045 The Case for Re-certification through National Boards of Physician and Surgeons

• Founded in 2015, the National Board of Physicians and Surgeons (NBPAS) provides physicians with a choice in continuous board certification that is clinically rigorous, evidence-based, less burdensome, and nationally accepted.
• Thirteen states have passed legislation prohibiting MOC/OCC as a requirement for medical licensing, hospital privileges and payor reimbursement. View here
• The anti-competitive nature of the ABMS MOC product caught the attention of the U.S. Department of Justice (DOJ), Antitrust Division. On September 10, 2018, the DOJ published guidance that strongly encouraged competition in physician certification. Read More
• The American Medical Association (AMA) issued a resolution stating that MOC/OCC should not be a mandated requirement for licensure, credentialing, payment, network participation or employment. Read More
• The ABMS released a Vision Commission report (2019) on MOC concluding that “ABMS must encourage hospitals, health systems, payers and other health care organizations to not deny credentialing or privileging to a physician solely on the basis of certification.” And in the same report, less than 1 in 10 of physicians found value in ABMS’s MOC programs.

Transcript

NBPAS The Case for a Better Board Re-Certification

[00:00:00] Dr. Herb: Hi George. How are you? I'm joining you from New York, Quantico based today at Durey Pediatrics. 

[00:00:09] Dr. George: Yeah. Hi. It's Tuesday morning once again where we elevate great physicians, but today we're gonna elevate a great opportunity. 

[00:00:18] Dr. Herb: The, you know how much I love free markets. I mean, competition's always good for the consumer and the customer.

So we have a pleasure today of welcoming Karen, who is the associate director at the National Boards of Physicians and Surgeons, and Dr. Robert, who is a family practitioner in Michigan and is left the American Board of Medicine System and join N B P A S. Welcome. It's a pleasure to have you on the show.

Thank you. Thank you. Pleasure to be here. Good to be here. Karen, can you tell us a little bit about your journey? How did you end up leading this organization? 

[00:00:57] Karen: Sure. Yeah, I'm very happy to. So my name is Karen Chattner and I serve as the Associate Director of National Board of Physicians and Surgeons. I've been with them about two years, started in a slightly different role developing programs for them, but as associate director I'm really in charge with all of the sort of outward facing elements of the programs.

So we look for kind of just like you said in your lead-in. We really believe in competition and choice in board certification. And so as you might guess, and most people will know, it's the US Health system is large and complex, so it's challenging to make changes, but you know, one of my jobs is to find where those problems or challenges might be and to help clear the way so that the national Board can be a choice for everyone.

[00:01:43] Dr. Herb: Excellent. And Robert you're out there in Michigan. What was your journey in changing from the family practice boards into B P A? 

[00:01:53] Dr. Robert: I think it really started, I was a Navy physician in the beginning of my career. I went to med school and a Navy scholarship, so serving in the Navy to pay back the scholarship, but also obviously gained lots of experience.

I did everything in the Navy and then when I moved to civilian practice in Michigan, I found that. Not doing all the things that I did. I wasn't doing obstetrics. There were, there were several things that I didn't do. So I was focusing on just clinic primary care, medicine. It didn't work in the hospital either.

So about the time that I did move to civilian practice, I've had re-certified with abms, American Board of Family Medicine. So ABFM. When I went through that process, it just became very clear that much of what I had to do for that wasn't relevant to my current practice.

Even though I had done all those things in the Navy, I was no longer doing those things. So I spent a lot of time reviewing and, and focusing on things for the. ABMS process that just wasn't relevant. It didn't seem like a good use of my time when , I don't even remember how I heard about MB Pass, but I do remember that this was in 2015.

When I did hear about it, I knew immediately that that's what I wanted in board certification. I wanted a valid credential that allowed me to focus on what I needed to focus. And was recognized everywhere and it sounded like they had a good system for becoming recognized. So that was you know, it's a cliche, but it was kind of a no-brainer for me.

 I jumped on immediately and that's not something that I usually do. 

[00:03:30] Dr. Herb: Great. And Karen, , why was it the BPAs founded? What was their mission? Sure. 

[00:03:36] Karen: Yeah. Well, we National Board of Physic. And surgeons or NBPAS a s was founded by Dr. Stein, who's an interventional cardiologist, cardiologist out at Scripps.

