and Surgeons at NBPAS.org. The President of this organization, Dr. Paul Teirstein, has waged a successful war with the ABIM and has launched a grass roots initiative to replace the current recertifying process with a simple, inexpensive, user-friendly option. The NBPAS website even includes sample letters for physicians to send to hospital administrators and colleagues explaining this alternative board certificate.

In the past, urologic surgeons like Ruben Flocks, Hardy Hendren, and Victor Politano (to name but a few) were giants among men. They blazed a trail of innovation and were undaunted pioneers. Can you imagine any of them performing the MOC requirements? I was attracted to urology not only for the cool toys, but also because urologists used to have an entrepreneurial spirit and a certain joie de vivre. Now we've degenerated into a bunch of sheepish hoop-jumpers. Let's get back to our roots. Don't tremble at the feet of the ABU; make them tremble at the sound of our unified voice.

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