User login
Two psychiatrists are suing the American Board of Psychiatry and Neurology (ABPN) over its maintenance of certification program, contending that the board has created a monopoly over the MOC market and that its process violates antitrust laws.
The lawsuit, filed March 6 in U.S. District Court for the Northern District of Illinois, alleges that the board is illegally tying its initial certification product to its MOC product, and that ABPN is using anticompetitive actions to prevent and limit competition from new MOC providers. The suit is filed as a class action on behalf of all psychiatrists and neurologists required by ABPN to buy MOC to maintain their certifications. The plaintiffs seek damages and injunctive relief arising from the alleged violations.
In an interview, ABPN President and CEO Larry R. Faulkner, MD, said the legal challenge has no merit.
“The ABPN intends to defend itself vigorously and anticipates that, like other similar cases previously filed against the American Board of Medical Specialties and other member boards, this lawsuit will be dismissed.”
Plaintiff Emily Lazarou, MD, an Odessa, Fla.-based psychiatrist, did not return messages seeking comment. The other plaintiff, Aafaque Akhter, MD, a psychiatrist based in Norton, Mass., declined to comment at the advice of his attorneys. In a LinkedIn post, Dr. Akhter wrote that he filed the class action to put an end to MOC.
“This moneymaking operation has to be abolished,” he wrote in the post. “MOC has to go.
The 35-page complaint against the ABPN contends that the organization’s antitrust and monopolistic actions have resulted in overly burdensome conditions for physicians forced to buy MOC, and that the board’s requirements constrain the supply of psychiatrists and neurologists, thereby harming competition. The ABPN has made tens of millions of dollars in MOC revenue from psychiatrists and neurologists, the suit alleges, while physicians face countless hours away from their practice and families in order to meet MOC demands, to the physicians’ financial detriment. The challenge also asserts that ABPN’s grandfather clause – which exempts from MOC physicians who received initial certifications prior to Oct. 1, 1994 – discriminates against younger physicians, women, and persons of color, all of whom are underrepresented in the group of psychiatrists and neurologists grandfathered by ABPN.
The lawsuit details how MOC has personally and professionally affected the plaintiffs. In 2017, Dr. Lazarou, a forensic psychiatrist who also practices telepsychiatry, asked the ABPN in advance for a private room during her upcoming 10-year MOC examination. At the time, Dr. Lazarou was nursing her twin newborns and needed the private room to pump, according to the lawsuit. The suit alleges that ABPN would not make an accommodation for Dr. Lazarou to pump at the testing site; however, as a professional courtesy, board officials allowed her to travel to a test center farther away that had private rooms. Because the distance required Dr. Lazarou to be away from her newborns for an extended period, she did not take the MOC examination, and her ABPN certification lapsed, according to the suit. Because of the lapse, she is no longer able to practice telepsychiatry, which has resulted in a loss of income and to the detriment of patients who need telepsychiatric care, she claims in the lawsuit.
Dr. Akhter, who practices addiction medicine, was informed in August 2018 that he was selected for a random audit of his ABPN MOC activities. During the audit, officials informed Dr. Akhter that the continuing medical education (CME) requirement for completion of his 3-year continuance maintenance of certification (C-MOC) cycle had not been met, according to the suit. As part of the 3-year C-MOC cycle, physicians are required to complete 90 CME credits, including 24 credits for self-assessment (SA) activities. ABPN defines SA activities as a specific type of CME activity that help physicians recognize their current knowledge base in order to identify specific topics for gaining further knowledge. Although Dr. Akhter had obtained a subspecialty certification from the American Board of Preventive Medicine, including completion of 60 CME credits that included SA activities, the board determined that those efforts did not fulfill Dr. Akhter’s SA CME requirements. The board denied his request to recognize the 60 CME credits as SA CME credits and also refused to give him SA CME credits for obtaining his subspecialty certification, the lawsuit says. He now is listed on the ABPN website as “Not Meeting MOC Requirements.”
The ABPN has not yet responded to the lawsuit. Defendants generally have 30 days from the time a challenge is filed to respond, unless they request an extension. Court documents show that an attorney for ABPN entered his appearance on March 20.