He joined with a group of colleagues who are widely known as thought leaders in both clinical and academic medicine, and they put together their collective brain power. MB a s was founded as a response to the growing and significant outcry and discontent among physicians who were really unhappy with the newly hatched MOC or maintenance of certification programs put forth by the dominant boards, which are ABMS and aoa and.

Discontent fostered new and growing demand in among physicians. And so just like Robert alluded to everyone wants excellent physicians and well trained physicians, and certainly we absolutely ascribe to that, but we wanted to create a continuing certification requirement that was truly evidence-based far less burdensome, but very importantly, specific to a physician's individual.

Clinical unique population needs, which the way, how specialized and siloed medicine is today, it's every practice is very, very different, even within specialties. And they were very mindful in their mission of making something that was less burdensome both to the individual physician, but I think in the broader scope, also far less burdensome on the American healthcare system.

[00:05:02] Dr. Herb: And Robert, have you found that any problem? Now that you're just NBPAS Cert re-certified as opposed to the family practice boards at the hospital, the health or the health systems, or the payer. 

[00:05:17] Dr. Robert: Not everyone recognizes NBPAS as I think Karen will explain the majority of the payers that I in network with do.

There was one that insisted on ABMS certification but then another one that. It was interesting because a lot of the patients in this area who were seeing physicians and then switched to, I don't wanna mention specific payer names, but this other major payer the physicians in this area weren't in that network and surprising.

I'm one of the few physicians in this area that's in the network of that payer. So rather than saying that there's problems, I think there's some shifting. And overall the vast majority of payers recognize and NBPAS. I use a credentialing service in another town, and they have they've told me they don't have any problem getting me credentialed with payers using the NBPAS credential.

[00:06:22] Dr. Herb: All right. Well, that's great to hear. Now, Karen, there's been some very good news for the organization lately, right? So there there has, Yes. . So what is the importance of the Joint commission? On hospital accreditation. Saying that you are an equivalent to the abms? Sure. 

[00:06:39] Karen: Well, let me I'll back up just for a minute.

So, I would say in the past, you know, 12 months, we've had lots and lots of good news on the accreditation side. That includes the Joint Commission, as you mentioned, and all. Actually all other major accrediting bodies, both on the hospital side and there's also the ever important health plan side. So on the hospital side it includes joint commission and their competitor, which is a great organization called the dnv.

And on the health plan side, it's N C Q A and U A U R A C. There's lots of acronyms in this world. The significance of Joint commission, specif. They named us as a designated equivalent source agency. It's important to note what that means. So just like Robert said, he contracts with a credentialing organization and joint commission accredits over 22,000 healthcare entities in the United.

States. So in every one of those entities, there are credentialing staff that need to make sure they're hiring well qualified physicians, and as part of that, they have to do something called primary source verification. They have to verify from a primary source that if a physician says, I'm board certified.

We wanna make sure the physician actually holds the credential that they claim to hold. We wanna make sure that they're actually licensed in the state, they're licensed in, et cetera. And you can't get that information by third party or hearsay. It has to come from a primary source. So the National Board of Physicians and Surgeons Primary Source verifies our data and hence we qualify under the Joint Commission terms to be a designated source agency to verify that information.

And so to Robert's point, any credential. Is nobody wants their job to be more complicated or have to jump through more hoops or steps. This makes it very, very easy for any credential or at any facility anywhere in the United States that's accredited by these bodies to look and say, it gives them the confidence to just know, Hey, this is okay.

I can check this box. I know these guys are above board. So it's a it's an important procedural step that has made you know, been very helpful for the organizations that we work. 

[00:08:47] Dr. Herb: Excellent. And tell me a little bit about the NC Q a, QA s It is, yeah. And cause almost all of us in private practice have used that at one point or 

[00:08:54] Karen: another.

Sure. So NC Q A, and I see if I can get the acronym correct. National Committee on Quality Assurance is the largest accrediting body for health plans. They really became very significant after the passage. To the Affordable Care Act because any plan offered on a federal exchange or state exchange has to be accredited by either NC Q a or Iraq.

And so suddenly these accreditation requirements became really, really important. And again, just like joint commission realizing how important that was for anyone who might wanna accredit our physicians on the payer side or enroll our physicians in their plan or program on the payer side, they need that confidence.

