094 Access to Care and Repetitive Stress Syndrome NBPAS is part of the Solution

THE NATIONAL BOARD OF PHYSICIANS AND SURGEONS

Established in 2015, the National Board of Physicians and Surgeons (NBPAS) is a non-profit, physician-led organization providing a pathway for continuous certification in all broadly recognized areas of specialty medical practice. Access the list of specialties NBPAS certifies.
A board of unpaid physicians leads NBPAS, thought leaders in clinical and academic medicine, and is the only continuing certification board that strictly prohibits the discriminatory practice of time-unlimited "grandfathering."
Karen Schatten, MLS, MFA, is the Associate Director of the National Board of Physicians and Surgeons (NBPAS), specializing in forwarding science-aligned policy within complex regulatory environments. Schatten brings prior experience from the public policy and planning sectors to lead strategic policy and growth initiatives, external-facing partnerships and communications, and state and federal advocacy during her tenure at NBPAS, the organization notably achieved recognition by all major national accrediting bodies for health plans and hospitals.
Dr. Pogacar is a graduate of Tufts University and the Boston University School of Medicine. After completing his pediatric residency at the Yale-New Haven Children’s Hospital, he practiced for five years at naval bases in Quantico, VA, and Groton, CT. Dr. Pogacar joined East Greenwich Pediatrics in 2005. Dr. Pogacar serves on the Executive Board for the Rhode Island Chapter of the American Academy of Pediatrics and is the Chair of the Chapter’s Pediatric Council and Director. Dr. Pogacar is the father of two sons and a daughter.

Physicians becoming harder to replace as burnout continues, study finds, THE JOINT COMMISSION HAS ADDED NBPAS AS A DESIGNATED EQUIVALENT SOURCE AGENCY, Beyond Burnout: Addressing System-Induced Distress,  AMERICAN BOARD OF PEDIATRICS Assets $147,000,000

Transcript

Access to Care and Repetitive Stress NBPAS Peter and Karen

[00:00:00] Dr. Herb: Well, hello, everybody. And we got a special, special episode today with Dr. Peter, who is a pediatrician, a former Navy pediatrician, and soon to be president of the AAP chapter in Rhode Island. 

[00:00:14] He's also a good friend of our list server, Pete's United. Supporter of our CK pages and a frequent we guest on our podcast with us is also Karen Chatman, who is the Associate Director for the National Board of Physicians and Surgeons.

[00:00:33] She's also a frequent guest in our PO and she's a good friend of the podcast and George and I. So welcome everybody. And we're going to talk about how we're going to solve some of this access to care and repetitive stress syndrome. How can NBPASS be part of that solution today? Welcome, Peter. 

[00:00:52] Dr. Peter: Yes, thank you.

[00:00:53] It's a pleasure to be here. And nice to meet Karen too as well. This is excellent. I appreciate the opportunity. 

[00:00:59] Dr. Herb: Welcome, [00:01:00] Karen. 

[00:01:00] Karen: Thank you. So good to be back and very nice to meet you, Peter. 

[00:01:05] Dr. Herb: So Karen we're going to ask you since last we talked, what's been going on at NBPASS? Sure. 

[00:01:10] Karen: Yeah. Always happy to share.

[00:01:11] You know, our goal is always to make sure or ensure that MB pass is accepted and an available choice for any physician across any specialty anywhere in the United States. So, you know, the ongoing work is always identifying and removing barriers. Throughout any state where we might find them. So it's really important to have these conversations with physicians on the ground to hear where those might be.

[00:01:35] But there are really three prongs to our approach and we've been working hard on all three. One, we need to engage with payers because everyone needs to get paid at the end of the day, whether you're a direct care, solo private practice. If you're in a physician specialty group or if you're a hospitalist or a hospital employee secondly, we take every opportunity like this to talk with physicians conferences, specialty societies, et cetera.

[00:01:59] And [00:02:00] our message is always the same, you know, please consider joining and certifying with NBPAS. And the reason is really twofold. One, by certifying through MBPASS. You get a less burdensome way to stay current in your specialty, but certifying with us is also a point of advocacy. It's joining a movement.

[00:02:18] So MB pass is a pathway. It's also a movement. And you know, because of physicians who have joined and added their voice. To what we do. We've really moved the needle. I don't know that the other certification organizations would have made changes without some of the external pressure that we have provided since it's since our physician founders, you know, started and be passed in 2015.

[00:02:40] So that's really important. These physician conversations. And then finally we've seen sort of an increased urgency in sort of, we call it following the money following physician data which often links to following physician dollars. And what we are finding is the money and the data sort of flow together and they paint a [00:03:00] really clear picture of, you know, where holdouts might be in terms of other organizations.

[00:03:05] who are not so excited about having a legitimate competitor in the market when it comes to physician continuing certification. So you know, we know competition's good for markets, for physicians, for patients, for the larger healthcare system. So we have kind of a multi pronged, you know, tackle. And we, we've been working hard on all three aspects.

[00:03:26] Dr. Herb: Great. And Peter, what's going on on your end? I, I always marvel at how well organized the chapter is in Rhode Island. Well, that you're going to be the incoming president. Congratulations on that. 

[00:03:40] Dr. Peter: Yeah, well, thank you. I mean, these, these are, you know, advocacy groups and that, you know, we work on, on the, you know, for the betterment of everyone within the chapter and it is a small state.

