Jane Orient, MD, the AAPS’ executive director, graciously agreed to discuss the issues with me.

Martin Merritt: I understand maintenance of certification (MOC) is one of the hottest topics in the field of medicine today?

Jane Orient: Yes. Many physicians are outraged, not only by the cost an expense which must be incurred to maintain certification, but also by the fear that MOC  is being advanced as a requirement for hospital privileges, and perhaps even maintenance of licensure (MOL).

MM: The public might think the ABMS is a government entity?

Jane Orient, MD JO: The ABMS is a not-for-profit corporation. According to the lawsuit filed by AAPS, the ABMS seems to exist to enrich its own executives, with little appreciable evidence that the MOC program has an effect on the quality of care.

MM: How does the ABMS MOC program actually work?

JO: I can mostly speak about what the lawsuit contains. ABMS and 24 separate corporations, which make up the 24 recognized board-certified specialties have agreed to impose on physicians a recertification program called the ABMS Maintenance of Certification. At one time, a physician could voluntarily choose to become board certified, and upon completion of the process, he or she was board certified for life. Now, the ABMS has decided to force board certified physicians to purchase its products every 10 years. If a physician cannot afford the time or the expense of recertification, he or she may be designated as “not meeting” the requirements of the ABMS, which tends to imply that a physician is less than qualified to care for patients.

MM: What is the AAPS seeking in the suit?

JO: AAPS’ lawsuit, seeks declaratory and injunctive relief to enjoin ABMS’s continuing violations of antitrust law and misrepresentations about the medical skills of physicians who decline to purchase and spend time on its program. AAPS also seeks a refund of fees paid by its members to ABMS and its 24 other corporations as a result of ABMS’ conduct.

Again, the lawsuit itself is the best source for information about the relief requested, but in a nutshell, what we are worried about is the fact that perfectly capable physicians are being black-balled, or locked out of the ability to treat patients, because they do not have the time, or inclination to purchase a product from a private corporation, which has nothing to do with the physician’s ability to treat patients.

MM. You cite an example in the lawsuit, I believe.

JO: In a case cited in this lawsuit, a first-rate physician in New Jersey was excluded from the medical staff at a hospital in his state simply because he had not paid for and spent time on recertification with one of these private corporations. He runs a charity clinic that has logged more than 30,000 visits, but now none of those patients can see him at the local hospital because of the money-making scheme of recertification.MM: I would like to thank Dr. Orient for speaking with us. You can follow this lawsuit and other issues of concern at the AAPS website.

By Bob Keaveney

Is board certification, the decades-old process by which physicians prove their clinical chops within their specialties, becoming a back-door way to micromanage them? Many doctors think so, and they’re planning to debate the subject tomorrow in Philadelphia. You’re invited.

Herbert Kunkle, an orthopedic surgeon in Pennsylvania, argues that board certification is overrated as a means of demonstrating clinical acumen, unproven as a way of driving healthcare quality, and is lately becoming intolerably onerous.

He acknowledges that board certification is “a time-honored thing” that physicians accept as part of the job, even though many feel “tortured by” it. “No one’s ever shown [a clear link between] board certification and clinical acumen and quality,” Kunkle says. “But it’s there and it’s accepted.”

What is angering the critics now are the boards’ implementation of plans to transform what started out as a once-in-your-career certification into something that’s “always on,” watching you. So-called “maintenance of certification” (MOC) was introduced, in principle, more than a decade ago when the 24 member boards of the American Board of Medical Specialties (ABMS) agreed to it, but the actual MOC programs are only now being implemented by the specialties.

The purpose is to ensure “that the physician is committed to lifelong learning and competency,” by “requiring ongoing measurement of six core competencies,” according to the ABMS. Only two of those competencies seem, by my reading, directly related to clinical knowledge. The others appear aimed more at ensuring that you work and play well with others. For example, you’ll now be expected to “demonstrate awareness of and responsibility to [the] larger context and systems of healthcare” and “call on system resources to provide optimal care.” You’ll also by judged on “interpersonal communication,” including your “active listening” skills.

These are nice ideals but they’re subjective. Many physicians worry that requirements like that are just thinly veiled attempts by hospitals, academics, and associations — what Kunkle calls healthcare’s “artificial aristocracy” — to control the way doctors work and interact with the healthcare system, not just how effectively they treat patients.