To know that we are a body, that primary source verifies our information. So we engaged with N C Q A just as we did with Joint Commission and all the other bodies. We presented our programs. They were in agreement and that we met the standards they were looking for. And again, we were written into N C Q A.

I'm gonna forget the date. I believe it became official November, 2021. 

[00:10:00] Dr. Herb: And I found it very interesting that the American Medical Association. Also made it a policy statement or resolution that passed against. 

[00:10:08] Karen: Yeah, so American Medical Association, along with pretty impressively the United States Department of Justice, have both weighed in at different times and in different ways on this issue of board certification.

Interestingly, the ftc, the Federal Trade Commission, has also made some statements in terms of the legality and the implications of professional regulation and professional associations and what those rules might or. Be in terms of competition. And so all three bodies have come out in different ways and at different times and said, Look, competition does many things in a, in a market, even in an association market.

It increases, it forces in, tends to force innovation. It tends to lead to innovation and change. It tends to lower. And a lot of people really widely credit mb a s with being the driving force in some of the changes that have occurred in the last several years with the traditional boards and their maintenance of certification programs.

There was actually a. Large survey done by abms itself known as the Vision Commission, where they surveyed their own physicians to see how physicians actually felt about MOC after MB a s came onto the landscape and they found that less than 10% of US physicians found any significant value in these programs.

And these are programs that are incredibly costly incredibly burdensome, not always relevant to practice. And it raises the question of if medicine is truly an evidence driven field, which we certainly hope that it is, why would we require something that's not evidence driven? 

[00:11:47] Dr. Robert: And 

[00:11:47] Dr. George: what I've noticed, I'm in the process of doing this moc, I've done it a couple of times.

I mean, I think it's good education wise, but there's so much technology. In this MOC process mm-hmm. between the part two and the part four and the points and the, and the moeds, you know, the testing, there's a lot of technology and I guess that's why it's so expensive, because just running that technology has to be expensive.

You know, I'm all for technology, but too much technology sometimes is no. Maybe a number two pencil and a piece of paper is good. 

[00:12:23] Dr. Herb: Well, I'm gonna circle a little bit back about what Karen said. Part of the problem is that if you're an independent practice and you are in a one or two person practice and your physician has to be gone for a week to get MOC, not only is it expensive, but who cares? The patients, we have a national shortage of providers and every time we pull away providers to do something that I call is checking the. Cuz it doesn't really add inequality to the care I'm giving. It takes a foot soldier out of the battle and those people are not taken care of and they're gonna go into the urgent cares and the emergency rooms increase the cost and the inconvenience to the patient.

Mm-hmm. . So we shouldn't have national policies that take people who are actually taking care of the patients out of the exam. If we can't show that that intervention actually improves the care the patients are receiving. And I think that has been lost. It's a lot of check boxes in moc and not a lot of results for what you get done.

[00:13:19] Karen: I would agree with that. And I think to that same point, it really fuels the, the epi epidemic of burnout among physicians and accelerates physician loss. And I really like to point out, there was a study that came out last week, I think this year on on record, 117,000 physicians left medicine. And I know one of them personally, and she is an mb she was dual boarded with MB a s and a B Im American Board of Internal Medicine. And. , it factored into her decision. She said, I've had enough. These requirements are onerous. They're not relevant to what I do. And so it's not a hypothetical, It is a real contributor.

[00:13:55] Dr. Herb: Plus the people don't like it when I say this, but the, it's not a fair system if you're a nurse practitioner or you're a pa. You can switch from being a pediatric PA to orthopedic pa to a plastic surgeon, pa, to a dermatology pa. Nobody's making you go back to residency. Nobody's making you take boards.

Nobody's making you recertified and you're seeing the same patient I'm seeing but I'm seeing the patient. I've been doing this for 30 years and I keep taking, taking tests right in. Love to prove that I am pediatrician. That's just blatantly unfair. I don't like unfair markets. 

[00:14:30] Karen: Sure. And I would agree with that. And also on the subject of unfairness, and you asked earlier why we started, how we started, you know, what's our mission? There's another significant aspect of unfairness of that moc. And as many physicians know when it was passed the dominant. Grandfathered, which is just another word for exempted, up to 40% of US physicians from its programs.

