Today one of my favorite families came for a visit.  The kids were behind on their check-ups, but this wasn’t too surprising. Their young mom was recently diagnosed with stage 3 cancer and was working her way through surgeries and chemo.  The length of time since our last visit made me worry that mom’s health kept the kids from their routine visits,  but upon entering the room she looked well. We chatted for a bit and caught up on her health before moving to talk about the kids.

“Sorry, we’re behind. Our insurance company sent a letter saying you were no longer a provider, so we had to transfer out.  I couldn’t find a doctor soon enough, so we just went to the ER and urgent care for sick visits and the care wasn’t as good.  When I called your office to get our records transferred, it turned out that letter was false.  I’m glad they asked why we were transferring, we almost left you based on that letter.”

I sat in stunned silence and blinked back tears of frustration and anger as the full weight of her statement hit me.  In the middle of cancer treatment, this family was forced to leave and seek care in the ER for one reason and one reason only: MOC.

I’ve hesitated to share the outcome of my failed MOC battle for many months now, but this visit today reminded me why we must fight against the monopoly of forced MOC. MOC doesn’t just harm doctors. It doesn’t just cost money. It harms our patients and it nearly cost me the right to care for one of my very favorite families in their most vulnerable time.

I’ve passed the American Board of Pediatrics board exam twice, I’ve completed countless hours of their proprietary online tests, I’ve completed three of their research projects on my patients. But when the ABP demanded another $1,300 or they’d revoke my certification, I had enough. In protest of the shake down, I didn’t pay. The ABP and ABMS advertise their MOC product as “voluntary,” so I took them at their word.

It turns out MOC isn’t voluntary at all. Within weeks of not paying, I received a letter from BCBS of Michigan telling me to buy my board certification by December 31, 2016 or risk being decredentialed. I am board certified through National Board of Physicians and Surgeons, and asked if that was acceptable, and was rejected. Only ABMS boards allowed.

The date came and went, I didn’t pay, and I prepared to defend my case in front of their medical directors at the two appeal hearings guaranteed in my contract. Certainly, the medical directors would understand this was a money grab by the boards, that I had passed every academic requirement due until 2023? Yes the medical directors would see how discriminatory it is to require me to pay and jump hoops unceasingly, while exempting grandfathered doctors from MOC altogether? Certainly, the medical directors would see I had fulfilled more board requirements than a grandfathered physician, resident, or medical student but was treated as less qualified?

The date for my hearing was set, and I felt confident the logic of my argument would prevail.

And then the phone calls from panicked patients started.

A full month before my hearing, BCBS started sending letters to my patients telling them I was already a non-participating doctor. Patients started to transfer out, my billers and partners started to panic. I called BCBS, and asked them to stop the letters until my hearings were completed. They refused. I contacted my state attorney general, he couldn’t help. I contacted the state insurance commission, they couldn’t help. I contacted the AMA, and they said to contact my state medical society. I contacted my state medical society and their lawyers for help. Their advice: just pay.

Tired, trapped, and under coercion, I paid $1300 plus a $200 late fee. Within seconds, I had my American Board of Pediatrics certificate in hand, within hours BCBS reinstated me, and never sent out another letter to my patients.  It was clearly, all about the money.

I am a diplomate of the American Board of Pediatrics against my will. I find it morally reprehensible to financially support an organization that harms fellow physicians.  I find it demoralizing to know my money supports their lobbying efforts against our state MOC legislation. Yet I paid in order to see my patients. I paid so I could still be a doctor. The American Board of Pediatrics could ask for another $1500 next year, and I’d have to pay again. There is no choice.

Is it possible I was targeted for being so outspoken on MOC? Possibly. My initial letter to the ABP has over 100,000 views. My medical society has used me on the cover of their magazine and their website dedicated to fighting forced MOC. The ABMS Senior Vice President knows me by sight, and has watched me testify against forced MOC in our state capitol on multiple occasions.

But I’ve been contacted by countless quiet Michigan physicians threatened and decredentialed for simply refusing to pay for MOC. It doesn’t matter who you are, an outspoken physician with a state medical society behind you…or a solo practitioner quietly trying to stay afloat…you must comply.

I don’t know the solution to this problem. It seems like every legal, logical, and ethical boundary that should prevent a certifying company from gaining such absolute unchecked power has been ignored, and every professional organization that should help us is impotent.

My state medical society has held clear policy opposing board certification, let alone MOC, for insurance plan participation for 20 years. They’ve been negotiating for 20 years, yet aggressive MOC discrimination continues.  The AMA has strong policy opposing MOC abuse, but refuses to do anything.  The FTC should see this monopoly as a clear anti-trust violation. They are waking up, but still not acting.   I am baffled the IRS doesn’t question the million dollar salaries raked in by these “non-profit” organizations. It seems like this would be a slam-dunk class action lawsuit for some smart law firm, but no one is interested in the case.  State legislation is likely our best bet, but the lobbying power of insurers, hospitals, the billion dollar ABMS certification industry and their codependent specialty societies is nearly impossible to fight.

If nothing is done, ABMS will win, because their entire coercive business model relies upon ourprofessionalism. As physicians, we take an Oath to “Do No Harm”. We promise this to our patients.

My first emotion when I heard my patients were forced to receive care in the ER was not anger at ABMS. It was gut-wrenching guilt. I dared to speak. I dared to fight.  I underestimated their power. I was stupid enough to think MOC was a physician issue. It never crossed my mind that my patients would be harmed. I know better now. The next time they ask for another check, I will comply, and they know that. I just hope something is done before then. Primum non nocere.

Meg Edison is a pediatrician and can be reached on Twitter @megedison.  This article originally appeared in Rebel.MD.

Image credit: Shutterstock.com