ABR MOC and the Art of the Apology

This week the American Board of Radiology emailed its diplomates in response to the continued concern that its initial fix to the over the top legalese in its agreements was buried so deep that no one could see it as well as the frustration that people who caved early didn’t have a chance to sign the new one.

I know some regular readers are getting bored of all this ABR talk—and we’ll be moving on from this flurry soon I promise—but there’s also a lot to learn here about management and organized medicine.

The ABR, clearly hoping for a gold star, started with this email subject line: “We listened to your concerns about our MOC Participation Agreement.”

Glad to hear it.

Today we’re discussing how to apologize.

Dear Diplomate:
As part of your enrollment in the ABR’s Maintenance of Certification (MOC) and associated interactions with our website, periodic renewals of user agreements are needed to codify the understanding of the limitations of usage of the materials and the extent of liability. This is especially important in establishing the security of the content used in assessment, in order to maintain a secure, valid, and fair process.

In March, an error in the creation of the agreement resulted in the posting of an incorrect document, with more restrictive language than was intended. Specifically, our request for those enrolled in MOC to waive certain legal rights was neither reasonable nor necessary.

I gave the ABR some advice on how to apologize back in 2017. When an accountable organization makes a mistake, they should:

  1. Express regret and acknowledge responsibility
  2. Be transparent and describe the mistake
  3. Give an action plan and steps to correct the problem
  4. Ask for forgiveness

They do a decent (incomplete) job of #3 and #4 in the following paragraphs. But they did a terrible job with #1 and #2.

The ABR is pretending that a Janice or Karen or Peter accidentally uploaded an “incorrect” document that was spuriously created in “error.” While we can all agree that waiving legal rights is stupid and unnecessary, this wasn’t an oversight. In terms of quality parlance such as might have been seen in the ABR’s manual for noninterpretive skills, the creation of the MOC agreement was not a “slip.” It was a bad choice and a manifestation of bad decision making.

It was deliberate. To say otherwise is ludicrous.

Especially so because this language was not new. I actually looked back at my own myABR history and saw that the same BS was in the “Agreement for Candidates and Diplomates” that I signed back in 2013, when I was a busy first-year resident unlearned in the machinations of our radiology overlords.

Perhaps the ABR was coyly suggesting that the language was unnecessary because all recent trainees have already signed away those rights. To wit, while the ABR changed the MOC agreement, they have not changed the Agreement for Candidates and Diplomates, which includes the same language.

Residents are a vulnerable population. Diplomates and organized radiology including the ACR should continue to put pressure on the ABR to fix this issue across the board. Don’t leave the trainees out to dry.

A revised document has since been implemented at https://myabr.theabr.org/moc-agreement. After discussion with counsel, acknowledging that the new language is far less stringent, this will supplant the original agreement for those who have already signed. Alternatively, these individuals may choose to sign the new agreement, but it is not required.

Now diplomates can now choose to sign the new agreement. Misuse of the term grandfathering has been avoided.

In view of the increasing administrative requirements inherent in the daily practice of medical practitioners, the ABR has an obligation to lessen such burdens whenever possible. We apologize for the error and hope to learn from it. No process is perfect, but we can and should continuously improve our processes based not only on internal quality control but also on feedback from our stakeholders, especially the radiology and physics professionals we are privileged to serve.

This is an excellent paragraph.

Sincerely,

Brent J. Wagner, MD
ABR President

Valerie P. Jackson, MD
ABR Executive Director

In short: I don’t know why the ABR is institutionally incapable of giving a real apology.

But more importantly, the ABR only fixed part of the problem. They responded to the loudest voices, but they didn’t even fix the imposition of onerous language on our youngest colleagues let alone address the problematic “processes” and organizational perspective that created it in the first place.

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