The ABPN lawsuit comes on the heels of a similar class action filed last year by a group of internists against the American Board of Internal Medicine (ABIM) over its MOC process. That lawsuit, filed Dec. 6 in Pennsylvania district court, contends that the ABIM is charging inflated monopoly prices for maintaining certification and that the organization is violating antitrust laws. In a motion filed March 18, attorneys for the ABIM asked the court to dismiss the suit for failure to state a valid claim. A third lawsuit that levies similar allegations against the Board of Radiology was filed in late February. All three lawsuits are being funded by the advocacy organization Practicing Physicians of America, through a GoFundMe campaign.
Richard Rosin, MD, a geriatric psychiatrist based in Vancouver, said in an interview that he welcomes and applauds the lawsuit against ABPN. He hopes that the legal challenge will put a spotlight on the board’s activities and compel administrators to answer questions about the MOC process that have gone unanswered in the past.
“If it is successful, I think the impact will be dramatic,” said Dr. Rosin, an outspoken critic of the ABPN’s MOC process. “They’ll essentially have to disband the [MOC] program.”
Paul G. Mathew, MD, a Boston-based neurologist, said he was not surprised by the lawsuit. Dissatisfaction about MOC continues to rise, and resistance grows as more diplomates learn about the financial misdoings and monopolistic nature of the board, said Dr. Mathew, director of legislative affairs for the National Board of Physicians and Surgeons, an alternative board that provides continuing certification for physicians.
“At the end of the day, I hope that the case wins, because diplomates have been forced to expend their time, effort, and money on a product that has scant evidence that it improves practice,” Dr. Mathew said in an interview. “Unnecessary administrative burdens of this nature that do not improve patient care contribute to physician burnout, which is a nationwide epidemic.”
Dr. Mathew hopes to see monetary damages awarded as well as injunctive relief that would enable competition in the MOC market, he said. Such relief would prevent insurance companies and other stakeholders from only recognizing and requiring recertification with ABPN.*
“This would allow physicians the flexibility to recertify with boards like the National Board of Physicians and Surgeons,” he said.
The ABPN, meanwhile, defended its recertification, calling it a credential that is valued by patients, families, and medical organizations as an indicator that physicians have pursued “a meaningful program of lifelong learning sufficient to maintain the competence to provide quality patient care.” In recent years, the board has made improvements to its MOC requirements based on constructive feedback from diplomates and consistent with the evolving standards of the American Board of Medical Specialties, Dr. Faulkner said in the interview.
“Relevant options have been provided for the documentation of self-assessment and performance improvement, and they have been well received by diplomates,” he said. “The ABPN is also in the process of implementing an optional, article-based Pilot Project as an alternative to its secure continuing certification examination. Almost 15,000 ABPN diplomates have enrolled to date in the Pilot Project, and initial feedback from those diplomates has also been very favorable.”
*Correction, 4/5/19: Due to an editing error, an earlier version of this article omitted the word "only" from this sentence.
Two psychiatrists are suing the American Board of Psychiatry and Neurology (ABPN) over its maintenance of certification program, contending that the board has created a monopoly over the MOC market and that its process violates antitrust laws.
The lawsuit, filed March 6 in U.S. District Court for the Northern District of Illinois, alleges that the board is illegally tying its initial certification product to its MOC product, and that ABPN is using anticompetitive actions to prevent and limit competition from new MOC providers. The suit is filed as a class action on behalf of all psychiatrists and neurologists required by ABPN to buy MOC to maintain their certifications. The plaintiffs seek damages and injunctive relief arising from the alleged violations.
In an interview, ABPN President and CEO Larry R. Faulkner, MD, said the legal challenge has no merit.
“The ABPN intends to defend itself vigorously and anticipates that, like other similar cases previously filed against the American Board of Medical Specialties and other member boards, this lawsuit will be dismissed.”
Plaintiff Emily Lazarou, MD, an Odessa, Fla.-based psychiatrist, did not return messages seeking comment. The other plaintiff, Aafaque Akhter, MD, a psychiatrist based in Norton, Mass., declined to comment at the advice of his attorneys. In a LinkedIn post, Dr. Akhter wrote that he filed the class action to put an end to MOC.
“This moneymaking operation has to be abolished,” he wrote in the post. “MOC has to go.