[00:03:50] So that's, that's where I think where you can see. the nimbleness and the ability to make some changes quickly is because of our size. You know, so we really try to take advantage [00:04:00] of that. But that also does mean we're talking about, you know, maybe the same group of 10 people that tend to be doing most of the heavy lifting and we try to share those responsibilities and really try to give different Priority to the issues at hand and you know, like everyone else, you know, we're just coming out of COVID.

[00:04:21] We're just getting back to our normal functioning as a chapter and that's a big deal. You know, I, I probably can't stress that enough is that we've really been on our heels a little bit with, with, for example, this particular topic, you know, really pushing for NBPAS for Rhode Island has been on the back burner.

[00:04:40] For four years now. And but no, it's time to wrap these things up, refocus, reenergize and get some things done. So we're, you know, I'm hopeful that we can, that I can get enough people in Rhode Island excited about this. And we work closely with the Rhode Island Medical Society, which is [00:05:00] a much bigger.

[00:05:01] Group with much more resources and and they were, they had this on their agenda for sure. So I will be definitely reconnecting with them to see where they, where they're moving in this, because all those issues that Karen brought up are exactly our issues, you know, how to be actually considered board certified.

[00:05:20] When you're solely certified with MBP, MB pass because MB pass in the past what they were issues where we were asking questions individually. At least my practice was, and we were hearing back from hospitals and certain insurers that no, we won't recognize you as board certified. And here are the consequences.

[00:05:41] And some of the consequences are things like not being able to be on staff or you know, qualifying for lower payment. Okay. And obviously those are huge barriers. So, so re identifying those barriers because some of them may have gone away. And then reorganizing the effort and the thought because again, I think this has slipped out of [00:06:00] most.

[00:06:00] Pediatricians minds at this point. You know, survival was number one. But you know, this is part of it.

[00:06:06] Dr. George: I guess Rhode Island is something similar to independent practices, smaller but more nimble. And I guess New York can be compared to big systems that are very bureaucratic and they say no no no this is just the way it is.

[00:06:21] Dr. Peter: follow what we say. So there's some truth to that. Yeah. 

[00:06:26] Dr. Herb: And so Peter and I disagree, you know, and a few things, but we mostly agree all the time. And I'm just done reporting BMIs. It's not that my computer can't figure out what the BMI percentages for the kid. It doesn't make any difference if I send it to Washington, they're not doing anything with the data.

[00:06:46] Quit harassing me about the data because you're not doing anything with it. It's unproductive. It's a waste of time. It's a waste of taxpayer money 

[00:06:54] Dr. George: Right on what am I we've had this discussion. 

[00:06:56] Dr. Herb: I'm done with MOC MOC is a waste of time [00:07:00] Yeah, I hear it. We hear it from leaders in our in our community like dr. Cressley That's that's not how adults learn That is taking us away from patient care. That is a burden on the practicing physician that actually sees patients. If I'm an academic person that's on service three months out of the year, write books, and play with rats in the lab the other nine months of the year, well, there's no skin off my back.

[00:07:27] I'll tell you a story when I was an employee. or contract physician to the hospital. I was the director of PALS for Northern Virginia, and I went to the big children's hospital and played with them. I did it at the school where they taught paramedics and nurses, but I was on salary. When I was out there, I had four other physicians that worked with me that covered the ER 24 7.

[00:07:50] The day I opened my own urgent care, I had to tell people, children's, I can't do it for free because when I leave the urgent care, I got to pay someone to be here. [00:08:00] And they got to keep seeing the patients. I can't just say I'm close. Cause I'm teaching pals at children's today and tomorrow. So sorry for the inconvenience.

[00:08:09] So it's a different perspective. I'm done with this silliness of d e a asking me to spend eight hours of my day. So I learn how to use narcotics. I never use narcotics. I haven't used narcotics in 15 years. 

[00:08:23] Dr. George: The problem is this follows her no more. Okay, listen, the problem is they're following adult medicine protocols, algorithms, formulas, whatever you want, and they're forcing Peter. So to comply, Peter is not 

[00:08:37] Dr. Herb: complying anymore. Dr. Dean, they're asking psychiatrists to manage narcotics that they never They're asking radiologists to manage narcotics, which they never do.

[00:08:46] It's bad medicine. So what is the purpose of all of this? 

[00:08:50] Dr. George: No purpose. Somebody made technology and they think it's good.

[00:08:53] Dr. Peter: Yeah, and and unintended consequences. You know, there was probably good intentions to start with, for example, [00:09:00] the D. A. Thing. The idea was this is part of the way to address the opiate you know, pandemic. And you know, obviously it's wrong headed and it should be better directed. And they have, in some ways, you know, developed, at least for pediatricians, some you know, training that's pediatric. Specific and it was kind, it was pseudo interesting. I, it's not nice to be forced into doing that type of thing.

[00:09:22] But for me, and I get it when you have multiple of these things eventually, especially, again, the main message to everyone should be, you know, our health care system almost died. You know, the pandemic almost killed us. That that message is like people have forgotten this whole thing where, you know, the new yorkers used to come out on the on the on the balconies and applaud the doctors and nurses coming home.

[00:09:47] That injury and that problem is just doesn't go away from one day to the next. And so instead they should Probably suspend as many as possible hoop jumping for doctors I don't know, two or three years. Why [00:10:00] not do that? If I had a magic wand, let's just suspend some of this hoop jumping nonsense.

