In regards to the court’s ruling on 6/24/2022, re: overturning Roe vs Wade, I dissent.
ALL MEDICAL DECISIONS are personal & private & no one outside of the direct patient:physician relationship should have any say on ANY MEDICAL DECISIONS.
Attempting to insert one’s personal views, beliefs, politics, religions, thoughts, conclusions is unethical, harmful, & will result in increased mortality & morbidity.
The public (& the government) have no business telling a woman/man/other what to do with their own personal reproductive parts.
The patient:physician relationship is sacred, honored, trusted, and private.
I find it unethical and egregious that outside non-physician parties want to interfere, intrude, dictate and attempt to control and/or play a role in PERSONAL & PRIVATE decisions between PATIENT & PHYSICIAN.
There is absolutely no role, nor place, for any other parties’ personal judgements, views, thoughts, opinions, rules, policies, religions, political preferences, or other, in our exam rooms.
Our patient’s views, choices, wants, desires, are to be honored & respected, not forced upon by any outside party.
In fact, as physicians, it is our professional duty to keep our own personal, political, religious, or any other beliefs, out of the exam room. Our purpose is to guide, counsel, provide information, help, protect, and support our patients to the best of our abilities.
As physicians we took an oath to first do no harm, and in upholding our oath, our loyalty lies with our patients first, foremost, & always.
And: WE ARE ALL PATIENTS.
Every daughter, sister, granddaughter, mother, grandmother, aunt, friend, cousin, colleague – every citizen – both women & men (fathers, grandfathers, brothers, uncles, sons) are affected by this Supreme Court’s ruling.
Medical decisions are based on science, evidence, risks, benefits, and are specific to each and every individual patient.
No one size fits all.
No black, nor white exists.
Multiple shades, layers, varied blurs and shadows of endless gray.
Each and every single one of us is a patient – an individual with different needs, thoughts, desires, beliefs.
Competent medical decision making requires YEARS of in depth study and training, and should be made between patient and physician only.
There is no place for debate, denial, or forcing of one’s political, personal, religious, opinion, or views in our exam room.
I recently responded to a post in a group re: how pediatricians are “undervalued/underpaid”. The thing is, it’s not just pediatricians, or primary care – but ALL PHYSICIANS.
The rise of corporatized for profit “healthcare” has affected all specialties – especially primary care and pediatrics. The way “reimbursement” works with insurance-based fee for service/RVUs even with the “time based” CPT coding change – our time – including the time we spend with patients developing trusted relationships – is perceived as “less valuable”.
As pediatricians we care for our most valuable assets – our children. One would think our children would be hailed by society as our world’s most important and valued resource – yet as pointed out by many – society at large has proven otherwise. (Gun control/violence, Education, Masking ending prior to children becoming COVID19 vaccine eligible, Anti-LGBTQQIP2SAA legislation, soaring drug prices, lack of paid parental leave, food insecurity, rising cases of mental health issues in younger and younger patients, the list goes on and on and on.)
At this point we need EVERY SINGLE PHYSICIAN in ALL SPECIALTIES to align & support each other.
We are ALL PHYSICIANS.
Our once learned profession of Medicine has been usurped by middlemen profiteers and turned into the business of healthcare. Medicine as we once envisioned and (for those older and practicing pre-EHR and pre-MOC) once practiced is gone. It’s been obliterated.
What we ALL need to do is BUILD ANEW.
There are physicians taking back our once honored learned profession & practicing as they were trained – for patients. Healing, helping, and honoring our sacred oath to first do no harm.
Where morbidity and mortality data count more than “community measures, MIPS & MACRA”.
Physicians ARE standing up to the current “status quo” of indentured servitude & are speaking up to create change.
Dr. McKnight spot on highlights all that has destroyed medicine and how to change it – by becoming activated physicians and using our voice to create change.
By believing in ourselves as PHYSICIANS and refusing to be the workhorses off of which non-physicians profit.
By taking a stand.
By using our collective voice.
By learning to SERVE AND EARN.
By setting boundaries.
By becoming the CEOs of OUR OWN LIVES.
By realizing that “No.” is a complete sentence and each and every one of us have a choice as to what we will or will not do each and every day.
We CAN rebuild and take back our profession by believing in ourselves – by shifting our mindset from indentured servitude to physician entrepreneurs. For without US there is no medicine!
Current non-physician extraneous middlemen are profiting off of OUR expertise, knowledge, skills, work & OUR DATA – so let’s stop giving it to them.
For those of you tired of the broken system called healthcare – there is a better way. We just have to BELIEVE IN OURSELVES & TAKE ACTION.