The 35-page complaint against the ABPN contends that the organization’s antitrust and monopolistic actions have resulted in overly burdensome conditions for physicians forced to buy MOC, and that the board’s requirements constrain the supply of psychiatrists and neurologists, thereby harming competition. The ABPN has made tens of millions of dollars in MOC revenue from psychiatrists and neurologists, the suit alleges, while physicians face countless hours away from their practice and families in order to meet MOC demands, to the physicians’ financial detriment. The challenge also asserts that ABPN’s grandfather clause – which exempts from MOC physicians who received initial certifications prior to Oct. 1, 1994 – discriminates against younger physicians, women, and persons of color, all of whom are underrepresented in the group of psychiatrists and neurologists grandfathered by ABPN.
The lawsuit details how MOC has personally and professionally affected the plaintiffs. In 2017, Dr. Lazarou, a forensic psychiatrist who also practices telepsychiatry, asked the ABPN in advance for a private room during her upcoming 10-year MOC examination. At the time, Dr. Lazarou was nursing her twin newborns and needed the private room to pump, according to the lawsuit. The suit alleges that ABPN would not make an accommodation for Dr. Lazarou to pump at the testing site; however, as a professional courtesy, board officials allowed her to travel to a test center farther away that had private rooms. Because the distance required Dr. Lazarou to be away from her newborns for an extended period, she did not take the MOC examination, and her ABPN certification lapsed, according to the suit. Because of the lapse, she is no longer able to practice telepsychiatry, which has resulted in a loss of income and to the detriment of patients who need telepsychiatric care, she claims in the lawsuit.
Dr. Akhter, who practices addiction medicine, was informed in August 2018 that he was selected for a random audit of his ABPN MOC activities. During the audit, officials informed Dr. Akhter that the continuing medical education (CME) requirement for completion of his 3-year continuance maintenance of certification (C-MOC) cycle had not been met, according to the suit. As part of the 3-year C-MOC cycle, physicians are required to complete 90 CME credits, including 24 credits for self-assessment (SA) activities. ABPN defines SA activities as a specific type of CME activity that help physicians recognize their current knowledge base in order to identify specific topics for gaining further knowledge. Although Dr. Akhter had obtained a subspecialty certification from the American Board of Preventive Medicine, including completion of 60 CME credits that included SA activities, the board determined that those efforts did not fulfill Dr. Akhter’s SA CME requirements. The board denied his request to recognize the 60 CME credits as SA CME credits and also refused to give him SA CME credits for obtaining his subspecialty certification, the lawsuit says. He now is listed on the ABPN website as “Not Meeting MOC Requirements.”
The ABPN has not yet responded to the lawsuit. Defendants generally have 30 days from the time a challenge is filed to respond, unless they request an extension. Court documents show that an attorney for ABPN entered his appearance on March 20.
The ABPN lawsuit comes on the heels of a similar class action filed last year by a group of internists against the American Board of Internal Medicine (ABIM) over its MOC process. That lawsuit, filed Dec. 6 in Pennsylvania district court, contends that the ABIM is charging inflated monopoly prices for maintaining certification and that the organization is violating antitrust laws. In a motion filed March 18, attorneys for the ABIM asked the court to dismiss the suit for failure to state a valid claim. A third lawsuit that levies similar allegations against the Board of Radiology was filed in late February. All three lawsuits are being funded by the advocacy organization Practicing Physicians of America, through a GoFundMe campaign.
Richard Rosin, MD, a geriatric psychiatrist based in Vancouver, said in an interview that he welcomes and applauds the lawsuit against ABPN. He hopes that the legal challenge will put a spotlight on the board’s activities and compel administrators to answer questions about the MOC process that have gone unanswered in the past.
“If it is successful, I think the impact will be dramatic,” said Dr. Rosin, an outspoken critic of the ABPN’s MOC process. “They’ll essentially have to disband the [MOC] program.”
Paul G. Mathew, MD, a Boston-based neurologist, said he was not surprised by the lawsuit. Dissatisfaction about MOC continues to rise, and resistance grows as more diplomates learn about the financial misdoings and monopolistic nature of the board, said Dr. Mathew, director of legislative affairs for the National Board of Physicians and Surgeons, an alternative board that provides continuing certification for physicians.