So if you were unfortunate to be young enough to miss that grandfathering cutoff, you are burdened with MOC as a requirement, whereas the other 40% of doctors are not. And when you look at some data, which was put put out by the American Association of Medical Colleges and you actually crunch the demo, Of grandfathered physicians, you find that 80% are are Caucasian and 70% are male.

And so, look at the other side of that grandfathering, discriminates against physicians based on age, race, and gender. And in this day and age, it's really sort of a. Stunning state of affairs that it's even allowed and that people turn a blind eye to it. You know, if I were a younger physician, a physician of color I would be, screaming from the mountain tops about this.

 It's really quite inequitable. You know, also to the unfairness aspect, if you look at the finances, which were really a concern to the board members of mb. You know, we really believe there's, there's some conflict of interest inherent to moc maintenance of certification programs. And I'll, I'll mention just American Board of Pediatrics since this is a pediatric focused program.

But if you look at a's nine 90, which is simply the publicly available tax forms from 2020, which is the most recent one on available. You'll see that they paid out over $20 million in salaries in 2020. Their CEO made over $800,000. Most importantly though, they had net assets of over 96 million.

So that's just extra sitting in the bank. Mm-hmm. . And their MOC revenue, so revenue not from initial board certification, which the national board very much believes in, and the data, you know, holds up. That initial board certification is really important to making a quality specialist physician, but their MOC revenue is over 17 million, which is nearly double the initial board.

So by suddenly requiring. MOC they've entirely changed and more than doubled their revenue models. And again, without good clinically peer reviewed evidence to show that it's superior that that presents a conflict 

in our,

[00:17:09] Dr. Herb: it's a whole industry, right? So that way that board works is it's unconscionable that a ceo, a not-for-profit, that doesn't have to recruit, doesn't have to fundraise.

Makes $800,000 a year. You know, most hospital CEOs don't make that money and they're running real organizations with real problems. Sure. Second, they dole out the money like the mafia, and so they pay people to write questions. So they find out academics, the write questions for the boards and they pay them.

And then academic institutions put MOC programs where they teach, where they make revenue out of teaching or the pediatricians in a classroom. And so everybody's getting a cut of the pie except the independent pediatrician who has to take time away from work, abandon his patients miss out on revenue and go sit in a dark classroom.

And check the boxes so they can continue contracting with health plans. It's really not a very nice system. I was very interested with the AMA declaration cuz we tried in Virginia to get MOC canceled from law from the standpoint of its unfair competition and also only really the state has a right to regulate.

Nobody else has a right to regulate medicine according to US law. And this is impinging on the state's, right, to regulate the care that their their population gets and there's no way of wanting them out. So it's not a representative system. We failed because of a conflict of interest. So one of the members on the board is allergist in Richmond, and he lobbied the legislatures in enrich.

Not the changes. And unfortunately some of the national organizations also came against us and we lost a battle on the committee. So I'm glad there's something else that we can do. Mm-hmm. Has the American Academy Pediatrics supported your efforts in any way? 

[00:19:03] Karen: So, that's a great question. I've been with MBPAS a s for two years.

During my tenure, I can't recall any formal conversations we've had with aap, but we have had formal conversations with other professional organizations such as the American Psychiatric Association, which now includes us on their website supports us as a va as a, an important. Option for continuing board certification and we're certainly very happy to have those conversations with aap.

And I would simply, you know, I like to remind people that we're a physician driven organization, we're physician led, we're physician driven. So pediatricians who might be interested, who might be, have associations or work with the aap, I would encourage them to reach out to us and certainly be happy to start those conversations.

[00:19:48] Dr. Herb: That's great. Later on I'll send you an email I'll introduce you to, to someone who's very active in the academy and very interested in what you're doing. Perfect. Cuz he's very he's a great guy. He's up in Rhode Island. And now how do I join if I wanted to join? Sure. 

[00:20:02] Karen: Well you know, we like to make it our process to be as straightforward and least burdensome as possible.

So any physician who's interested in joining can look at our website, which is N BPAs n b p a s.org. We have some big bold click here buttons apply now. To re-certify with us. The requirements are pretty straightforward. We require 50 hours of AMA category P, category one cme.