I highly recommend those interested in taking back their profession and their lives consider attending Dr. Nneka Chineme Unachukwu’s (aka Dr. Una) EntreMDLive2022 FREE virtual conference this Saturday 6/11/22 and earn 6 CME credits too‼️ www.EntreMD.com/live.
Dr. Una is a powerhouse serial entrepreneur with the goal of helping 100,000 physicians build 6 & 7 figure businesses. Learn more by joining in this weekend, listening to her free podcast The EntreMD Podcast , and buying what she refers to as a $16 MBA The EntreMD Method . Dr. Una’s goal is to make 2025 the Year of the Physician – and I truly believe we can achieve this goal – together!
Additionally, connect with other like minded activated physicians with the #DoctorsDAO aka HPEC – the first of its kind technology owned & designed by physicians for the purpose of serving physicians so that we can better care for our patients. HPEC, using secure blockchain technology, allows physicians to create their own SSI (self sovereign identity) digital wallet to own and control their credentials and data. HPEC also allows onboarded physicians to communicate directly with other physicians – free of censorship/oversight. Check out HPEC’s explainer video here: https://youtu.be/Wjz-sT5_6VE
HPEC allows physicians a secure private way to easily connect & organize!
These are just a few words I’d use to describe my younger sister, Cat King, 47y/o married, mom of 3, artist, incredible loving giving amazing friend, with a heart overflowing with kindness and love.
Cat is currently battling stage 3 pancreatic cancer. She underwent robotic Whipple surgery on 1/6/22, and started aggressive chemotherapy 6 weeks later. She’s completed 5/12 treatment sessions, and pushes onward, dealing with side effects, and matter of factly stating, “It is what it is” while continuing on with her day, caring for her family.
My brother in law jokingly compares her to Wolverine – the badass MARVEL character that heals himself – and he’s totally spot on! Cat is in a league of her own when it comes to fighting this awful disease, and she’s determined to rid her body of every last inkling of cancer.
We formed our team, Cat King Crusaders, to help raise funds to support patients and families affected by pancreatic cancer, and provide means for further research and treatment development.
From the PanCAN PurpleStride USA 2022 website/info page:
We’re going to help make progress, with your support.
Our team is participating in PanCAN’s PurpleStride, a year-round national movement that funds lifechanging programs and services for pancreatic cancer patients and their families.
Every dollar you give means more patients can benefit from PanCAN’s free, one-on-one support, personalized information, service and resources that can make a real difference in their lives.
Please join our team as a participant, or make a gift of any size to get us one step closer to our fundraising goal and improving more patients’ lives. You can donate to a team member or make a general donation to the team.
The past two years have been incredibly challenging. I am extremely thankful and grateful for my colleagues, peers, friends, my own personal physicians, and those physicians currently caring for and helping my sister battle pancreatic cancer. Thank you for everything. This blog post is for you.
To ALL Physicians everywhere, THANK YOU for being YOU.
Thank YOU for: Choosing medicine. Working hard Succeeding Sacrificing Your hours of study Your skills Sleepless nights Missed family events Your compassion Your resiliency For showing up, day after day & night after night, despite the unknown unseen virus that’s wreaked havoc on all our lives.
Thank YOU for Helping Healing Caring Holding a hand Shedding a tear Returning our calls, texts Reaching out, following up, & making sure we’re ok.
Thank YOU for Your passion Your strength Your creativity Your problem solving Your innovation Your belief in helping, healing, & to first do no harm. Honoring life Holding our hands & being there in death.
Thank YOU for Listening Hearing, understanding, & your ability to diagnose, differentiate, & instantly formulate plans of action. Waking up, showing up, jumping in, & Leading each & every single day. At work, at home, at the hospital, the park, the concert, the airplane, the restaurant, the school, during the week, the weekend, on vacation, day or night, you answer the call.
Thank YOU for Your advocacy Speaking up Recognizing & calling out when unjust, wrong, unfair, causing harm.
Thank YOU for Sharing Writing Speaking Lifting Leading Teaching Being an example of what’s possible.
Thank YOU for your dedication.
Thank YOU for being a human with a special skill set & for choosing to practice the science and art of medicine.
Thank you for being a Physician.
This National Physicians Week is for YOU, to honor, thank, recognize, & celebrate all that you are, all that you’ve done, and all that you will do.
I’m a pediatrician that started practicing BEFORE MOC existed, when being board certified actually meant something.