“At the end of the day, I hope that the case wins, because diplomates have been forced to expend their time, effort, and money on a product that has scant evidence that it improves practice,” Dr. Mathew said in an interview. “Unnecessary administrative burdens of this nature that do not improve patient care contribute to physician burnout, which is a nationwide epidemic.”
Dr. Mathew hopes to see monetary damages awarded as well as injunctive relief that would enable competition in the MOC market, he said. Such relief would prevent insurance companies and other stakeholders from only recognizing and requiring recertification with ABPN.*
“This would allow physicians the flexibility to recertify with boards like the National Board of Physicians and Surgeons,” he said.
The ABPN, meanwhile, defended its recertification, calling it a credential that is valued by patients, families, and medical organizations as an indicator that physicians have pursued “a meaningful program of lifelong learning sufficient to maintain the competence to provide quality patient care.” In recent years, the board has made improvements to its MOC requirements based on constructive feedback from diplomates and consistent with the evolving standards of the American Board of Medical Specialties, Dr. Faulkner said in the interview.
“Relevant options have been provided for the documentation of self-assessment and performance improvement, and they have been well received by diplomates,” he said. “The ABPN is also in the process of implementing an optional, article-based Pilot Project as an alternative to its secure continuing certification examination. Almost 15,000 ABPN diplomates have enrolled to date in the Pilot Project, and initial feedback from those diplomates has also been very favorable.”
*Correction, 4/5/19: Due to an editing error, an earlier version of this article omitted the word "only" from this sentence.
Two psychiatrists are suing the American Board of Psychiatry and Neurology (ABPN) over its maintenance of certification program, contending that the board has created a monopoly over the MOC market and that its process violates antitrust laws.
The lawsuit, filed March 6 in U.S. District Court for the Northern District of Illinois, alleges that the board is illegally tying its initial certification product to its MOC product, and that ABPN is using anticompetitive actions to prevent and limit competition from new MOC providers. The suit is filed as a class action on behalf of all psychiatrists and neurologists required by ABPN to buy MOC to maintain their certifications. The plaintiffs seek damages and injunctive relief arising from the alleged violations.
In an interview, ABPN President and CEO Larry R. Faulkner, MD, said the legal challenge has no merit.
“The ABPN intends to defend itself vigorously and anticipates that, like other similar cases previously filed against the American Board of Medical Specialties and other member boards, this lawsuit will be dismissed.”
Plaintiff Emily Lazarou, MD, an Odessa, Fla.-based psychiatrist, did not return messages seeking comment. The other plaintiff, Aafaque Akhter, MD, a psychiatrist based in Norton, Mass., declined to comment at the advice of his attorneys. In a LinkedIn post, Dr. Akhter wrote that he filed the class action to put an end to MOC.
“This moneymaking operation has to be abolished,” he wrote in the post. “MOC has to go.
The 35-page complaint against the ABPN contends that the organization’s antitrust and monopolistic actions have resulted in overly burdensome conditions for physicians forced to buy MOC, and that the board’s requirements constrain the supply of psychiatrists and neurologists, thereby harming competition. The ABPN has made tens of millions of dollars in MOC revenue from psychiatrists and neurologists, the suit alleges, while physicians face countless hours away from their practice and families in order to meet MOC demands, to the physicians’ financial detriment. The challenge also asserts that ABPN’s grandfather clause – which exempts from MOC physicians who received initial certifications prior to Oct. 1, 1994 – discriminates against younger physicians, women, and persons of color, all of whom are underrepresented in the group of psychiatrists and neurologists grandfathered by ABPN.
The lawsuit details how MOC has personally and professionally affected the plaintiffs. In 2017, Dr. Lazarou, a forensic psychiatrist who also practices telepsychiatry, asked the ABPN in advance for a private room during her upcoming 10-year MOC examination. At the time, Dr. Lazarou was nursing her twin newborns and needed the private room to pump, according to the lawsuit. The suit alleges that ABPN would not make an accommodation for Dr. Lazarou to pump at the testing site; however, as a professional courtesy, board officials allowed her to travel to a test center farther away that had private rooms. Because the distance required Dr. Lazarou to be away from her newborns for an extended period, she did not take the MOC examination, and her ABPN certification lapsed, according to the suit. Because of the lapse, she is no longer able to practice telepsychiatry, which has resulted in a loss of income and to the detriment of patients who need telepsychiatric care, she claims in the lawsuit.
