Achieving a Broadened View of Professionalism

By: Lois Margaret Nora, MD, JD, MBA, President and Chief Executive Officer, American Board of Medical Specialties

As members of the medical profession, physicians are called upon to use our special knowledge and skills for the good of others. In the May issue of Academic Medicine, Wynia and colleagues encourage us to supplement the predominant professionalism focus on principles, traits, and behaviors with a more transcendent view of professionalism as a belief system. In this system, individual physicians and our professional organizations jointly declare a shared resolve to professional standards that incorporate commitment to scientific knowledge, high levels of competence in the activities of our medical work, and a humanistic approach to the patients, families, and communities we serve.

This overarching view of professionalism has been inherent in the history and conduct of American Board of Medical Specialties (ABMS) Board Certification. Protecting the public through establishing and assessing professional standards that include knowledge and clinical activities was fundamental beginning almost a century ago when the first board, the American Board of Ophthalmology, was founded in 1917. This view of professionalism was fundamental to the movement from single point in time certification to periodic certification to the current ABMS Maintenance of Certification® (MOC) program.

Dr. Fred Hafferty is a co-author of this paper. Whenever I see Fred’s name, I am reminded of one of his most important contributions to medical education: the naming of the hidden curriculum and the role it plays in setting and actually achieving (or not) the professionalism we seek. Context and environment are important. The article reminds us that the overarching professionalism sought by the authors needs the commitment and engagement of three groups: individual physicians (where our focus on traits, virtues, and behaviors has rested), professional organizations (professional societies, ABMS Member Boards) and places of practice (hospitals, health systems, and accountable care organizations, etc.).

The Standards for the ABMS MOC Programs that will take effect in January 2015 recognize the role of ABMS and our Member Boards in achieving a broad view of professionalism. In addition to outlining a program that incorporates high standards for physician and clinician-scientist diplomates, the standards call upon ABMS and the Member Boards to meet our primary obligation to the public with assessment systems that contribute to ongoing learning and are relevant and meaningful to our diplomates; regular organizational review that incorporates input from our diplomates and the public we serve; and continuous quality improvement.

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5 Comments

  1. David Musick, PhD
    April 23, 2014 at 8:02 PM

    Well stated, Dr. Nora! Thank you for the conviction of your words, and for the commitment of the ABMS to assessment of the quality of the health care system through the MOC program.

    • Marc S. Frager
      January 14, 2016 at 7:29 AM

      Actions speak louder than words, Dr. Musick. The actions coming from the ABMS are mostly to impose MOC on unwilling diplomates and to increase their cash flow by selling data about their diplomates. ABMS is very concerned about maintaining their monopoly status and quashing any dissent about their MOC program, which has little, if any, proven efficacy. The concept of “voluntary in name only” MOC is highly insulting to diplomates and incredibly cynical on the part of ABMS. We know that previously, when MOC was truly voluntary without inappropriate linkages to licensure/insurance credentials, that <5% of physicians participated. Maybe the MOC program is not good enough to stand on its own, so that it must be forced on unwilling diplomates. THAT is not professional, Dr. Musick!

  2. Larry A. Green, MD
    May 25, 2014 at 4:22 PM

    If professionalism is a belief system about the best way to organize health care, what are the alternative ways to organize health care? Is professionalism the way the US has organized health care or are we following an alternative way? One alternative to professionalism as the best way to organize health care is commercialization with market forces deciding what care is rendered to whom in what manner. If professionalism is a group affair that requires discussion, debate, discernment and declaration within the profession, might there be an immediate opportunity of medicine’s national organizations to galvanize a robust re-consideration of “the best way to organize medicine?” Such an effort would require all the medical specialties to participate together listening to the needs of others. Perhaps such an effort could commence by discerning if medicine in the US now remains and behaves as a profession and if so what it believes is the best way to take care of all our people?

    • Marc S. Frager
      January 14, 2016 at 7:34 AM

      Dr. Green, what if professionalism were really about practicing at the highest level and had nothing to do with health care organization? What if the ABMS acted professionally and did what was in the best interest of its diplomates rather than forcing participation in an unwanted, costly, unwieldy MOC program? What if ABMS bureaucrats didn’t try to overreach their limited abilities, didn’t try to force their concept of testing assessment on others, didn’t try to tell diplomates that only ABMS knew what they needed to know/study? What if board and board chairpersons went back to the original board concepts of frugality and helpfulness? What if board chairpersons were paid the median salary of the physicians they were testing/assessing? What if MOC were truly voluntary? What if ABMS didn’t try to quash expressions of differences about MOC? Try freedom sometime, Dr. Green. You may find it highly enlightening

  3. Paul Kempen
    January 19, 2016 at 3:36 PM

    Dr Nora “talks” about professionalism and yet bypasses or perhaps has NEVER known the essential component of physician professionalism: Ethical responsibilities! Dr Nora and the ABMS boards continue to fail to recognize their “brand” of professionalism is the same as Dr Fata, who was a board certified oncologist and used his position of power to use his patients for fodder to fill his pocketbook (http://www.allgov.com/news/controversies/nations-worst-cancer-doctor-pleads-guilty-to-medicare-fraud-140919?news=854299).
    Dr Nora and the ABMS use their fallacious programs to extort money from all physicians to fill their pockets and maintain their standing. (www.jpands.org/vol19no3/kempen.pdf)
    Both have failed completely in maintaining ethical standards to “do no harm”. The ABMS forces their testing on every physician without ANY outcome based proof that board certification matters, yet alone the newest product MOC, which even the ABIM has admitted they “got it wrong”. It is finally time for all physicians, hospitals, insurance carriers and frankly, any person with above disabled intelligence to recognize, the ABMS executives belong with Dr Fata among the “worst physicians of 2016”! But then, these ABMS executives are not physicians-they are executives like those at ENRON-out to make that “fast buck” and cash in using the American public!
    It is finally time to let the WHOLE certification industry go the way of the DODO! We are letting non-physicians with limited education practice medicine, while forcing REAL physicians out of practice, because it has become to expensive and time consuming to remain!