That number jumps to a hundred if your initial certification has lapsed or expired. And we've, you know, some people have said to us, Well, gosh, well how is that different from licensure? And actually it is because as you, as physicians know, when you Complete CME for your medical licensure at whatever state you're in.

There are requirements that might pertain to let's say opioid use or you know, things like what else? Some states, even like Texas, require you to know the law state Texas law. So even though they might say 50 cme, which on paper looks like the same number many of those CME credits for licensure may be diverted to non-clinical, non-specialty specific areas.

So one of the ways we try to really serve, you know, what Robert referred to as, I need work that's relevant to my patients and what I do. We make sure that the physicians are picking ama. P i category one that's specific to their practice and to their subspecialty. And we hand check that very carefully and communicate with physicians on those points.

[00:21:32] Dr. Herb: So remind me a little bit cuz what is an AMA category one cme? What are they requirements of that? Is it, does it have to be in person cme or? Can it be video or how can I get it, those 

credits? 

[00:21:45] Karen: Sure. Ama actually, if you Google Ama p Cat one, FAQs, so frequently asked questions. The AMA actually has a really nice document, it's probably 40 pages long, that really talks about what P Cat one is and what it isn't.

My understanding is that it can come from many different sources but that it has to be of a higher standard. They also even say in their FAQs, they're looking for category one or materials that really look at not just knowledge retention, but it also looks at performance and tries to forward performance improvement clinical outcomes and professional development of the physicians.

And you know, sometimes people say, Well, you don't have a part four and you don't have a part three, and you know, how, how are you this, how are you good enough? And I say, Ama Pra Cat One is designed to cover all of those bases. It's designed to cover physician learning, patient outcomes professional improvement.

And so it's all overseen and accredited by the accrediting body for cme, the A C C E. And we feel really confident. It's also important to point out that the dominant boards, abms and a. Also now heavily require and use the same materials, Ama p, Cat one. So it's not as if we're doing something radically different in that respect.

[00:23:06] Dr. Herb: Absolutely. I think this is as you get to be older peer to peer learning is much more important. That's why I think the Pediatric Lounge podcast has been helpful because it allow people to have these kind of conversations and learn from each. Which is much more engaging than if you send a room with 200 doctors and somebody lectures about one endocrine problem in kids, and I'm going to see maybe one in 20 years.

So there's a much better mode of learning and even our, our last webinar and suicide prevention. And risk assessment. We got a lot of great feedback and a lot of practices are changing what they're doing just based on that conversation. What you're not gonna get from a huge lecture where 300 people in the room where you can't ask questions and you can't really clear your doubts or your fears this is a much more elegant system.

 I really thank you for you doing this is a great option I think for physicians. I was gonna ask you something and you don't have to answer it online, but I don't know. I think you've talked to Dr. American and Dr. Kerry up in Long Island. They're very much supporters of you.

Okay. And Although I think a lot of us not myself included in that category, but a lot of us in in our groups are very supportive of your venture. Everybody wants to tiptoe in you know they, they, there's still some hospitals that don't, don't accept this as credentialing and that makes 'em nervous.

So is there a way that we could all come in as a bunch, mostly to support you and get an initial. Would your organization be open to that? And you don't have to say yes or no, just putting out there the idea that if we could get a hundred or 150 pediatricians to all come together and support your organization.

Would that be something that we could talk to talk about later? 

Sure. So there's really two parts to your question. So in terms of can you join, can you become a part of what I would suggest is not just a way to continually board certified, but there's. Joining NB a s is a point of advocacy, right?

It's an important statement that you are taking a stand against for something and also in opposition to something that you perceive as unnecessary and unfair. And so we have many, many physicians. If you think back to when we started, no one knew who we were and we weren't really accepted probably anywhere in 2015.

And so everyone who joined, joined. As a point of advocacy and support, and that's still the case today. We have physicians who join every day, every week who say, We love what you're doing. We believe in what you're doing. I'm gonna join and then I'm gonna start working with my hospital. And I think that's actually critically important and we've grown organically from those conversations because once a hospital has, you know, 20 physicians, wonderful physicians, you know, respected high quality physicians who they see are doing exceptional work, With their Mbpa s credential, some of that tiptoeing turns into forward action and they Sure.

This makes a lot of sense. Let's do it. So I would encourage everyone who's interested and supportive of our mission to join and we can certainly help and support your efforts with your organization, be it on the payer or on the employment side as necessary. To your point of discount. You know what I like to say?