[00:10:04] And there is a lot of hoop jumping. And what George is saying is correct, as far as the adult model, when, when you're describing about value based payment, that's coming right from CMS and Medicare and Medicare has no implication on how we practice. We're just getting shoved into that square peg. To to get paid.

[00:10:22] We have no increase in fee for service. If you want more money, you have to do value based. If you want to do value based, you've got to report whatever the heck they tell you, you've got to report. And it's big systems, and you know, Rhode Island trying to object against this big system is not going to work never mind my practice.

[00:10:39] So there are some hoop jumpings that we just, I just have to kind of take on the chin. But when I can, and, and we have the opportunity to push back. We should. And so while I agree with everything we're about to say, those, those are all very valid concerns. What are we going to do about them?

[00:10:55] Well, for MOC, I think there is, there is a path forward. It just makes [00:11:00] so, this is self inflicted wound. You know, this is us, the government doesn't necessarily want to tell us how to board certify. They just, they're, they're happy to have us self govern. Let's do that right. You know, I mean, come on, that's so basic an issue we're getting in our own way.

[00:11:16] And either people don't are somehow misunderstanding the situation or benefiting from the situation that those are the only two reasons why it continues like this. 

[00:11:27] Dr. George: So it's understanding part, Peter is a general doctor thing. It has to be perfect. Super analyzed and deducted the other people that are benefiting is who the computer companies that create all that technology. That's super expensive. I'm doing the M. O. C. 

[00:11:41] Right now. It's really impressive technology what they got there. 

[00:11:46] Dr. Peter: Right, but I bet we paid the biggest issue is it has to be paid. But the biggest issue is transparency. I don't know. My feeling is from from what we can gather from what is public is that [00:12:00] there's a huge war chest right now of money at the American pediatric board. level, nevermind the national board, but the American pediatric board level, they have a huge amount of money that they're willing to spend on, on all kinds of research that we have no idea about. We don't vote on, we don't review, it doesn't affect us, and it has nothing to do with recertification of doctors.

[00:12:23] It's their own, it's their boards, their board decides what they spend, where they spend their money on, what research. And of course, as we all know, the very obvious things where it's kind of becomes. Almost embarrassing and and somewhat unethical and dangerous is their own salaries and their own benefits I mean, there's no oversight of this.

[00:12:41] They're This is not okay You know unless we're completely wrong and we have the wrong information. They have a lot of money What are they doing with it? You know, so forget about the cost because apparently they have tons of money. 

[00:12:54] Dr. George: Yeah, an interesting thing is I can't hire pediatricians because of loan forgiveness that they [00:13:00] can't come to my office because I'm not a federally qualified health center or a not for profit or whatever nonsense.

[00:13:08] Dr. Peter: So why doesn't the board start a loan forgiveness program? 

[00:13:12] Dr. George: Well, they did. They made a whole new loan forgiveness 

[00:13:14] program that they did, but it's only good for specialists. 

[00:13:16] Dr. Peter: Well, that wasn't, that wasn't, that wasn't, that was the AAP and the government 

[00:13:22] Dr. Herb: working together. We're talking about the AABP, which is a standalone not for profit organization where the pediatrician CEO, now everybody's a CEO. And I am the CEO of this podcast, co CEO, George, and he pays himself 800, 000 a year, while the starting salary, according to Sue Kressley for a pediatrician in Wisconsin is 120, 000, and the starting salary for a pediatrician in Rochester, New York is 140, 000. And the starting salary for a pediatrician in Northern Virginia is 160, 000. And you cannot buy a townhouse with less than 600, [00:14:00] 000 in Northern Virginia. That is a crime committed by one of us against all of us. And they have millions of dollars in reserves that they could use to help young medical students who are passionate about pediatrics get free medical education. That is part of the solution to our shortage of medical primary care physicians.

[00:14:25] Eliminate the burden. Eliminate the debt. And give them a good salary so they can do what they want to do, which is to take care of patients that goes for internal medicine, family practice and pediatricians that are in the front line of taking care of people in their communities and in their neighborhoods.

[00:14:41] It is a crime committed by our own people against us. 

[00:14:45] And then we, 

[00:14:47] Dr. Peter: we do have those that are, that are just misinformed and we do have a well intentioned, you know, sort of pediatricians and leadership positions in academia that just really don't,[00:15:00] they really view the markets. Why are you guys complaining? It's a really good way of, you know, staying with your, keeping up your skills and thinking about problems. And you know, we're working, we're, we're all the same team, but they don't seem to understand that you, you know, that when you're in, when you're not in academia, that you, these, these are big costs and a big time suck, and we don't have the time to donate to these extra.

[00:15:25] Efforts like, you know, almost every other part of the mock besides the, the the computer based learning part, which is actually a good thing to develop. It's not like they can't do good things. The mocha peds part of the mock is not a bad thing. I think, I actually think most of my colleagues would enjoy doing it.

[00:15:42] It doesn't have to be the cost, and it could be the only part. You know, and again, so that's that one issue. There's that jumping issue of doing the mock versus the the financial transparency issue. Both are big issues. I would argue the financial transparency [00:16:00] issue is the biggest issue because there's just tons of money just sitting there.

[00:16:03] And they're, and we have folks that have no accountability that could make changes tomorrow that could affect all the pediatricians in the country and because they want to, you know, why, why would we have that situation where folks can just make these decisions because they want to, there's, there's, there's no formal pathway to becoming the CEO, it's just whoever they decide.

