Still Qualified?

Your doctor has some qualification. Your doctor graduated from medical school, probably. Your doctor has some training after medical school, probably. But what about after that?

There are several things to consider here:

  1. Does your doctor still possess the specialty skills for which she was originally certified?
    • How would you know?
    • Should you care?
  2. How up-to-date is your doctor’s skill or knowledge?

Almost every medical board in the US requires some “continuing education.” Historically this was the chance for a physician to go off to a resort and drink and hang out with old friends and colleagues while his/her spouse wandered around the resort or town and squandered money. It was just something you did because the state medical board said you had to.

Now the certification boards have gotten in on the action. The American Board of Medical Specialties

works in collaboration with 24 specialty Member Boards to maintain the standards for physician certification. Our focus is on improving the quality of health care to patients, families, and communities by supporting the continuous professional development of physician specialists. We achieve our mission as an organization by helping physicians achieve their potential as providers of quality health care.

The ABMS website further notes:

ABMS Mission Statement

The mission of the American Board of Medical Specialties (ABMS) is to serve the public and the medical profession by improving the quality of health care through setting professional standards for lifelong certification in partnership with Member Boards.

Higher Standards Drive Lifelong Assessment and Learning

For more than 80 years, we’ve evolved the standards for medical specialty practice and certification to support advancements in medicine, science, and technology. As a community of learners and leaders, we periodically evaluate and update our professional and educational standards to reflect the changes in medical specialty practice and health care delivery processes.

Physicians meet these standards in order to become Board Certified. Maintaining the following competencies keeps their certification active throughout their career and forms the foundation of the ABMS Program for Maintenance of Certification (ABMS MOC®):

  • Professionalism
  • Patient care and procedural skills
  • Medical knowledge
  • Practice-based learning
  • Interpersonal and communication skills
  • Systems-based resources

The standards guiding the ABMS Program for MOC are patient-centric with a greater emphasis on professionalism, patient safety, and performance improvement. They help physicians become active participants in the evaluation of their own practices. Physicians can see how their practice compares to those of their peers, how it differs from published best practices, and how their own practice evolves over time, progressing toward the ideal practice.

The standards also include guidelines which help the ABMS boards select learning programs and improvement activities, create assessment and evaluation systems, and pioneer effective new pathways for physicians to learn the latest innovations in their specialty.

Lifelong Assessment and Learning Inspires Quality Improvement

Quality improvement is vitally important to our nation’s health care. Patients place an unprecedented level of trust in their physicians. They expect that the certifications held by their physicians represent a current demonstration of their knowledge and skills. The ongoing process of MOC assures that level of quality and trust.

The ABMS Program for MOC has grown to respond to the needs of patients by tapping into and extending the deep reservoir of duty and compassion of our physician specialists. Both patients and the profession benefit as the MOC competencies become deep-rooted into medical practices as well as our nation’s educational, accrediting and certifying activities.

All  that sounds pretty good. In fact how could any reasonable physician argue with something like “improving the quality of health care.” But lately physicians have begun pushing back against “re-certification” programs. One physician resented re-certification so much that he invented a certification board and certified himself! You know him as Senator Rand Paul (see here, here, here, here, here, and here). His “certification” is 100% bogus. His “certification” board appears, at this time to be 100% non-existent.

But the boards (all of the ABMS member boards) are in trouble. They need to find a reason for their existence. If we look at just Internal Medicine (ABIM). The exact number of graduates of American IM residencies who pass the ABIM certification exam is not widely distributed information. But generally the 5-year “conversion rate” to certification is in excess of 95%. (First-time taker pass rate here. Program pass rates generally exceed exceed 90% and almost universally exceed 80%.) The real question is if “Certification by the American Board of Internal Medicine (ABIM) has stood for the highest standard in internal medicine and its 20 subspecialties” How can pass rates be that high? Seriously- Navy SEAL training has an 80% attrition rate. The navy can recruit from the very best fighters from the navy and marines and still there’s an 80% attrition. Internal medicine residencies draw from American and international grads (some of whom barely speak and understand English) and 80% pass the exam! How does an 80% pass rate comport with a claim of “the highest standard?” In fact, ABIM barely establishes a minimum acceptable command of basic medical knowledge.

Bearing that in mind, why would anyone care about re-certification? Let’s turn this around. Since certification really sets a minimum standard (yes these physicians are limbo-ing under the bar of “minimal knowledge”) then certification only matters if a physician does not have it.