We, we offer discounts in two circumstances. We offer them to fellows, medical fellows, and. Also offer them to anyone who's military or former military like Dr. Vander Brook. The reason we can't offer wider discounts is because I like to say we are the discount . You know, I highlighted some of the incredible numbers of American Board of Pediatrics with 96 million in assets in the bank.

I can tell you that National Board of Physicians and Surgeons, we break even every year. We are we are fiscally responsible. We don't waste people's money. We don't have layers of bureaucracy. And if we did crunch some numbers, so your members might be interested to know that on average when you re-certify with the National Board of Physicians and Surgeons, it's about 72% on average, less costly.

 I like to say by joining us, you are selecting , you are getting incredible value. And, and still staying very current and educated on your medical specialty in a, in a much less burdensome way. 

[00:27:24] Dr. George: Yeah. I think the fear that a lot of physicians will have is how do I give up my board certification?

Repercussions, the insurance repercussions the hospital, you know, for us and my organization, we have 17 doctors. They're all doing MOC and we're paying the bill. It's expensive. Mm-hmm. , you know, and they're spending a lot of time. And your C has 60 doctor, or 70. Yeah. Yeah, 

[00:27:50] Karen: sure. Well, and you know, you asked me very at the top of the hour, You know what, what's my job at MBPAS?

So my job is to try to, you know, work to remove those barriers so that you and all your colleagues can feel confident in doing that. And to educate those payers and help pave the way for you to keep it as smooth as possible. 

[00:28:08] Dr. George: Do, do you have to be initially board certifi? Right after residency, 

before joining this?

[00:28:14] Karen: Yes. So, you know, I mentioned we're evidence driven and the evidence is really clear that initial board certification, which as any physician knows, doesn't just mean you take a test. It means you complete a very intensive residency in your specialty. You get trained. The, the initial board exam is sort of akin to a final exam, and so we absolutely require that for all of our physician diplomats.

So, and you can only apply to MBPAS in whatever specialties or subspecialties you have, pass an initial board exam in. So yes, we do require initial board, There's no exceptions. And then beyond that, physicians need to meet our requirements. 

[00:28:52] Dr. Herb: And then I was gonna ask Robert, how, how can we make sure that someday.

This new organization won't force us into MOC and taking tests and charging us $2,000 a year. 

[00:29:04] Dr. Robert: The thing that comes to mind when I hear that is, you know, this is what MBPAS stands for. It stands for physicians doing relevant work to maintain their credentials. And so I think it the idea of having some sort of MOC test or some sort of MOC requirement in the future goes completely against everything that MBPA stands for.

 That idea is so contradictory to what I've experienced with MB a s and what I think MB a s stands for, that you know, there's no guarantees in life. , but I think it's an impossibility for that to happen. 

[00:29:43] Dr. Herb: Great. Karen, what haven't I asked you that I think would be important for pediatricians across the country to know about your organization and what you're doing and.

Whatever else you wanna mention. Sure. 

[00:29:57] Karen: Yeah, I appreciate that. I mean, I think, you know, we touched and we covered a lot in a short amount of time. I think the most important thing for physicians today especially in the post covid era, in the era of. Unprecedented burnout and physician loss. You know, MBPAS wants above all to keep excellent physicians in medicine, seeing patients providing outstanding patient care.

And if we can do that, By providing continuing to provide this less burdensome pathway, that is our mission and our goal and, and we're very proud to do so. I think the most important thing is as we continue to grow even if your hospital, your health system, your employer is still saying, Mm, I'm not sure this is new.

Change is hard. Change is always hard. But it comes from growth and momentum and we have a considerable amount of sort of wind in our sales right now. And I know there are a lot of really, really unhappy overburdened pediatricians in the United States . I have three children and I really, really want my pediatrician to stay in medicine because she's outstanding.

And so I would say, you know, really encourage people to go to. Site, go to mbs.org. Please feel free to email us with questions and continue strongly consider certifying even as you are getting started with your organization. It's an important point of support and advocacy. And we love our physician diplomats.

We love communicating with them. We support what they do, and we'd be very happy to hear from anyone. 