[00:16:27] You know, how is that a reasonable thing that one person could just be king without any kind of true election and without any accountability? That person was completely benign. 

[00:16:39] Dr. Herb: I wasn't born in the U. S. Right. And I, although I look old, I'm not as old as America is, but there were some King, I think King George, it was, he's called who got into a war because of taxation without representation.

[00:16:56] Karen: Well. You know, there's so many, so [00:17:00] many good issues being raised here. And I think, you know, Peter, you said something about you know, the money, you know, how is this okay? And I think, you know, the, one of the most important points that NBPAS likes to focus on is ABMS and AOA are nonprofit 501 C3 organizations, which by law under, you know, under IRS law are supposed to be public.

[00:17:25] Charities, right? They're supposed to be public charities. I know the American Board of Pediatrics has a ton of money in its war chest and that's just one and it's certainly not the biggest. If you look at ABIM, you're talking about hundreds of millions of dollars. And this is physician money from doing MOC.

[00:17:45] And I always like to take it back, especially when we're talking with physicians, because you guys know how to read data, interpret data, and say, is this clinically proven or not? And so when anyone says, well, you know, but it's, [00:18:00] you know, yes, computer programs can be impressive. Technology can be, you know, wow, bells, whistles.

[00:18:05] This is exciting. Does it improve? Our patient care, our clinical outcomes. Does it make better physicians? And the data says after 20 years of trying and trying and trying the answer is no, there is no level a evidence that suggests any of those things. So those dollars are being required made. saved, spent in ways that physicians have no control over.

[00:18:30] So, you know, one of our big goals is just to constantly, you know, remind everyone. And I think it's really hard for physicians because physicians are naturally trained to constantly learn and And so you almost feel like I had a psychiatrist tell me they believe, this was their theory, that physicians have a psychological drive.

[00:18:51] You feel like you're doing something wrong. If you're not taking an exam or taking a test or somehow proving yourself, right? But again, [00:19:00] the data, the data, the data. Right? When I bring my child to the pediatrician with a sore throat, she's not going to get antibiotics unless she's positive for strep, why?

[00:19:10] Because of the data, we know. So it's, it's Why we don't give unnecessary treatment to patients. Ideally, why would we require unnecessary modules for physicians? And so it's one of the points we really try to, to educate people on. And I think Peter, your other point is really, really good that some of the people in the academic positions really are very well intentioned.

[00:19:30] I spoke to an anesthesiologist recently on another podcast incidentally, and she said, you know, when I was young, there was so much excitement about like, I'm going to be a board examiner. I'm going to submit questions. I'm going to be part of this process. And, but then, you know, 10 years down the road, you look back and say, these organizations have really lost their way.

[00:19:49] I don't want to be a part of this anymore. And so I think part of it is, you know, as physicians going through residency, the initial board certification has tremendous value. That's what makes you the [00:20:00] pediatrician in this case, you know, that you are, that is your specialty training. That is a. Very stellar, very impressive and very meaningful credential.

[00:20:08] Unfortunately, MOC is completely separate, and it's a different product, and I want to emphasize and underline and bold product. It is a product and it's an unproven one at that. And so you know, the more we can clear the pathway and, and relieve the burden for physicians you know, that's what we exist to do.

[00:20:28] Dr. Herb: Yeah. And Karen because this is a problem for us, right? So pediatrics is only 30% white, only 30% male now. And it's a woman problem then, because 70% are women. And they're leaving the profession four to seven years. After they start, they're just exhausted. And George complains about it. Peter complains about it.

[00:20:58] Kathleen complains about [00:21:00] it. Nola complains about it in Alabama. We can't find pediatricians to hire to see the kids. I mean, George has got 25, 000 kids in his roster with you know, more than half of those being kids on Medicaid or CHIP. And he can't hire a pediatrician. The end. The problem here is that when we're made to jump through hoops and do repetitive actions that don't improve the care of our patients and that don't change anything that we're doing, that leaves the physician disengagement and we cannot have any more of our colleagues die by suicide.

[00:21:42] We cannot be losing women pediatricians the way we are. And we not only have to address the debt burden, the inequity in salaries, but we also have to stop asking them to do things that don't [00:22:00] improve the care they give to their patients. I think NBPASS has done some studies or has some data that shows this also leads to physician disengagement. Am I correct? 

[00:22:14] Karen: I'm not sure what you mean about data or studies. But we know, I mean, from, you know, we work with physicians day in and day out. We hear from them all the time. And so, you know, we know physicians are exhausted and burnt out and have no gas in the tank at the end of the day, the week, the month, the year.

[00:22:30] And you know, I know one of the questions you're curious about, Herb, is, you know, so why, why isn't Envy passed everywhere? And, you know, the answer is because physicians are exhausted from seeing patients. And they don't have time in their schedule to go out and start lobbying and, you know, becoming political activists.

[00:22:46] It's a very, very exhausting and tiring job. And so that's what we work on. You know, from the administrative level, you know, trying to clear the pathway. But I think what we've learned is the majority of physicians we talked to [00:23:00] would very much want to certify with us. And the obstacles are not with certifying with MBPASS.

[00:23:05] The obstacles are are systemic, you know, in the structures. So, you know, Peter is in Rhode Island, so it might be perception of hospitals in Rhode Island. And so that's what we work very, very hard to turn the tide on. You know, I think To Sue Cressley's point on your, I don't know when you recorded that other episode, she said we're being, you know, physicians are dying a death by a thousand cuts.

