How the Medical Boards are Fleecing America’s Doctors with Chuck Kroll

Today's episode strikes right to the heart of the reason I started this podcast - the injustice of maintenance of certification. We've talked about the corruption of the American Board of Internal Medicine, the shakedown by the neurology and psychiatry board, and general state of MOC in America. If you're a doctor, you know all about the unfairness of this system which requires more money, paperwork, money, testing, money, time away from patients and families, and money. It contributes to physician burnout and stress as it is an unwavering pest over our shoulders every day we practice. For patients, it is why your doctor might retire early, look stressed out, or be unavailable when you need him or her most. In this episode, we delve into the details about why the medical boards which oversee maintenance of certification are borderline corrupt.

What is Maintenance of Certification?

Briefly, every physician today goes through residency specialty training. That training is standardized within each specialty by a board (eg, American Board of Pediatrics, American Board of Internal Medicine, etc.). If you pass their requirements for completing a residency and testing you are board certified. Prior to the 1990s, this certification was a lifetime certificate. But beginning in the 90s, the boards began requiring testing in cycles and the certifications were awarded in a time limited fashion (usually 10 years). Over the years, the boards have required more and more components to fulfill your maintenance of certification including increased fees, courses, CMEs, in person sessions, research projects, quality improvement projects, and increased testing.

How are the Specialty Medical Boards Ripping Off Doctors?

Most insurance providers and/or hospitals require physicians to be board certified or be in good standing with their maintenance of certification. This means that the doctors are beholden to the rules, requirements, and fees of their medical boards. There are no recognized alternative boards (the NBPAS is not recognized by most insurers or hospitals) which means it is a monopoly system where doctors have no choice but to comply. Initially, the boards had a fairly loose recertification process just demanding a few thousand dollars every 10 years and simple test to stay certified.

But in mid-2010s many of the specialty boards were becoming financially unviable and were in financial 'death spirals', as my guest today explains. The maintenance of certification fee schedule brought in an infusion of needed cash. So much so that the boards don't appear that they knew what to do with it. They began spending it on real estate, massive compensation for executives, and setting up fully funded retirement accounts and pensions for their employees. They are now so awash in cash that they really don't need any revenue for a few years and could significantly cut fees or suspend fees if they wanted.

Who is Watching the Boards?

My guests today, Charles Kroll and Elizabeth Tremblay, are following the money for these boards. They are investigating all of the corrupt transactions, off shore accounts, and exorbitant executive fees. Their research is helping other physicians challenge the legitimacy of the boards and their financial grip on doctors and their ability to practice medicine.