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  • #16




    Who cares if they want to retire? Let them go. Being a doctor is lifetime learning, you don’t get to just shut it off because you’re old. If you want to do that, then retire.
    Click to expand...


    Lifetime learning and MOC have nothing to do with one another.  And if half of my department quit, you can bet my hospital would care!  They'd be really scrambling to replace that many people in short order.

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    • #17







      so now having been in practice for a long time and have had a chance to see how decisions get made in 3 reasonably sized organizations.   i can’t tell you how many times a new policy or rule is developed and someone asks well what about dr. x who has been doing this for 30 years.  so a grandfather clause is made with the expectation that time will solve the problem and avoid prematurely ending someone’s career or practice pattern or whatever.

      question for discussion is- how do we feel about grandfathering?  is it something with nuance or just plain wrong and policies should be developed with blind eye toward how it affects specific individuals.  for the sake of our discussion, which hopefully will remain civil, let’s just talk about medical policies, rather government or other stuff.  eventually, if lucky, we will all be on the other side of the slope, and no longer specifically trained in procedure x or surgery y.   is everything going to be like ACLS?  take some computer class to authenticate your diabetes management?

      thanks for any thoughtful comments.
      Click to expand…


      COUNTERPOINT: a new grad has 30-40 future yrs to give to the practice and specialty, so they should have more voting power on policies than a grandfathered doc with one foot out the exit.  Yes there is a nuanced discussion to be had about the out of date physician, but we should not be handing out golden parachutes.  I also reject the argument that too many docs would retire without grandfathering leading to a shortage, those in academia know we have a surplus of med school grads now and the bottleneck is that we do not have enough residencies/fellowships.

      MOC in theory for continuing education is perfectly reasonable, but the price gouging and the time suck is outrageous.  Adding on new rules for incoming diplomates was easy as they had no say and no clue what was happening, but they couldn’t do that to all the established diplomates for fear of restriction of trade lawsuits.  However, they ingeniously split the potential lawsuit pool by more than half by letting one group out of MOC and won by complacency.  Can’t help but notice the grandfathered group was also the wealthiest group as they had minimal school debt and have been in practice the longest while accruing some of the highest income to cost of living ratios for physicians ever recorded.

      /end rant
      Click to expand...


      thanks for your thoughts.  over the years, i have seen younger and younger physicians added to the committees, but obviously still more represented by senior physicians.  i would submit that the end result is the same.  in other words, when faced with the rationale for proceeding with exceptions, grandfathering of some form remains the default solution.  it may not be age related specifically, but some combination of wanting to permit a practitioners some independence and either conflict avoidance, unwillingness to go back a level to change some hospital bylaw, or legal issues etc, the outcome remains the same in my observations.

       

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      • #18
        I mean I'm not a fan of MOC either and agree it doesn't mean the same thing as wanting to keep learning but if the dinosaurs don't want to play the game, then either get rid of the game or retire. Not sure why they should get prefential treatment when if anyone is dangerous it's probably them.

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        • #19




          thanks for your thoughts.  over the years, i have seen younger and younger physicians added to the committees, but obviously still more represented by senior physicians.  i would submit that the end result is the same.  in other words, when faced with the rationale for proceeding with exceptions, grandfathering of some form remains the default solution.  it may not be age related specifically, but some combination of wanting to permit a practitioners some independence and either conflict avoidance, unwillingness to go back a level to change some hospital bylaw, or legal issues etc, the outcome remains the same in my observations.

          Click to expand...


          what's your quality assurance process once you've given a grandfatheree* (*not a real word) an exemption?  what's your liability?
          It's psychosomatic. You need a lobotomy, I'll get a saw.

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          • #20




            I mean I’m not a fan of MOC either and agree it doesn’t mean the same thing as wanting to keep learning but if the dinosaurs don’t want to play the game, then either get rid of the game or retire. Not sure why they should get prefential treatment when if anyone is dangerous it’s probably them.
            Click to expand...


            agreed

            what other professional societies do this?  would you fly on a plane piloted by someone who's been grandfathered in?
            It's psychosomatic. You need a lobotomy, I'll get a saw.

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            • #21
              I think the older I get the less mature I become. Fart jokes just get funnier and funnier.

