TUCSON, Ariz., Aug. 29, 2013 (GLOBE NEWSWIRE) -- In the past, "board certified" physicians were certified for life. More recent graduates must undergo periodic or even continuous re-evaluation for "Maintenance of Certification." Writing in the fall 2013 issue of the Journal of American Physicians and Surgeons, Kenneth Christman, M.D., a board-certified plastic surgeon, questions the purpose and value of MOC.

"The elite medical establishment correctly foresaw that there was a huge treasure in the medical certification business," he states. "After all, who could argue against 'standards' to 'protect' the public?"

From public sources, Christman has collected data on the revenue streams to private, nonprofit specialty boards, and compensation packages to their executives. The combined revenue of 24 specialty boards was $320 million in 2011, he reports. He also traces the interconnections between the AMA, the American Board of Medical Specialties, the 24 specialty boards, the Robert Wood Johnson Foundation, the Federation of State Medical Boards (FSMB), the National Quality Forum (NQF), and numerous other agencies.

While MOC is asserted to be voluntary, it is often tied to hospital privileges and participation in insurance panels, and may become a requirement for licensure. Consequently, physicians who choose not to incur the substantial costs or spend an enormous amount of time collecting practice data or studying for exams—or who fail an examination—may not be able to work, Christman writes.

One subspecialty examination had a failure rate as high as 40.9% in 2005. Christman states: "Thus, highly qualified physicians are driven into oblivion simply because they did not know what the elite wanted them to know."

Do patients then get better care? Lacking access to a re-certified physician, patients may be treated by non-physician paramedical personnel. "Does it even matter that they are doing procedures they have not been trained to perform?" Christman asks.

If they really believed their own assertions about quality, Christman asks, why would so many specialty board directors decline to engage in MOC themselves? "Could it be that they truly realize that MOC is irrelevant to quality care?"

Christman warns that MOC, coupled with practice monitoring through electronic medical records, may destroy the patient-physician relationship and give elite organizations, in collusion with government, the power to control medical treatment.

The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties, founded in 1943.