[00:23:29] And I think another message that physicians, not just NBPAS, but physicians must advocate for is ABMS and AOA, they'd like us to believe that if you don't do participate in MOC, you're going to be a lesser physician. You are somehow not learning. You're somehow not staying competent. And I sent out an email just to 10 of our physicians that I know well.

[00:23:52] And I said, Could you please send me a list of every quality program, every education, every data collection that you [00:24:00] participate in, whether some of them are private practice, some of them are hospitalists, very, you know, wide variability among specialists. I have a two page long list. You know, weekly case conference, monthly case conference, morbidity, morbidity and mortality.

[00:24:14] You know, complication reviews, protocol writing, student teaching you know, mid level supervision council meetings, quality meetings, performance, peer review meetings. Sounds like my life. Yes. Right. Quality conferences. And then if you, depending on your specialty, your pediatricians, I don't know what national, you know, incentives there might be for, you know, reporting that you're. your children are all vaccinated and you're meeting these benchmarks for diabetes screening and so on and so on and so on and so on. Your life is quality improvement. You have signed up for a career of lifelong learning and education. It, it's not valid. And we know the data shows again and again and again, there's really no validity that doctors, you know, have to [00:25:00] participate in MOC to become and maintain their, their lifelong excellence.

[00:25:04] And so, you know, it's an education, it's an education job, and we have it one conversation at a time. 

[00:25:10] Dr. Peter: Karen I have a question for you. Sure. I maybe just missed in the beginning of the point we're just making, who are those people that are saying to you that that physicians, you know, if you don't participate in a mock like process, maybe not the mock product, but a mock like product process that you're not engaging in lifelong.

[00:25:28] Education or 

[00:25:30] Karen: I think so. I think it's general messaging and marketing that I'm talking about. And I'm talking about that from the mothership. And when I say the mothership, I'm talking about a BMS. And there's a lot of PR and marketing and maybe I'll just pivot to that. About a year ago, in fact, a year ago tomorrow, we announced that MBPAS had been added as a designated equivalent source agency by the Joint Commission.

[00:25:55] It was big news. Everyone was really excited. It caused a lot of [00:26:00] excitement. Our numbers jumped up. About two weeks later or less, ABMS released a press release. And then shortly thereafter, something called a toolkit, and we are pretty confident that it went to state medical boards. specialty societies you know, specialty organizations, all their member boards.

[00:26:18] Nobody wants a substandard physician, right? Nobody wants a non current physician. So it is our opinion and position.

[00:26:27] This is really good marketing and marketing is not science and marketing is not medicine. 

[00:26:33] Dr. Peter: Yeah, Karen, I couldn't agree more. I think that's That's some of the pushback I initially got when we were sort of just grassroots. This was like years ago now, maybe even 10 years ago where we were grassroots, sort of the as the AAP Rhode Island chapter is very much just a group of pediatricians.

[00:26:51] We were saying, what is going on when the first got modified? We're like, this is just doesn't make sense. You know and when they still had their you know, their you know [00:27:00] in. test center exams that you have to take to go sit for an exam in a closed box. And it was just horrendous. Type of situation we're pushing back.

[00:27:09] We did get a lot of pushback from You know, people who are not benefiting from from, you know, financially from the mock in any way, they really believe that that that this lifelong learning thing is essential, you know, I was definitely getting that message loud and clear and But why? I mean, I can explain what we're doing.

[00:27:30] Explain, like, I get your idea, but let's look at what we're actually doing and tell me, tell me how this is. Is this really making, you know, doing anything besides hoop jumping? And it was a little bit of a back and forth and I was very, I was shocked that there was pushback, but there was pushback. You know, from the from the hot, mainly from the hospitals and from the hospital leaders and from the physician leaders at the hospitals.

[00:27:52] So I'm very interested if you could send us a link to that tool kit you know, to everybody you know, to the, just just so we can, So we can share that [00:28:00] information because I am definitely taking this to the Rhode Island Medical Society and I'm sure they're pushing for it because I know they have been.

[00:28:05] And whatever the barriers are, I'm going to work to try to minimize those barriers. So everyone has the option to think about if they want to pay for the mock or if they, or if they want to do and be a pass and be board certified. If, we get to a situation where we have that choice to be. You know viewed as board certified with either the mock or the MB pass system.

[00:28:28] Let the people choose. And I think, I think it's going to be very quick exodus. That's my perspective. But 

[00:28:34] Karen: Well, I agree. And, you know, I like to emphasize that MRC is a product and if it was true, it's supposed to be voluntary, but in reality, it's a defect. It's become a de facto requirement to practice medicine in the United States.

[00:28:46] And, you know, one thing I like to say to people is if you have a really good product. You don't need to force people to buy it. I don't need to force anyone to buy an iPhone. Everyone goes out and buys an iPhone. You know, we don't drive Model T Fords anymore. Someone's [00:29:00] invented and innovated something new.

[00:29:01] You know, MBPAS is an innovator and a leader in a way that we are reducing burden and trying to, to do it in a much more efficient way. I mean, every hospital in the United States should be banging on our door for this because on average we're, we, Our certification with MBPass is about 72% less, right, than, than participating in MOC.

