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    In defense of Sen. Rand Paul

     

    The subject of Sen. Rand Paul (R-KY) among my colleagues is probably tempered by the same force, which has produced the above oddities. Ophthalmologists, in my personal experiences, don’t approve of him mostly because of his rough history with the American Board of Ophthalmology (ABO), the only certification organization for ophthalmologists in the United States. 

    In short, Sen. Paul disagreed with the ABO’s 1992 decision to exempt pre-1992 certificate holders from the need to re-certify every 10 years. He felt it was an “injustice” and that “the establishment” needed to hear a “clear message” that they would lose members, and their dues, if they did not treat all of their members equally.

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    Sen. Paul established the National Board of Ophthalmology (NBO) as an alternative to allow agreeing ophthalmologists to send this “clear message” and to make what he felt is a more rational process for attestation.2

    This is not the first time a national, certifying organization has been confronted with organized opposition.

    As recently as this year, the American Board of Internal Medicine (ABIM)—an organization that continues to certify about 200,000 physicians4—has received a great deal of push back from San Diego cardiologist, Paul Teirstein, MD. Met with the demands and inconsistencies of Maintenance of Certification (MOC), Dr. Teirstein contacted his group of interconnected cardiologists and asked his interventional cardiology fellows to organize a petition to change the way the certification process is mediated.

    Among Dr. Teirstein’s complaints are the price of MOC, its clinical relevance, and the general manner in which the ABIM could not mount a sufficient response to what he saw as an obvious issue. In other forums, he points out the dearth of evidence supporting the measures in place to certify physicians and notes that there is a significant financial conflict of interest in maintaining the offices of certifying organizations.5

    Dr. Teirstein raised significant support, garnering more than 10,000 signatures within a short period and has started a conversation loud enough that the ABIM has responded.

    Less than a month ago Richard Baron, MD, president of ABIM, contacted his diplomats to inform them they would make some changes to MOC and planned other unspecified changes. This was not satisfactory to Dr. Teirstein, who had already established and named himself president of the National Board of Physicians and Surgeons (NBPS). He has already implemented policies with NBPS and described in popular print the “Paulian” ethos of monopoly, freedom, etc.

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    Zack Oakey, MD
    Zack Oakey, MD, is an ophthalmology resident at the University of California, Irvine.

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    • Anonymous
      This makes total sense. The ABO has had this policy in place now for 23 years and those older ophthalmologists who were part of the old guard are now retired or dead. This leaves the rest of us with a two tiered system. It is high time that ALL diplomates receive the SAME treatment and also that the "MOC" be more reasonable to those of us in mid life with busy personal and professional lives. The ABO is simply an organization of our own colleagues adding to the administrative burden of all practicing ophthalmologists and they can demonstrate NO meaningful benefit to their recent changes to MOC to merit the current system. I have finished 3 cycles of recertification (being in the first year of the non-permanent lifetime certificants) and they can go to hell if they think I'll do it again. All the members of the ABO board should hear from its members and be more accountable for caring on this charade...and that's all it is
    • Anonymous
      This makes total sense. The ABO has had this policy in place now for 23 years and those older ophthalmologists who were part of the old guard are now retired or dead. This leaves the rest of us with a two tiered system. It is high time that ALL diplomates receive the SAME treatment and also that the "MOC" be more reasonable to those of us in mid life with busy personal and professional lives. The ABO is simply an organization of our own colleagues adding to the administrative burden of all practicing ophthalmologists and they can demonstrate NO meaningful benefit to their recent changes to MOC to merit the current system. I have finished 3 cycles of recertification (being in the first year of the non-permanent lifetime certificants) and they can go to hell if they think I'll do it again. All the members of the ABO board should hear from its members and be more accountable for caring on this charade...and that's all it is
    • Anonymous
      This makes total sense. The ABO has had this policy in place now for 23 years and those older ophthalmologists who were part of the old guard are now retired or dead. This leaves the rest of us with a two tiered system. It is high time that ALL diplomates receive the SAME treatment and also that the "MOC" be more reasonable to those of us in mid life with busy personal and professional lives. The ABO is simply an organization of our own colleagues adding to the administrative burden of all practicing ophthalmologists and they can demonstrate NO meaningful benefit to their recent changes to MOC to merit the current system. I have finished 3 cycles of recertification (being in the first year of the non-permanent lifetime certificants) and they can go to hell if they think I'll do it again. All the members of the ABO board should hear from its members and be more accountable for caring on this charade...and that's all it is
    • Anonymous
      Did you ever meet Rand Paul ? his history of unpleasant run ins have been well know through out his career . I think that he is self centered to the point of being unreasonable . His NBO was a failure because of not only the way he went about,but it has always been his way or the highway > i suggest you personally meet up with some people who did work with him including his fellow residents at Duke . > i think your tone might be different > He is very smart but that does not make him a great person and I would predict a very poor and unpredictable president . I think his past will haunt him if he gets into the nomination . Time will tell , but I am certainly one of those old farts that have not retired and am still practicing actively at the age of 65. Somewhere seniority does count and sometimes you can draw the line of when things become a classic and or need new tires-but not always is it right or easy !. I am glad i did not have to recertify but that is for another day !!. IF THIS COUNTRY FINDS RAND PAUL AS PRESIDENT IT WILL BE IN BIG TROUBLE !

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