              I think grandfathering is generally BS (if the wisdom of older/experienced doctors trumps the need to pay for and pass a test, sure, but that should apply to all older/experienced doctors moving forward, not just the ones who got board certified prior to whatever year) but I also recognize that my thoughts on the matter aren't going to change anything and I'll gray/wrinkle more slowly if I don't get aggravated about it. If and when I can't keep up with the mandates/changes/etc at least I should be financially prepared to pull the eject cord.

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              • #22
                As an old fart retired from practice for 2 yrs I was permanently certified for 2 of my boards but had to recertify (successfully) for the 3rd. Theoretically the 3rd runs until 2022. I agree with the "whippersnappers" that permanent certification isn't appropriate for medicine. There is just too much to keep track of if one doesn't keep reading. I once heard a Dr describe an older GP (that old) as a Dr who worked for 40 yrs. "Practiced for 1 and repeated it 39 times. " Ouch, may none of be so described.

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                • #23




                  what you think you look like

                  (borrowed from biography.com)

                  Image result for chris hemsworth

                   

                  what the freshly graduated doctor you hired thinks you look like

                  (from aarp)

                  Related image

                   

                  roughly when does this happen?  after fifteen years of clinical experience? twenty? more?

                  literally no one will call you by your first name?

                   

                  actually i do have a question for the board.

                  i think most young physicians are outraged when they first learn that there is something called grandfathering with respect to board certification.  that if you happen to be above a certain age, that your certificate is unlimited and you don’t have to retest periodically.  they bemoan the fact that the older generation sold them out.  i certainly felt that way many moons ago.

                  so now having been in practice for a long time and have had a chance to see how decisions get made in 3 reasonably sized organizations.   i can’t tell you how many times a new policy or rule is developed and someone asks well what about dr. x who has been doing this for 30 years.  so a grandfather clause is made with the expectation that time will solve the problem and avoid prematurely ending someone’s career or practice pattern or whatever.

                  question for discussion is- how do we feel about grandfathering?  is it something with nuance or just plain wrong and policies should be developed with blind eye toward how it affects specific individuals.  for the sake of our discussion, which hopefully will remain civil, let’s just talk about medical policies, rather government or other stuff.  eventually, if lucky, we will all be on the other side of the slope, and no longer specifically trained in procedure x or surgery y.   is everything going to be like ACLS?  take some computer class to authenticate your diabetes management?

                  thanks for any thoughtful comments.

                   

                   
                  Click to expand...


                  Doesnt matter. If dr x does y procedure is fine and proficient, etc...and no one wants to disrupt him as it makes no sense, than your policy makes no sense in the first place. This is usually true as a general rule for such policies. Otoh, if it turns out they feel justified in their reasoning, they should just bring down the guillotine. Nothing else makes logical sense. Grandfathering is still just a political tool and thats all it can ever be, it just it.

                  I've made my feelings known about MOC and frankly board certification (if everyone passes and its required of all, then come on, its dumb and a tax), its bs and a money grab only, in the guise of ideas and words that make the doctor believe its in good faith and necessary.

                  We had a similar issue at my new hospital, privileges starting becoming segmented with standard and "special" which included a bunch of normal stuff and random stuff, liposuction, endoscopic carpal tunnels, microsurgery where they wanted x/cases in last year or documentation etc.....which as a slippery slope doesnt make any sense. Are you going to single out a bunch of procedures and cut off a segment of practice each year and have it vary? Likely they are trying to limit people not trained in said areas, but it kind of defeats the purpose if you have been.

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                  • #24
                    I was grandfathered in for my primary certificate (Diagnostic Radiology) but play MOC on a voluntary basis. I am afraid that @panscan is going to take over my group and kick me out if I don’t! ?

                    Comment


                    • #25
                      First, q-school vanished around the time of the Forum software change. Miss some of sharing of wisdom he did.
                      No opinion on MOC and grandfathering the oldies. It is a long journey from MCATs to Board Certification. For sure, the process was changed by Covid. ABOS sent out pass notifications today. That little note on one’s CV is valuable.
                      Congrats to all of you for getting a pass, this time or in the past. Ten years or not, makes a Dad proud. I doubt recertification will have near the impact.
                      Done.

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