[00:29:24] I think the statistic from the end of 2022 from the American Hospital Association is nearly 80% of hospitals were ending 2022 year in the red. People are looking for every cost savings and So much emphasis on value based care. I don't, you know, this in a sense is a very value oriented option and it's a good option and it's a rigorous option and this 

[00:29:49] Dr. Peter: MB pass have a dedicated website or source where folks can review the financials.

[00:29:54] I know you have to publish it, but those things are not as easy as you think to find. I remember when I did research on that, [00:30:00] it was, we found the information and then even interpreting it was a little bit difficult and where I was getting pushed back on how I was interpreting it. And I'm not a lawyer, you know, like that stuff is, is challenging.

[00:30:10] Yeah, 

[00:30:11] Karen: absolutely. We believe in transparency, full transparency. I believe our 990s every year are published on our website. And I'll, I'll double check that to make sure I'm speaking correctly, but all our data is there. We don't have lobbyists. We don't have in house lawyers. We are a true nonprofit.

[00:30:26] I like to say we burn what we earn. None of our. Top leaders, you know, none of, no, none of our top leaders in the organization clear a hundred thousand dollars. We're all making less than that. 

[00:30:36] We are here to truly serve physicians, their patients. You know, as, as just a, a layperson in society, I see the crisis. I see the crisis as a patient with my own doctors. I see a crisis with my own pediatricians and my children burning out and wanting to get out of medicine. It's. This is not a problem. This is a problem that can be ignored and, and it can't be [00:31:00] marketed away by organizations with lots and lots of money.

[00:31:03] You know, I you know, this is a pediatric specific program and I shared with Herb and George, I believe last time I had a friend who worked for the American Board of Pediatrics. not in a medical capacity, but in a technical capacity and described their headquarters as the Taj Mahal and said they didn't know what to do with their money.

[00:31:23] Food carts, mahogany paneling, artwork, gourmet this, time off at Christmas. And, but physicians don't know this information. It's, Unconscionable. It is unconscionable. So the more that every physician can stand up, join MBPASS, to add their voice to our important work and mission, amplify these stories like George and Herb do on this broadcast, it's critical.

[00:31:53] And you know, some of them, you know, we really, really exist to support physicians. Physicians take care of [00:32:00] us, us, and I mean us. Everyone, you know, physicians care for, for people and. And bpa, we truly, we truly wanna support physicians in the very hard 

[00:32:11] Dr. Peter: work. I would consider this outside your scope, , to be honest, but, but maybe it's something you do provide.

[00:32:17] Do you have like legis legislative liaisons or, or advocacy folks that, or or do you do that, like anything official like that I can contact? Or is, is it more like just unofficial? 

[00:32:30] Karen: I'm not, you mean 

[00:32:30] Dr. Peter: in-house? What do you Yes, yes. You guys have like a division of. Legislative you know, legislation advocacy, you know, because 

[00:32:38] Dr. Herb: I'm going to, I'm going to explain to Karen a little bit.

[00:32:40] So for the American Academy of Pediatrics has his office in D. C. Okay. Lawyers and all the staff that it's supposed to advocate for things that are important for children. And so what Peter is asking is, do you have an advocacy office? For NBPaaS that has a template for us to [00:33:00] use. 

[00:33:01] Karen: Sure. So you're, so you would be talking to me, you're talking, I am the department and and yes, we could certainly talk, you know.

[00:33:10] Talk later at a time to talk about whatever you might need, Peter. Okay, 

[00:33:14] Dr. Peter: because that's definitely going to happen. Yeah. And, 

[00:33:16] Karen: and, and that's, I always like to say that's really how true nonprofits often run, you know, lean we're lean staffed. We wear many, many hats. So I can change my hat on a moment's notice and you know, and work on what needs to be done.

[00:33:31] Dr. Herb: I'm in a level so a little bit because it's not just a pediatric problem. Sure. So, on the average, a big health system, whatever that health system is, loses 100, 000 to 150, 000 per year on primary care doctor, but health systems are not very efficient. And so it's very difficult for them to be in a low margin, high volume business.

[00:33:54] I just talked to some friends in Columbus, Ohio. The local [00:34:00] hospitals are trying to find internal medicine doctors. They're starting them at a salary of 200, 000 a hundred thousand dollars sign on bonuses so they can retire some of their student debt just to get an internal medicine doctor that's, you're not going to make that back on revenue.

[00:34:17] It's impossible. And we've already addressed how people are, are leaving. just because they just can't stand it anymore. It's like, let me take care of my patients or just, I'm leaving. And it's affecting, it's affecting my friends, my adult friends. They can't get into an endocrinologist. It's affecting my dad.

[00:34:39] He called for his cardiologist appointment. He said, we'll see you in November. It's affecting the children. You, good luck trying to get a pediatric neurologist in Northern Virginia. They don't even have a wait list anymore. If you have a seizure, send the kid to the ER, the rounding doctor will see him on the, , in the ER, and then they'll get a clinic appointment.

[00:34:58] That's what we used to do in the nineties.[00:35:00] If you want to see a pediatric psychiatrist, despite the fact we have three or four medical schools with the driver's distance, the current wait list is two years. And We need to do everything, loan forgiveness, better payment for primary care doctors, more respect for primary care doctors less hoop jumping for primary care doctors so that we can have healthcare.

[00:35:27] Karen: I think I, you know, you can't fight every battle, but you know, the AMA is. complicit in a lot of this because they generate all the coding. And though they lobby as if they represent all physicians in the United States they actually, I think at current current counting, they own their paid membership in terms of actual attending physicians.

