Post Author: Wes Fisher, MD

Wes Fisher is a cardiologist.

Wes Fisher is a cardiologist.

How to help physicians end maintenance of certification nationwide

Physician
August 12, 2019

Physicians who are board-certified by one of the American Board of Medical Specialties (ABMS) 24-member boards saw their lifetime certification change to time-limited certification in 1990.

Several class-action federal lawsuits have been filed against several member boards of the American Board of Medical Specialties, including the American Board of Internal Medicine, American Board of Radiology, and the American Board of Psychiatry and Neurology.

Dr. Wes Fisher …

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When patients tweet their own heart attacks

Social media
August 17, 2016

I was called at 4:30 a.m. for a patient with tachycardia in the hospital, and as I logged into my EMR from home, I saw this on Twitter:

https://twitter.com/EM_Educator/status/759297946160656384?ref_src=twsrc%5Etfw

In under two hours, there were 15 retweets, 44 “likes,” and 19 comments that appeared on Twitter (so far), most wishing the patient the best, looking forward to pictures of the angiogram, etc.

This is the lovely world of social media, but it also demonstrates his …

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So you failed maintenance of certification. What now?

Physician
May 25, 2015

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What is it like for physicians to fail their ABMS Maintenance of Certification® (MOC) program examination? How does the largest member board of the ABMS, the American Board of Internal Medicine (ABIM), respond to doctors who fail their secure examination?

As I continue to confidentially collect information from physicians who have failed their MOC examination, I thought it would be important to publish …

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Fixing MOC: Will creating another board entity help?

Education
January 22, 2015

I admire Paul Tierstein, MD’s honest attempt to create a greatly simplified alternative to the  ABMS’s Maintenance of Certification (MOC) program called the National Board of Physicians and Surgeons (NBPAS).  I hope he’s successful, but I sense there will be large headwinds for the effort ahead.

Here’s why.

The Affordable Care Act (ACA) modified Sections 1848 (k) and 1848 (m) of the Social Security Act, which defines how CMS pays physicians for their services.  …

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A physician investigates the American Board of Internal Medicine

Physician
January 7, 2015

Is it medically professional for a non-profit organization to use physician testing fees to “choose wisely” a $2.3 million luxury condominium complete with a chauffeur-driven BMW 7-series town car? In my view, obviously not. To most people, such an action would conjure up images of hypocrisy, waste, and corruption.

After a review of public and tax records, it appears to me this is exactly what has happened.

Background

In 1999 for reasons that …

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A cardiologist undergoes knee surgery. Read what he learned.

Physician
December 10, 2014

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The phone rang one evening and a pleasant voice was on the other end.  “Hi, my name is nurse so-and-so and I’m the educational coordinator for your upcoming knee surgery. Do you want to go to the patient orientation session?” she asked.  “It’s very helpful to go over things before and after  your surgery and to answer any questions you might …

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When the patient treats the doctor

Physician
November 10, 2014

Another day, another pacemaker, at least so it seemed at first.

The usual greeting the patient, answering the last questions, consent signing, placement of the IV, EKG leads, prepping of the surgical site and initiation of the preoperative antibiotics were all recent memories.  He laid there, smiling, knowing he’d made the right decision after years of struggling with his arrhythmia in other ways.  His heart was showing signs of slight weakening and …

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The last visit: Turning off the defibrillator

Physician
October 9, 2014

He had called the other day to update me up on his condition.  He did not sound upset, but resolute.  “They offered me peritoneal dialysis,” he said, “but I decided against it and figured I’d just let nature take its course.  The hospice people are so wonderful — I’ve got things all set here at home, but I have two questions.  What should I do about my warfarin?  You know, …

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Doctors have to learn to play the game of numbers

Physician
October 1, 2014

The dark underbelly of health care is becoming all too visible now.

Fresh faces in neatly pressed white coats are in the halls.  Eager.  Enthusiastic.  Clearly very bright.  All hoping for a moment, an experience, an encounter that makes all their hard work worth it.  Surely they’ll have one, but not before the thousands of keyboard clicks, the mandatory lectures, rounds and lots of lengthy, lonely call nights.