Being a “board certified physician” meant you had passed the equivalent to a PhD thesis: you had finally reached a pinnacle in your medical career. After a minimum of 11 YEARS of higher education, graduating medical school and completing years of additional supervised training called residency – you earned the privilege of sitting for your specialty exams/certification – and you passed.
Passing boards meant you were now considered an EXPERT in your chosen field of medicine.
Passing boards meant you were worthy, trained, and trusted to independently care for patients.
Passing boards meant you were now an official attending physician.
At the top.
Once a trainee, now a master.
Being “board certified” used to mean something special.
MOC was initially introduced as voluntary. Billed and promoted as a way to show everyone you were still at the top of your game. Participating meant you were a team player, and everyone – even those physicians “grandfathered in” – aka exempt from MOC – we’re encouraged to play.
If you chose not to participate – no harm, no foul.
Until the boards realized not enough physicians were willing to sign up and pay to play. All of sudden, the board members unilaterally decided MOC was no longer optional, and in 2003 pediatricians not grandfathered in, were required to participate in MOC.
“In 2000, the American Board of Medical Specialties (ABMS) partnered with the Accreditation Council for Graduate Medical Education (ACGME) to adopt six core competencies for physicians. These competencies became the foundation of improvements in initial certification and in MOC, which emerged in 2003.” This description is from ABP’s website.
On the surface, this process appears to be in place to make sure physicians are keeping up to date with the latest medical advances, developments, and standards of practice. What the ABMS fails to recognize and mention is that in order to remain licensed to practice medicine, physicians are already required by their state medical boards to complete continuing medical education (CME). Minnesota’s medical licensing board requires 75 hours of CME every 3 years. Participation in MOC fulfills this requirement, but so does completing alternate physician chosen CME.
Again, this MOC requirement appears to be in place to protect patients and to make sure physicians are keeping up to date with the latest and greatest medical developments. Physicians, by nature, are driven, resilient, overachievers. We strive to do best for our patients. By default, we are engaged, continuous learners and seekers of knowledge. We are strong willed, independent, fierce leaders. We had to be in order to be accepted into and make it through our vigorous medical training. We physicians are accomplished learners and do not need micromanaged suggestions in order to stay up to date and current in our specialty.
So physicians have a choice, right? Participate in MOC or choose your own CME?
Unfortunately, for most, the answer is No.
Since it’s introduction, MOC has morphed into being required and tied to hospital & insurance credentialing.
FAIL to PAY the ABP, and you are no longer “in good standing” and will be unable to continue caring for your hospitalized patients because you are now no longer “certified”. One day you’re rounding in the hospital, and the next you are unqualified? Did our years of education, training, and experience suddenly disappear because we refused to pay to play?
To date, published studies have found no association between MOC/OCC and improved patient outcomes from participation in MOC. There are, however, thousands of physicians dissatisfied with the patriarchal monopoly, as proven by this recently circulated petition. Additionally, over $411,000 has been raised via a GoFundMe campaign in order to help with legal efforts to end MOC nationwide. Interested in learning more about the history/corrupt for profit driven practices of the ABMS? Visit Dr. Wes Fisher’s blog.
While MOC is expensive, burdensome, & unnecessary, what I find absolutely egregious is that the ABMS has done nothing to protect patients from non-physicians legislating their way into increasing their “scope of practice”; essentially akin to practicing “medicine” without any of the required medical education, training, or a medical license! Due to these lobbying efforts, 29 states now allow nurse practitioners “full practice authority” to “practice at the top of their license”.
Is this not an exact situation the boards were initially formed to prevent?!?
89 years later – almost a century after initial formation – isn’t it ironic the ABP is failing to act on the very premise for which it was founded?
The lack of action on the part of the ABMS in all specialties is likewise reprehensible. While our medical boards continue to extort us, they are colossally failing at protecting our patients, and continue to disrupt needed patient care. If curious as to how patients are being harmed, please read “Patients At Risk” by Drs. Niran Al-Algba and Rebekah Bernard. As a patient, please remember It’s Ok to Ask for the credentials of whoever’s wearing that white coat.
Frustrated with the mandated MOC programs, in 2014, over 20,000 physicians signed a petition to provide an alternative pathway, and NBPAS was formed.
On November 2, 2021, it was announced that NBPAS meets all national accreditation standards for health plans. This update clarified to all health insurers that NBPAS performs Primary Source Verification and therefore meets the NCQA and URAC requirements for health plans – meaning NBPAS is an accepted alternative to MOC – so MOC is no longer needed to receive health plan payment reimbursements!
In December 2021, I applied, met all standardized requirements, and officially certified as a NBPAS diplomate.