[00:35:46] It's just shy of 12% of physicians in the U S that is nowhere near a majority. And so again, following the data, following the dollars. you know, paints a picture that no one is really advocating for what matters, but you guys are [00:36:00] advocating for what matters. MBPASS is advocating for what matters. And so these are the important conversations of how we move forward.

[00:36:07] Dr. Peter: Historically to make changes, you know, a lot of these are government. There isn't a free market in healthcare. It's these are government, everything's government regulated, you know? So, and the people who are donating the physicians that are donating to politicians are not pediatricians, you know, these are the surgeons and the surgical groups and the big groups, and they, they have money talks.

[00:36:28] You know, and they get listened to, and we don't, and it's not a respect thing. It's a money thing, which is common for all these things. I mean, some of these big, big bullies are run by moms who love their pediatricians. And, and you know, a lot of , the doctors that I talked to that, that are more in my generation, I'm not doctors, I'm sorry but administrators that I talked to and government officials that I talked to that are my, that are my generation who are now in charge.

[00:36:51] They're very they love their pediatrician and whenever, and it actually does help when I, it does, it does win us a lot of points, a lot of [00:37:00] respect with when we bring up, oh, this is the pediatricians are in peril. I can convince them, but the idea of connecting their pediatrician to the pediatricians in the state and what's happening, what's going on with pediatricians for everyone.

[00:37:13] Is a disconnect. They're all all about their pediatrician, but you can, your kids, you guys can go see a nurse practitioner. It's cheaper. And that's a very big disconnect that's another struggle that we have. You know what's good for me isn't what's good for everybody all the time. You know?

[00:37:26] And there's a lot of, there's a lot of different interests and influence and the money's talking. And we're not putting in the money, and we don't necessarily have the money to put in. And right now, we don't have the energy. We don't have the people that are going to come out of the woodwork to start fighting some of these fights harder.

[00:37:42] Who's supposed to do that? Yeah, we can only advocate for ourselves. I mean, that's, that's really, that's it. 

[00:37:49] Karen: Well, and you know, somebody asked me once, what would it take just to, you know, to just have a landslide for MBPAS, you know, on a, the turn of a dime. And I said, every [00:38:00] physician simply say no more, I'm not going to do MOC.

[00:38:03] I mean, could every physician in the US be fired? Could we, could we, you know, nobody could function. You know. If it's truly voluntary, because that's what ABMS will say, they say it's voluntary. 

[00:38:16] Dr. Peter: Well, the problem with that problem is, you know, a psychological issue. Mainly physicians are getting to become, answer the call to be physicians.

[00:38:27] Yes. Because they feel like they're servants. You know, we feel like we serve our patients. And doing something like you just said would feel like way too much like abandoning our responsibilities, and that just is such a high ask for physicians, especially especially pediatricians, even more so pediatricians, I would argue that that's that just will never happen.

[00:38:50] They would, they would almost, we would almost be publicly flogged. Oh, yeah. Oh, I would never, 

[00:38:55] Karen: I would never want you to abandon your patients, Peter. I'm 

[00:38:58] Dr. Peter: not even saying, I'm not saying [00:39:00] you're saying that I'm saying that's their person. It would be, it would be. Yes. It's their, it's their psycho, it's other folks' psychological you know, sort of he, what they hear from that.

[00:39:10] You know, stop doing the mock, don't, don't get board certified. Put your board certification up at risk. You know, those type of thoughts are just way too you know, pro provocative for most pediatricians to, even remotely consider. So, so this idea of some kind of mass exodus is just one that would just not fly.

[00:39:31] Dr. Herb: It doesn't have to be a mass exodus. We, we are right. Petitioners are extremely conservative, which is odd because in social agendas, they're very liberal, but it's behavior. We're very conservative. And we don't want to rock the boat in any which way. You know, We, we don't want to give a child antibiotic unless they really, really need it because they might get diarrhea, they might get anaphylaxis, you know, always doing less is better with [00:40:00] kids and so that's just our nature, but I could bet you almost 10 that.

[00:40:05] If half the pediatricians in Rhode Island wrote a letter, they all signed it together to UnitedHealthcare and said, as of January 1st of 2024, none of us will will continue with MOC. We're going to NBPASS, and we urge UnitedHealthcare to adopt the military and the FAA process, which is, if there is an event, a near miss, We will all review it and we will all learn from it.

[00:40:32] But if you need to kick us out of your contract, January 1st, 2024 

[00:40:38] Dr. Peter: Well, and is that even a thing? This is united, not is national united, not recognizing 

[00:40:44] Dr. Herb: and be passed state by state. I don't 

[00:40:47] Dr. Peter: even ask to tell you the truth. I think it's just a message that's out 

[00:40:50] Karen: there. The boogeyman, there's a lot of misunderstanding on the payer side.

[00:40:54] Our, we have many empty past positions who have really good relationships with United Health. care [00:41:00] united health group. And one of the most common misconceptions out there is there's a difference between board certification and verification of board certification versus what's called primary source verification, which is what all insurers require.

[00:41:14] It's what the national credit. accreditation standards require, which simply means that whoever is looking at a physician to credential them, whether it's a payer for enrollment and network, whether it's a physician for employment in the hospital or a job, you have to verify their credentials from the primary source.