No, you should not trust your health to any physician who cannot pass his/her certification exam. It does not matter why he/she can’t pass. That physician has not demonstrated  a minimal command of basic knowledge.

Soon, we’ll look at the myriad reasons, almost all vacuous, why physicians don’t want to re-certify.

 

 

 

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Academic Corruption

Many patients are skeptical of their physician- you probably should be too.  contributed a piece over at the Diet Doctor. The Diet Doctor states this on the “About” page:

Regaining health in a sick world requires thinking and acting differently. It requires trusting not in corporate propaganda or old misinformation, but in nature. In the power of your own body to return to its natural state, given the right environment.

Our mission is to find the truth about health and supply tools for those who want to free themselves. Thus empowering people everywhere to revolutionize their health.

Dr Fung highlights some of the most egregious conflicts of interest many physicians labor under. Money is the cause. You doctor is swayed by payments. You can (and should) check your physician at https://projects.propublica.org/docdollars/.

Almost all doctors acknowledge that physicians can be swayed by payments. However, they limit that persuasive effect to other doctors. No physician admits that a few bucks, or a golf trip, or a free lunch might cause him/her to compromise a patient’s care.

But let’s look at a specific example- Charles “Sam”Fillingane, DO from Jackson, Mississippi (how appropriate that he hails from the state that is routinely number last in everything good).

Wall Street Journal article cited the case of one doctor, Charles “Sam” Fillingane, as “the most prolific test prescriber among 296 doctors who referred patients to HDL.” He may have earned as much as $23,000 in six months on P&H fees at one point. In 2010, according to the Journal, he received $3,000 a month for serving on HDL’s medical advisory board. By 2012, as the former HDL employee told me, Fillingane received $6,000 a month to serve on the advisory board. This was on top of the P&H fees and his fees for speaking on behalf of the company. Despite all these revenue streams, the company gave him $100,000 in unsecured loans “because he was struggling in his business.”

If you do a quick google search for “Dr. Fillingane” in addition to his distinction as one of the highest referrers to the operations of HDL he can be found on several websites. On his own website he notes this:

Dr. Sam Fillingane is a board certified family practitioner whose practice is totally dedicated to “Cardiovascular Risk Reduction.” Dr. Fillingane has had a passion for CV Risk Reduction for years which has led him to develop a treatment protocol for cardiovascular disease that has had great success in reducing cardiovascular events in a high risk patient population.

Dr. Fillingane has been teaching courses related to cardiovascular risk reduction all over the country for many years. Recently Dr. Fillingane has become the TV host of a national television show related to cardiovascular risk reduction, “Straight To The Heart,” which can be seen weekly on My Family TV Network. Dr. Fillingane utilizes his experience and knowledge of cardiovascular biomarkers to identify patients at risk for cardiovascular disease and how to remove that risk from each patient.

Dr. Fillingane has been a sought after speaker for multiple topics related to CV disease. He has also assisted in the training of multiple medical students and residents throughout the years. Dr. Fillingane was selected as the AOA Mentor of the Year in 2009.

Dr. Fillingane is a medical director for Jackson Sleep Laboratory, and assists with the care of numerous cardiovascular patients with sleep abnormalities. Dr. Fillingane has laser surgical training that includes many years of experience treating obstructive sleep apnea with LAUP (laser assisted uvulopalatopharyngoplasty) when conservative treatment with CPAP or BiPAP are not an option.

Dr. Fillingane is a graduate of Kansas City College of Osteopathic Medicine and Biosciences. Dr. Fillingane also did his rotating internship in Kansas City at Lakeside Hospital, which included cardiology training at St. Luke’s Hospital. Dr. Fillingane is the founder and CEO of Fillingane Medical Clinic in Jackson, Mississippi.

He also has another website here, which also make many of the same self-serving claims. Ironically, it also touts his relationship with the now defunct HDL.

All of the websites indicate Dr. Fillingane practices here:

Fillingane Medical Clinic
1021 North Flowood Drive
Jackson, Mississippi

Yet this location is closed. The bank has taken possession of the property. Dr. Fillingane has abandoned the building, his patients, and his practice. Yet he still has a Mississippi license and has acquired, miraculously, a Florida license as well.

The public is right to be skeptical of “academic” credentials. The public- you included- should carefully check out whether you doctor’s credentials are real or simply bogus “puffery.” Licensure doesn’t help as a screening tool (ask Mississippi and Florida). At least Alabama had the good sense to deny “Dr. Fillingane” a license.