My hope is that every single physician chooses to participate in NBPAS, and in turn petitions their hospitals to accept NBPAS as an alternative to MOC. If every single physician does so, we have power to stop the extortion and make MOC/OCC obsolete.
As Gary Keller describes the incredible power of the “Domino Effect” in his bookThe One Thing, we too can create massive change by collaborating together.
This is perhaps one of the MOST IMPORTANT PODCAST episodes ever created. If you are a physician or know a physician (which is pretty much everyone because we’re ALL patients!) PLEASE LISTEN.
Then reach out and ask your colleagues, your friends, your own physician, yourself: How are you really?
It’s ok to not be ok.
🙏 Please check in on each other. 🙏 Please reach out. 🙏 Please ask for help. 🙏 Please normalize being human. 🙏 Please normalize mental health, needing rest, & taking a break.
As physicians, we are some of THE MOST RESILIENT HUMANS ever in existence. If we say we’re tired, we need a break, ask to switch a shift, call, weekend, call in sick, or just need a day off – please listen to us. It’s our way of saying we need help, we’re struggling. Please hear our cry and act – instead of judging and pushing us to do more. Accept that we’re human and we need all of the human things: food, water, sleep, love, kindness, time to use the bathroom.
We all struggle. We all need rest. We all need a break. We all have brains & brains need to be cared for too.
Mental Health Matters.
Let’s normalize seeking help when we need it.
Please listen, share, support and watch out for each other. 🙏
Prior to SAFE and EFFECTIVE #COVID19vaccines, recently FDA EUA APPROVED for everyone ages 5y/o & older, being widely & readily available.
I honestly thought, as did many of my physician colleagues, that we’d be in a very different place right now.
We’ve been on the frontlines fighting this pandemic for the past 20+ months.
We have SAFE and EFFECTIVE VACCINES at our disposal. If EVERY SINGLE ELIGIBLE Minnesotan did their part & were to be fully vaccinated, we’d be in a very different place – with increasing herd immunity & less chance for persistent & continued SARS-CoV-2 viral spread.
Our resources are stretched to the limits, we’re short-staffed, & we‘re exhausted. Physicians, nurses, & support staff are fleeing in droves, retiring early, cutting back hours or quitting all together. And the effect is devastating.
Patients are suffering. Treatments are delayed. Morbidity and mortality are increasing.
There are no readily available hospital or ICU beds throughout the state.
Physicians are desperately reaching out via FaceBook posts in last ditch efforts to find open ICU/hospital beds in which to transfer patients needing higher acuity levels of care.
I can personally attest to the direness & brokenness of our current healthcare system.
This past weekend I was admitted to a local hospital due to unforeseen/unexpected circumstances. As a “physician patient” I am well aware of what to expect & what is considered acceptable standard of care.
These standards were NOT met.
Luckily, I have the knowledge & wherewithal to advocate appropriately on my behalf in order to obtain needed lifesaving treatments.
I personally witnessed physicians & nurses struggling to meet the needs of patients; exhausted, overworked, strapped for resources, & with too high a patient a census to adequately be able to give the needed time & attention to individual patients. Trying their best, wanting to help, while at the same time lacking in urgency; compassion worn thin.
Multiple stops/quality control check points/measures to be met/gone through before needed urgent medication could be given. Delays due to the EHR, orders difficult to find, access, or incorrectly entered, forgotten, or lost somewhere in cyberspace.
Constant shift changes, requiring pages to the on call physician, delayed responses, & the need for the rapid response team to be called – who then STILL needed to wait for pharmacy “approval” before administering urgently needed life saving medication treatment.
I am thankful, grateful, & lucky I am a physician able to speak up & advocate for myself, that I’m well connected to other physicians willing to help, lend support, & advocate on my behalf, & that I’m well trained & educated to know exactly what was happening & the emergent treatment needed.
I very well could have ended up intubated, in the ICU, or worse.
I share all of this to highlight the extreme, dire situation in which we are currently living.
I am personally asking & imploring every Minnesotan to:
🙏 PLEASE HELP US HELP YOU.
💉 PLEASE GET VACCINATED.
😷 PLEASE WEAR A MASK.
🏡 PLEASE STAY HOME WHEN ILL, GET TESTED & QUARANTINE APPROPRIATELY.
🤔 PLEASE THINK TWICE BEFORE GOING to that next get together, gathering, or game. & before traveling.
WE NEED EVERY SINGLE MINNESOTAN TO HEAR & HEED OUR CRIES.
Please. We need your help to end this pandemic. 🙏
To find & schedule a COVID19 VACCINE near you, please visit: Vaccines.gov.