“If you think about lawyers, they pass the board once, that’s it,” says Beth Haynes, a family doctor in San Francisco and executive director of the Benjamin Rush Society, the physicians’ group that’s putting on the debate at the University of Pennsylania. (Can’t make it? Stream it live at 6 pm ET.) Haynes is referring to the bar exam, of course. “That’s what we used to with board certification. It was a lifetime mark of achievement, period. But now it’s becoming this very intrusive way of trying to tell people how to practice. … It’s just complete micromanaging of physicians.”

The boards are technically voluntary. You’re not required by law to be board-certified to practice, and as many as a quarter of U.S. docs aren’t. But outside of rural areas where doctors are sparse, board-certification is a prerequisite for hospital privileges and payer credentialing. You can’t work without board certification, so attempts to broaden certification requirements to include the kind of “soft” skills often valued by administrators, as well as the fact that measurement is now “ongoing” rather than periodic, strikes some as an attempt by bureaucrats to control docs.

Kunkle’s assertion, by the way, about the lack of firm evidence of the boards’ value in driving healthcare quality is a matter of debate. There are studies that demonstrate a correlation between the boards and quality, though proving causation requires the ability to control for other factors that might affect quality, and that’s a very difficult thing to do. Yet even if one accepts the premise that it makes sense to measure a physician’s skills related to her chosen specialty, what’s needed is evidence of how well and by much board-certification drives quality. Otherwise it’s hard to see a scientific basis for new and expanded requirements.

There’s a comforting-to-white-people fiction about racism and racial inequality in the United States today: They’re caused by a small, recalcitrant group who cling to their egregiously inaccurate beliefs in the moral, intellectual and economic superiority of white people.

The reality: racism and racial inequality aren’t just supported by old ideas, unfounded group esteem or intentional efforts to mistreat others, said Nancy DiTomaso, author of the new book, The American Non-Dilemma: Racial Inequality Without Racism. They’re also based on privilege, she said — how it is shared, how opportunities are hoarded and how most white Americans think their career and economic advantages have been entirely earned, not passed down or parceled out.

The way that whites, often unconsciously, hoard and distribute advantage inside their almost all white networks of family and friends is one of the driving reasons that in February just 6.8 percent of white workers remained unemployed while 13.8 percent of black workers and 9.6 percent of Hispanic workers were unable to find jobs, DiTomaso said.

This week, the professor of organization management at Rutgers University and her ideas have captured the attention of the business press. There was a blog about her book in The Wall Street Journal and a story in Bloomberg Businessweek. DiTomaso, who is white, has gathered evidence that racism and inequality actively shape the labor market and make it far harder for black workers to find jobs.

“Across all three states where I did my research, I heard over and over again [white] people admitting that they don’t interact very often with nonwhites, not at work, not at home or otherwise,” said DiTomaso about the 246 interviews with working-class and middle-class whites she did over the course of about a decade in Tennessee, Ohio and New Jersey. Her research included detailed job histories and information about the way her study participants obtained jobs over the course of their careers.

“That was true for just about everybody unless they were still in college,” DiTomaso continued. “Others would allude to some college friend or experience. But since then, they had not had much contact with blacks. So how would they pass opportunities and information across race lines?”

DiTomaso concludes, based on her research, that most white Americans engage, at least a few times per year, in the activities that foster inequality. While they may not deliberately discriminate against black and other non-white job seekers, they take actions that make it more likely that white people will be employed — without thinking that what they’re doing amounts to discrimination.

“The vast majority assumed everyone has the same opportunities, and they just somehow tried harder, were smarter,” DiTomaso said of those she interviewed. “Not seeing how whites help other whites as the primary way that inequality gets reproduced today is very helpful. It’s easy on the mind.”

So white Americans tell a neighbor’s son about a job, hire a friend’s daughter, carry the resume of a friend (or, for that matter, a friend’s boyfriend’s sister) into the boss’s office, recommend an old school mate or co-worker for an unadvertised opening, or just say great things about that job applicant whom they happen to know. But since most Americans, white and black, live virtually segregated lives, and since advantages, privileges and economic progress have already accrued in favor of whites, the additional advantages that flow from this help go almost exclusively to whites, DiTomaso said.

DiTomaso’s findings aren’t exactly new, said Algernon Austin, director of the Race, Ethnicity and the Economy program at the Economic Policy Institute, a left-leaning Washington-based think tank.

“Listen, I think it’s an important piece of work to reiterate and clarify the ways in which blacks are disadvantaged in the labor market,” Austin said. “Of course, part of the appeal of this is that there’s no malice. You can say no one is to blame. The Businessweek piece says, well, people just like helping out their friends, which is perfectly natural and normal.”

