A conservative physician group has filed an antitrust suit against the American Board of Medical 鶹ý in federal court, claiming its board recertification program is "a money-making, self-enrichment scheme" that reduces patient access to physicians.
The Association of American Physicians and Surgeons (AAPS) filed its lawsuit Tuesday in U.S. District Court for the District of New Jersey, seeking to end the ABMS' sometimes criticized Maintenance of Certification (MOC) program, .
The Tucson, Ariz.-based AAPS, representing a New Jersey physician in its suit, and violates antitrust laws by having worked with the Joint Commission since 2009 to require physicians to obtain MOC in order to renew hospital medical staff privileges. Health insurers also use ABMS' board certification as a recognition of credentials, the lawsuit states.
"There is no justification for requiring the purchase of [ABMS]' product as a condition of practicing medicine or being on hospital medical staffs, yet ABMS has agreed with others to cause exclusion of physicians who do not purchase or comply with [its] program," the complaint stated. "Defendant's program is a money-making, self-enrichment scheme that reduces the supply of hospital-based physicians and decreases the time physicians have available for patients."
ABMS works with 24 specialty boards, which cover nearly every medical specialty, to develop recertification programs and promote continuous professional development. Those 24 boards aren't named in the lawsuit.
MOC requires most certified specialists seek recertification -- typically every 10 years -- by successfully completing a four-part assessment. The program started in 2000 but recertification has accelerated since 2009.
AAPS said in the lawsuit it seeks to stop the MOC program from continuing, end "misrepresentations" about doctors who decline the program, and receive a refund of fees paid by its members for MOC-related activities.
MOC Evidence Slow, but Coming, ABMS Says
ABMS hadn't yet seen the AAPS lawsuit as of late Wednesday. "Until we see a lawsuit, there's no comment we could make," ABMS spokeswoman Karen Metropulos told 鶹ý.
However, the group defended its MOC program, saying that the program is "anchored in evidence-based guidelines, national clinical and quality standards, and specialty best practices."
"Because the MOC program is relatively new (as it has been introduced gradually during the past decade), we don't yet have evidence that results from decades of gathering data, but the data are emerging," the ABMS said. "Early studies show a link between MOC and improved clinical performance and outcomes by participating physicians."
As further support of its MOC, Metropulos pointed to which has compiled nearly 50 peer-reviewed articles related to the MOC process.
More than 450,000 physicians participate in the MOC program, which ABMS says is to help assure a doctor has successfully completed a rigorous evaluation process and assures competency. The pool grows by roughly 50,000 physicians a year.
AAPS said every state licenses physicians to practice medicine, and patients have a right to seek care from any of them. The group said ABMS' work with the Federation of State Medical Boards for maintenance of licensure as a requirement of state licensure was a further antitrust violation.
ABMS' "actions have no legitimate purpose and reduce the supply of physicians available to treat patients in various settings," the lawsuit said.
The MOC "program imposes far greater burdens than any analogous program in any other profession, and surveys demonstrate that an overwhelming majority of physicians – perhaps more than 90% – feel that this program is unjustified," the complaint stated, .
The lawsuit cites the "unjustified exclusion" of an AAPS member with 29 years' experience -- identified only as "J.E." in the complaint -- from the medical staff at Somerset Medical Center in Somerville, N.J. The physician wasn't allowed on the medical staff in 2011 until he had been certified by the American Board of Family Medicine.
Recertification would have exceeded 100 hours for a typical physician, "thousands of dollars in fees and travel expenses," and time away from patients. Furthermore, the American Board of Internal Medicine earlier this month told physicians it "is requiring more frequent participation in MOC of all board-certified physicians," the lawsuit noted.
MOC Draws Fire from Docs
Physician concerns about MOC expense and the time-consuming process involved were noted in a .
Robert Baron, MD, medical professor at the University of California, San Francisco, and journalist John Iglehart noted the low number of "grandfathered" specialists -- those certified before 1990 and granted time-unlimited credentials -- as evidence.
Only 1% of nearly 67,000 such physicians holding only time-unlimited certificates from the American Board of Internal Medicine have been re-certified through MOC, they said in the December piece.
MOC fees charged by boards over a 10-year period range from $4,820 from the American Board of Plastic Surgery to $1,250 from the American Board of Surgery, the authors noted.
ABMS said its fees average roughly $300 per year.
The MOC recertification process is complicated, and Baron and Iglehart note that if it went away it could be replaced by a more burdensome system to assure physicians competency.
"If that is indeed the case, the ABMS and its boards must actively (and transparently) respond to the MOC concerns of all physicians, young and old alike, and accelerate its collaborative efforts with external organizations as they strive to navigate a complex system that melds professionalism, government regulation, and market forces," Baron and Iglehart wrote.
This week's action against ABMS isn't the first dramatic step taken by AAPS, which was formed in 1943 to preserve the private practice of medicine, according to its . The organization was one of the first to file a lawsuit against the Affordable Care Act in March 2010, claiming it was unconstitutional, and over her handling of the Clinton administration's health reform task force. It also broke stance with other medical organizations to support the patent protection of isolated genes in recent Supreme Court oral arguments.