NGO Pushes for Centralized Power, Control Over Physician LicensureJames Holbrooks The letter was in response to the FSMBs continuing efforts to overcome issues facing the concept of telemedicine. As the name implies, telemedicine is the practice of providing medical care at a distance. This encompasses everything from a simple phone consultation to something as complex as remote surgery via robotics, often referred to as telesurgery. Specifically, the senators were addressing a piece of model legislation being drafted by the FSMB that would come to be known as the Interstate Medical Licensure Compact. Purportedly, the compact is designed to streamline the process of licensing physicians who seek to practice in multiple states. As it stands, this can be tricky. Each state has its own certifications a physician must hold to be legally allowed to practice there. So in theory, a doctor providing telemedical care across state linessay, a routine checkup via Skypecould potentially be violating state law if the requisite licenses werent in order. So far so good, yeah? Here we have a problem, specific to our modern age, being taken on through a concerted, common sense measure. I mean, youd have to be nuts to see the compact as anything other than the honest attempt at facilitation is so clearly is, right? Well, as it happens, there are still a few nuts out there. ULTERIOR MOTIVES On January 26 of this year the Association of American Physicians and Surgeons sent a letter to the United States Senate in direct response to the one sent by senators to the Federation of State Medical Boards a year earlier. By this time, the final draft of the FSMBs Interstate Medical Licensure Compact had been published and publicly endorsed by the American Medical Association. The AAPSs letter asserts that, far from being a tool through which doctors can more effectively serve their patients, the FSMBs licensing compact is in fact little more than a pretext for transferring state sovereignty to out-of-state private, wealthy organizations that are neither transparent nor accountable to the voters. In short, its a power grab. At this point you may be asking yourself a basic question: What the hell is the Federation of State Medical Boards? The answer is more interesting than you might think. The FSMB is a private, non-profit organization representing each of the fifty states medical boards, as well as those of the American territories. As stated on the groups own website, the FSMB is an innovative catalyst for effective policy and standards and strives toward promoting excellence in medical practice, licensure, and regulation as the national resource and voice on behalf of state medical boards in their protection of the public. So yeah, I find it highly interesting that medical policy for the individual states is influenced by a private organization that, as the folks at the AAPS claim, is neither transparent nor accountable to the public. Thats eyebrow-raising stuff. But as interesting as the what of the FSMB is, its nowhere near as interesting as the who. And the who is doctors, of course. Doctors of all stripes. Lawyers, too, but that goes without saying. In fact, the FSMB leadership roster is uncannily similar to that which youd find at just about any other of the innumerable healthcare non-profits scattered throughout the country. And this, according to the Association of American Physicians and Surgeons, is a significant part of the problem. In their letter to the Senate, they point to the incestuous relationship the FSMB has with the self-credentialed patient safety or medical quality industry. What the AAPS is getting at may be best understood via the ordeal involving CareFusion. A FAMILY AFFAIR On January 9, 2014yeah, the same day the senators sent that glowing letter to the FSMBthe Department of Justice announced that CareFusion Corporation had agreed to shell out $40 million to the United States government. The payment was in response to allegations that the company had bribed, to the tune of $11.6 million, an influential member of the National Quality Forum into promoting a CareFusion product to health care providers. The NQF is another one of these non-profit, non-governmental organizations. That groups current CEO, Dr. Christine Casselwho, as it happens, is the former head of the American Board of Internal Medicine and sits on the Presidents Council of Advisors on Science and Technologycame under scrutiny herself last year when it was revealed that shed been paid hundreds of thousands of dollars by two medical companies that had a stake in National Quality Forum policy. Naturally, Cassel swore up and down that no conflict of interest existed at the NQF. This was backed up by Brent James, MD, former member of NQFs Strategic Framework Board. Dr. James asserted that there were never any allegations of inappropriate financial inducement regarding which quality measures were actually endorsed by the organization. James, by the way, in addition to serving as Chief Quality Officer for Intermountain Healthcare (an NGO), is also a member of the Institute of Medicine (an NGO). It isnt difficult to see the kind of incestuous relationship the AAPS is talking about. These various private organizations, influencing policies and practices in the various medical fields while maintaining deep connections to healthcare companies, seem to be headed by a shared network of industry bigwigs. As Dr. Michael Katz of Strong Memorial Hospital in New York put it on his personal blog: Which brings us back to the Interstate Medical Licensure Compact. Because if the AAPS is right and the compact is indeed an attempt to override state sovereignty and centralize power within a single, private, non-governmental organization, then how exactly would it work? In this instance, the control mechanism of choice would be the Maintenance of Certification program. THE WAY IN MOC is the process by which physicians stay up-to-date on their certification requirements. These requirements are set by specialty boards, each approved of by the American Board of Medical Specialtiesan NGO, in case you were wonderingand professed to increase a physicians knowledge of a particular field. The people of the AAPS, however, fundamentally disagree with this assertion. While irrelevant to good patient care, states the AAPS in their letter, Maintenance of Certification (MOC) activities promoted by ABMS and its member boardsare extremely lucrative to the executives who administer them. Practicing physicians uniformly find MOC to be of minimal or no value. There is near unanimity that MOCs only effect is to drain physicians time and money. And the AAPS isnt alone in this opinion. In the fall of 2013 the Journal of American Physicians and Surgeons published an article titled Maintenance of Certification (MOC): the Elites Agenda for Medicine. The author, Dr. Kenneth Christman, used public sources to examine the practice of MOC as conducted by the specialty boards of the ABMS. Apart from identifying multilayered connections between MOC policy and organizations such as FSMB and NQF, Christman discovered that in 2011 alone ABMS boards took in $320 million in certification-attributed revenue. The elite medical establishment correctly foresaw, writes Christman, that there was a huge treasure in the medical certification business. And while the MOC program is technically voluntary, things such as insurance policies and hospital privileges often require doctors to participate in order to gain employment. You dont pay, you dont play, as it were. But the truth is, the FSMB isnt breaking any new ground with their power grab. One has only to take a casual look around to see the pattern. Look at Common Core, and how the federal government is trying to control education through uniform testing standards. Look at Net Neutrality, and how the FCC is trying to open the door to federal regulation of the Internet. Its hardly surprising. The trend for government is always toward greater hegemony. So far the Interstate Medical Licensure Compact has been introduced in twelve state legislatures, but as the FSMB declares on its website: Support is growing among legislators and health policymakers The organization cites the letter from the bipartisan group of senators as evidence of the strengthening endorsement, and unfortunately for those of us who find labyrinthine bureaucracy and centralized power to be a detriment to society, its hard to argue that logic. James Holbrooks is a professional writer and editor. You can find his work at HolbrooksWordsmithing.com where this article first appeared. Follow James on Twitter. 