[00:41:32] And what was so important about MBPAS being added as a designated equivalent source to the joint commission is we are now in a. equivalent pathway to verify that for physicians. Many many major payers are agnostic to board certification status, but because board certification is the highest level of education and training for most physicians, it simply needs to be verified as part of the credentialing process.

[00:41:57] So Rank and file credentialers [00:42:00] will look at their policies and procedures and they'll see verify through a BMS because a BMS is a primary source. It does not mean they require a BMS. It means they simply need verification of board certification. That's why we have these conversations, Peter, because very often and we're finding a lot of favorable outcomes where payers say, No, no, you're fine.

[00:42:23] You're fine with me past. Just let us know. So I can't answer specifically for Rhode Island because It can vary state by state. I'd have to look into it. But we, you know, we do have success. You know, we certainly do have success with that. I think, you know, I want to circle back to one really critical point that Peter brought up, which is physicians don't want to give up their board certification.

[00:42:43] And that's really the kicker because physicians should not. be able to be stripped of their board certification credential for not participating in MOC. And that's not just the position of EnbyPASS. The Department of Justice weighed in on a piece of pending legislation [00:43:00] in the state of Maryland for us back in 2018.

[00:43:03] And they said physicians should not be allowed to have their credential removed. And I always use the analogy of lawyers. If you told a lawyer, You were going to remove them from admittance to a bar in their state after they passed a bar exam. It would be like DEFCON 1. They would never stand for it. Why would anyone be allowed to strip your credential?

[00:43:25] I've graduated from high school. I'm a high school graduate. I've graduated from college. I'm a college graduate. I've graduated from law school, med school, fill in the blank. You are a graduate. You graduated from residency, you passed the board exam initially, you are a board certified physician. MOC, continuing education, we believe should be an entirely and completely separate credential, which speaks to that point you make, Peter, which is, look, you know, you're not giving up board certification by coming over to Envy Pass.

[00:43:55] You are becoming certified continually through Envy [00:44:00] Pass for phase two, which is the lifelong learning and that part of your career. So. That is, you know, an area we work really hard on. It's a complex issue legally, legally, but it's a really important one for us. You are board certified. Why should anyone ever be allowed to decertify you?

[00:44:18] And the fact is, to Herb's point, you know, across, I can't speak for every member board of ABMS, but I know that some of the ABMS member boards absolutely list physicians as not certified and will remove them from their database for not participating in MOC and, you know, we think there's some serious problems with that.

[00:44:39] Dr. Herb: Well, Peter, when you start doing this, let me know what I can do to help you. 

[00:44:44] Dr. Peter: I'm starting next month and I'm definitely going to work with Karen on this. You know, so you know, that, that toolkit, that DOJ communication that you just mentioned those would be two very powerful pieces of information for me when, as I fight this fight.

[00:44:58] So you know, put that out, put [00:45:00] that out on the, on the listserv and through the podcast and the sub stacks. And certainly I'll be taking advantage of that. 

[00:45:07] Dr. Herb: Terrific. All right. Well, I want to thank everybody. This is a very important conversation. Very heated. Very heated. It's always heated because it's emotional.

[00:45:18] I mean, we need, we need physicians. 

[00:45:21] Dr. Peter: And it's so frustrating because it's self inflicted and not necessary. It's not like there isn't two sides to this. There just aren't. It's so obvious that this is an issue, you know, and that frustrates me more than anything else. 

[00:45:36] Dr. Herb: Well, we do the future of the country, which is the future 

[00:45:40] Dr. Peter: of the country. I mean, people will become big people with problems if we don't fix them. They become big people right in front of us. 

[00:45:47] Dr. Herb: Well, Peter, we'll let you go onto your boat.

[00:45:50] Dr. Peter: It is a nice day here in Rhode Island. I'm going back to save the world. 

[00:45:55] Dr. Herb: And now by you, Karen, you're going to the pool next, I guess. No, 

[00:45:59] Karen: [00:46:00] my day is only about half over now. So we'll dig in and. See what other, what other good fight we can fight. And, you know, really try to keep the ball rolling and really appreciate all your great work.

[00:46:12] Not just taking care of kids everywhere as pediatricians, which I really do appreciate as a mom. But you know, your advocacy to talk about these issues and to, you know, put energy into helping your. You know, current physicians and all the physicians that will come later. I think it's super important.

[00:46:29] So thanks for having me on again. 

[00:46:30] Dr. Peter: And I see Dr. Bravo is dressed up like us, Peter saving the world 

[00:46:35] Dr. Herb: today. I'm working today. You're working for 

[00:46:37] Dr. Peter: the busiest unemployed physician I've ever seen. 

[00:46:40] Dr. Herb: That is true. Well, Karen, thank you because you and MBPASS is really doing a great job and Peter, thank you. You know that you and I disagree on the value of certain organizations, but I see, I think the leadership and the work that the pediatricians in Rhode Island put for their community as physicians [00:47:00] and their children is admirable.

[00:47:03] And I don't think it's the organization. I think it's you. and your fellow pediatricians in Rhode Island. They're an example to be admired, applauded, and thanked for your care for your children. 

[00:47:19] Dr. Peter: Well, thank you. And thank you for the opportunity. This is very helpful for me. I appreciate 

[00:47:24] Dr. Herb: it. Great. We'll see you all soon.

[00:47:26] I got to get back to seeing patients. Okay. All 

[00:47:29] Dr. Peter: right. Have a nice day. All right. Bye bye. 

[00:47:31] Dr. Herb: Bye everyone.