[00:31:29] Dr. Herb: Great. I'm definitely gonna. Excellent. I'm joining just to make a statement, , on Tuesday of election. No, I think you're, you're doing an excellent service and I thank you for that. I think market competition is good for everyone.

That's why your cable or internet at home isn't the greatest cause there isn't really much of a competition. Sure. So when we have competition, people innovate, people get creative cost goes. And more importantly, the consumer has choices. Sure. That's very important . I really want to thank you for that. Well, thank 

[00:32:03] Karen: you.

We, we appreciate that. 

[00:32:05] Dr. Robert: Before we sign off, can you 

[00:32:06] Dr. George: just quickly list what are the requirements exactly, and maybe share 

what the fees are. 

[00:32:12] Karen: Sure. Yeah, absolutely. So real quick, so 50 hours of practice specific AMA PRA Cat one CME every two years, the number jumps to a hundred. If your certification is lapsed, you must maintain a medical active and unrestricted medical license in your state of practice.

We have a requirement again, we require re-certification every two years. Our fees are 180 9 every two years, or 94 50 a year, which again, comes out to about 72% less over a 10 year period when you compare them to maintenance of certification fees with other organizations. We also do require, if you have surgical privilege that you, if you're some surgical specialties, rather, you must have outpatient or hospital privileges with a facility.

And we think that's really important. It's kind of a subtle point. Abms we believe does not require that. It's really important because you could do. Score a hundred on a test and still have terrible technical surgical skills. So we wanna be sure you're being peer reviewed and you know, you're seen by someone in a hospital and so people can attest to the quality of work that you do.

And those are our requirements, 

[00:33:19] Dr. Herb: I guess. No test. 

[00:33:22] Karen: No, we do not believe in a test. And you know, to Herb, to your earlier question, like how do we know that you guys won't change in the future? I can tell you that people call and write in almost weekly with ideas of how we might change or be different.

And sometimes people say just. Why don't you just give a test because everyone else does and they'll stop, you know, complaining about, about you and, and that's not our mission and that's not what the data shows, right? Again, I like to really come back to evidence driven medicine. The evidence is not supportive of the fact that repeated testing makes better physicians.

So we stick to the data and I think our founders. Would would never agree to diverge from the sort of passionate mission that drove us to be formed in the first place. Yep. 

[00:34:11] Dr. Herb: Any, any other questions, George? No, I think it's 

[00:34:13] Dr. George: good. You know, I just finished all my MOC stuff, so I'm good for a bit, but maybe the 

[00:34:20] Dr. Robert: next round.

Well, no, now's a perfect time for you to join Mbpa. I agree with Robert. You got all the bad stuff outta the way. Now go for the good stuff, right? I guess. Well, I guess because it restarts again, to be honest, that's actually what I did. I, I had completed my board, so the American Board of Family Medicines, all the requirements I saw Mbpa s again, I was made aware of it in 2015 when they, they were founded and I jumped on board.

Right. I didn't need additional board certification. And then when the my ABMS or ab FM certification expired, I had already been renewing my MBPA certification. I think it was the, the third or fourth time I just kept it mm-hmm. , and that's all I have. And I shouldn't say all because to me, you know, I was listening to all the comments and it's always good to hear Karen review some of the, some of the great things that Mbpa stands for.

But for me, I literally would not be able to keep doing my job if it weren't for mbpa s and I don't want that to sound you know, inflated or anything. I'm a solo physician now, and I have to devote all of my time to what comes. Every day for my patients. Not something that I need to go home and spend a couple hours on the weekend or a half hour every night reviewing for moc, 

[00:35:46] Dr. Herb: what did you say, George?

Shall we join? I maybe. Maybe. Come on. Let's get a yes on the, on air from you for this one. ? Yes. All right. So you probably have two advocate me. Joiners. Perfect. Well, thank you very much, all of you for your time today. It's been a wonderful conversation. Again, just from my perspective, not talking for the podcast or for George, I think you were doing a wonderful job.

I like the advo advocacy piece cuz I'm a big believer in free markets in changing medical education in the us cuz we need less burnout in physicians that are actually seeing patients taking care of people to get us through this. So thank you so much. Thanks for your time and I wish you the best of luck.

[00:36:30] Karen: You're very welcome. It's pleasure. 

[00:36:32] Dr. Robert: Thank you. Thank you for having us.