Dr. Akhter, who practices addiction medicine, was informed in August 2018 that he was selected for a random audit of his ABPN MOC activities. During the audit, officials informed Dr. Akhter that the continuing medical education (CME) requirement for completion of his 3-year continuance maintenance of certification (C-MOC) cycle had not been met, according to the suit. As part of the 3-year C-MOC cycle, physicians are required to complete 90 CME credits, including 24 credits for self-assessment (SA) activities. ABPN defines SA activities as a specific type of CME activity that help physicians recognize their current knowledge base in order to identify specific topics for gaining further knowledge. Although Dr. Akhter had obtained a subspecialty certification from the American Board of Preventive Medicine, including completion of 60 CME credits that included SA activities, the board determined that those efforts did not fulfill Dr. Akhter’s SA CME requirements. The board denied his request to recognize the 60 CME credits as SA CME credits and also refused to give him SA CME credits for obtaining his subspecialty certification, the lawsuit says. He now is listed on the ABPN website as “Not Meeting MOC Requirements.”
The ABPN has not yet responded to the lawsuit. Defendants generally have 30 days from the time a challenge is filed to respond, unless they request an extension. Court documents show that an attorney for ABPN entered his appearance on March 20.
The ABPN lawsuit comes on the heels of a similar class action filed last year by a group of internists against the American Board of Internal Medicine (ABIM) over its MOC process. That lawsuit, filed Dec. 6 in Pennsylvania district court, contends that the ABIM is charging inflated monopoly prices for maintaining certification and that the organization is violating antitrust laws. In a motion filed March 18, attorneys for the ABIM asked the court to dismiss the suit for failure to state a valid claim. A third lawsuit that levies similar allegations against the Board of Radiology was filed in late February. All three lawsuits are being funded by the advocacy organization Practicing Physicians of America, through a GoFundMe campaign.
Richard Rosin, MD, a geriatric psychiatrist based in Vancouver, said in an interview that he welcomes and applauds the lawsuit against ABPN. He hopes that the legal challenge will put a spotlight on the board’s activities and compel administrators to answer questions about the MOC process that have gone unanswered in the past.
“If it is successful, I think the impact will be dramatic,” said Dr. Rosin, an outspoken critic of the ABPN’s MOC process. “They’ll essentially have to disband the [MOC] program.”
Paul G. Mathew, MD, a Boston-based neurologist, said he was not surprised by the lawsuit. Dissatisfaction about MOC continues to rise, and resistance grows as more diplomates learn about the financial misdoings and monopolistic nature of the board, said Dr. Mathew, director of legislative affairs for the National Board of Physicians and Surgeons, an alternative board that provides continuing certification for physicians.
“At the end of the day, I hope that the case wins, because diplomates have been forced to expend their time, effort, and money on a product that has scant evidence that it improves practice,” Dr. Mathew said in an interview. “Unnecessary administrative burdens of this nature that do not improve patient care contribute to physician burnout, which is a nationwide epidemic.”
Dr. Mathew hopes to see monetary damages awarded as well as injunctive relief that would enable competition in the MOC market, he said. Such relief would prevent insurance companies and other stakeholders from only recognizing and requiring recertification with ABPN.*
“This would allow physicians the flexibility to recertify with boards like the National Board of Physicians and Surgeons,” he said.
The ABPN, meanwhile, defended its recertification, calling it a credential that is valued by patients, families, and medical organizations as an indicator that physicians have pursued “a meaningful program of lifelong learning sufficient to maintain the competence to provide quality patient care.” In recent years, the board has made improvements to its MOC requirements based on constructive feedback from diplomates and consistent with the evolving standards of the American Board of Medical Specialties, Dr. Faulkner said in the interview.
“Relevant options have been provided for the documentation of self-assessment and performance improvement, and they have been well received by diplomates,” he said. “The ABPN is also in the process of implementing an optional, article-based Pilot Project as an alternative to its secure continuing certification examination. Almost 15,000 ABPN diplomates have enrolled to date in the Pilot Project, and initial feedback from those diplomates has also been very favorable.”
*Correction, 4/5/19: Due to an editing error, an earlier version of this article omitted the word "only" from this sentence.