He was a doctor …

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Doctors need more quiet time

Physician
September 19, 2014

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After you’ve written on a blog for a long time, you begin to ask yourself why.  Oh sure, there are the great opportunities for a single person to make a point, to act as a tiny tugboat trying to push a corporate mothership in a slightly different direction, but you begin to realize that there are very few times that actually …

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The desire to spoon-feed medical residents today

Education
September 2, 2014

As I begin another year teaching EKGs to our new residents, I find I am increasingly asking myself, “Where to teach?”

I do not mean to imply a geographic sense to the word “where” (although this is difficult, too, as residents move from hospital to hospital in large health care systems like ours as they change rotations), but rather as more of a “level.” What level do I teach our residents …

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This is what lifelong learning in medicine should look like

Physician
August 27, 2014

He left a little early to stop by the cath lab to see his patient before her procedure.  Cordial “hellos,” “good mornings,” and “any last questions?” were mentioned before she signed her consent.  The team was working feverishly to prepare her for her procedure.  “Have you met the anesthesiologist yet?” was next, and almost on cue, the anesthesiologist arrived and took over for a bit.

He hurried upstairs to the conference …

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Bring your daughter to work: A reminder of what’s important in medicine

Physician
August 16, 2014

“Dad, you have the nicest patients!”

She was right, of course. Daughters that you bring to work with you to shadow for a day can bring you back to what’s important in medicine.  In fact, seeing medicine through fresh eyes is helpful, especially when we forget to look up from our work-a-day lives.

It had been over ten years since I had my first “bring your daughter to work” experience.  Her first time …

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Mainstream media highlights the MOC debate: What did they get wrong?

Physician
July 28, 2014

Recently, the American Board of Medical Specialties’ (ABMS) Maintenance of Certification (MOC) program debate reached a larger mainstream media audience when the Wall Street Journal published their article by Melissa Beck entitled “Skill Reviews Upset Doctors.”

While it is certainly nice to see an article reaching the main stream media concerning doctors’ concerns with the MOC program, the issue with the MOC debate is not that doctors are upset.  The real issue is …

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What kind of doctor are we breeding in medicine now?

Physician
July 7, 2014

Disruptive innovation is competitive strategy for an age seized by terror.
– Jill Lepore, author of The Disruption Machine: What the Theory of Innovation Gets Wrong

“What do you want me to do with all the stuff in this box?” my wife asked this weekend.

I looked inside and saw my former self: one of BNC and pin connectors, wires, a notebook with sin, cos, theta, and a host of other equations — a …

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Maintaining board certification: Stop with the patient surveys

Physician
June 25, 2014

It’s one thing to ask a doctor to stay current on his knowledge, it’s quite another to insist he survey his patients for a private enterprise, especially if that survey represents unvetted independent research.

Recently, a colleague of mine was attempting to maintain his board certification credential with the American Board of Internal Medicine (ABIM) and signed up for the ABIM’s requirement for a practice improvement module worth a required 20 …

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The health care industrial complex is stronger than ever

Physician
May 30, 2014

Irontriangle

Walking to the 2014 Heart Rhythm Society (HRS) Scientific Sessions recently, I couldn’t help but marvel how beautiful San Francisco was. The weather was perfect, the streets bustling, the quaint shops and eateries doing brisk business in a very hip metropolitan city with a distinctive West Coast vibe. As I walked up to the Moscone Conference Center, I was struck by …

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Physician regulators get paid so much more than front line doctors

Physician
May 13, 2014

Medicine has always had it regulatory fiefdoms, but in 2002 they were greatly expanded. At that time, a charter on “medical professionalism” was published by the American Board of Internal Medicine, the American College of Physicians, and the European Society of Internal Medicine in the Annals of Internal Medicine that touted three fundamental principles:

  1. the principle of primacy of patient welfare
  2. principle of patient autonomy
  3. principle of social justice

The first set of professional responsibilities for physicians was a …

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Testing doctors is big business

Education
April 15, 2014

If you want to understand the world of professional board certification, it is important to understand the business and politics of testing professionals. Such testing is big business. So big in fact, that huge international media and education companies that trade on the New York Stock Exchange have been created to service this need. According to one article on Reuters from 2012, “the entire education sector, including college and mid-career training, represents nearly 9 …

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