DiTomaso’s work does confirm that networks — not just the kind you build over awkward conversations, finger foods and watered-down cocktails but the kind you’re born into — matter, Austin said. It also points to just how different forms of inequality feed one another. Family-and-friends segregation feeds job and income inequality. That in turn feeds neighborhood and school segregation. That then leaves some kids less likely to receive a quality education and escape from the cycle, he said.

Austin thinks that increased public awareness of opportunity hoarding, as well as public policies that enhance options for blacks and Hispanics, could make a difference. Bringing more blacks into the labor force would have the immediate effect of reducing black poverty, and quality early-childhood education has been proven to blunt some of the short- and long-term effects of childhood poverty, he said.

“To President Obama’s credit, he’s certainly focused on early childhood education,” Austin said.

It’s not that black workers don’t attempt the same sort of job assists within their own networks, said Deirdre Royster, an economic sociologist at New York University and author of Race and the Invisible Hand: How White Networks Exclude Black Men From Blue Collar Jobs.

African Americans ask neighbors, significant others, the significant others of neighbors, relatives and friends about open jobs, too. But since black unemployment rates were far higher than white rates before, during and after the recession, the number of people in a typical black social network who are in a position to help is far more limited.

According to Royster, there’s an additional twist: When blacks are aware of a job, they describe the job, the boss, the company and its preferences and needs. Then they follow up with a warning.

“They give the person looking for a job all sorts of information and then they say, ‘But don’t tell them I sent you,’” said Royster.

Black workers are aware of something that researchers are still trying to explain: White bosses often worry, lack of statistical evidence aside, that black workers are more likely to sue them or band together in the workplace and try to change things, Royster said. That seems all the more likely if the black workers already know one another, she said. And many white hiring managers still assume, consciously or unconsciously, that black workers bring undesirable workplace habits and qualities, Royster said.

Indeed, a 2003 study by Devah Pager, now a Princeton University sociologist, found that white men with criminal records were more likely to get callbacks for job interviews than black men with the same qualifications and no criminal history.

Date: Tuesday, March 26, 2013 By: thegrio.com

Have you received a wake-up call yet?

For too many of us, it takes a sudden wake-up call — in the form of a major or minor health crisis — to make us realize that we’re not invincible.  And tragically, for some, that call comes too late.

As black men, we often don’t talk about our health or seek help until something goes wrong. We may exercise and eat right. We may know how our habits today affect how we feel. But what about tomorrow? Are we making the right choices to stay healthy as we grow older? Most importantly, are we having the right conversations about health and well-being with our sons and our fathers, with our brothers, our colleagues, our neighbors, and our friends?

According to the Office of Minority Health at the U.S. Department of Health and Human Services, black men are 30 percent more likely to die from heart disease and 60 percent more likely to die from a stroke than white men. And unfortunately, the list goes on — black men still suffer from higher rates of disease and chronic illness such as prostate cancer, diabetes and heart disease.

Unless we act now, these disparities will continue to affect generations to come.  Their existence should be a wake-up call for all black men. It’s time to invest not only in our own health, but in the health of our communities.

That starts by putting ourselves in the driver’s seat when it comes to our own care. The health care law signed by President Obama in 2010 is removing many of the obstacles to health care we’ve faced in the past. It provides access to preventive services – like screenings for blood pressure, cholesterol, and type 2 diabetes – at no cost to us.

It will protect those of us with pre-existing conditions like asthma or heart disease from unfair premium rates or outright denial of coverage. It makes major investments in America’s network of community health centers, where over a quarter of patients served are African-American. And on October 1st, the law will open the door to affordable coverage for millions of African-Americans, through the Health Insurance Marketplace.

That means brothers running their own businesses will have the opportunity to get coverage for themselves, their employees, and their families. That means men working in barber shops, body shops, and construction companies across America will have access to affordable coverage if they don’t have it now. That means when you hit a rough spot and are between jobs, you don’t have to sacrifice the well-being of your loved ones. It means greater peace of mind and financial security for our families and communities.

There’s a lot of great work being done in our community to close gaps in access to quality care. I’m encouraged by the tireless work that our faith- and community-based groups are doing every day to raise awareness and push policies that will make the health care system work for all Americans. They are leading the way – but it’s up to all of us to do our part.

The wake-up call that brings better health to our communities shouldn’t be a private alarm that we hear alone. It should be a chorus of voices that speaks to us, our families and our communities. This year, let’s put our health in our own hands, and create a brighter, more secure future together for all of us.