Symbolic Measures and the Silence of the ABR

Earlier today the ACR passed resolution 50 without dissent, a gesture made in response to the recent (and ongoing?) MOC agreement debacle. The thrust of the resolution is that the American Board of Radiology should strive to “minimize power imbalance in decision-making between those professionals and the certifying body by committing to representative, inclusive, and transparent decision-making.” Also that they should consult the ACR before making terrible participation agreements and should also share said agreements in advance for public comment from candidates and diplomates.

Little birdies informed me that the ABR was working hard behind the scenes to spike this resolution. However, when it was presented during the reference committee hearing on Monday and then came up for a vote today, the ABR maintained complete radio silence. Not a peep.

This is, oddly, in strange contrast to recent promises of greater communication and transparency, such as when the ABR President recently said he wanted to “take ownership of flawed or incomplete communications.” Given the opportunity to literally address the entire radiology community and its largest deliberative body, the ABR didn’t say anything. They didn’t argue that they were right. They didn’t admit that they were wrong. They offered no window into the agreement process or any public acknowledgment or response to the many questions and comments that are contained in the resolution or that were raised during the discussion.

Why?

Because they don’t have to.

The core problem with the ABMS member boards like the ABR is that they are completely unaccountable. They may claim “business league” nonprofit status as 501(c)(6) organizations, but they are not accountable to their fields or their diplomates. The ACR has no power over the ABR. So why should the ABR work with them? Why subject itself to a public flogging? Better for that to occur on Twitter, anonymous forums like Aunt Minnie, and yes, right here.

During the reference committee discussion, I offered this testimony:

In its recent apology email to diplomates, the ABR suggested that the new MOC agreement was a slip-up. They wrote, “an error in the creation of the agreement resulted in the posting of an incorrect document, with more restrictive language than was intended.” This statement is at best misleading. The document was not simply a one-off overreach. I would like the members of the college to know that I and all other recent diplomates have been forced to sign similar agreements during our training. I signed a nearly identical agreement waiving my own due process rights in 2013 when I was a first-year resident. And today, despite softening the language of the recent MOC agreement after the public outcry, the current Candidate Agreement containing the exact same problematic language remains completely unchanged. We are leaving our most vulnerable colleagues out to dry.

The ABR is currently starved of external influence and oversight. Their bylaws mandate that nominees for the Board of Governors are solicited internally and elected by 3/4 majority of the current BOG. This insular approach essentially precludes outside perspectives. Once elected, the ABR conflict of interest policy “requires the Governor to act in the best interests of this Corporation, even if discharging that duty requires the Governor to support actions that might be contrary to the views, interests, policies, or actions of another organization of which the Governor is a member, or to the discipline of which the Governor is a member.”

This is deeply problematic. The ABR, by its own bylaws, is unaccountable to radiology and to radiologists. This is why we have our current state of affairs.

What we do matters. We should demand transparency and excellence from any organization that has an impact on our field and our practice. And if the ACR will not take a stand for radiologists then who will? This resolution could be a small first step toward creating a more meaningful working relationship.

Ultimately, this ACR resolution is purely symbolic.

Unfortunately, the ABR’s softening of the recent MOC agreement language was also merely a placating gesture, because it’s functionally similar despite the removal of the most heinous legalese.

There is a massive power imbalance here. In a situation where you can only vote with your feet, you have to be able to walk to wield influence. But doctors can’t strike. And the only people that can meaningfully do so in the current climate are the grandfathered lifetime certificate holders who are optionally enrolled in MOC, and they make up a shrinking fraction of the ABR’s profits every year.

Until the ABR decides that transparency and democracy will help their mission (or their bottom line), they have no need to listen.

But I hope they will. And I hope the ACR will take increasingly strong positions in future years because they’re an important part of the certification narrative that the radiology community needs to hear.

5 Comments

  1. Great work Dr. White. I commend you and hope that with an increasing voice we all can come together and expose the dastardly actions of the ABMS and its member boards. How at this point de facto requirement of “Board Certification” is still called, or labeled, “voluntary” is beyond me. The many aspects of “corporatism” have been so commonly understood as detrimental in the modern day, and their direct impact on society in eroding trust, continues to baffle and degrade even other institutions as it simultaneously exposes them. We see this in law when these matters are taken on by judges that show lazy or magical thinking in order to not make waves or just refuse to stop inertia.

    I am happy to see that there have been some reforms in the past few years, but in a society (especially in the corporate world) where terms like “justice” and other such buzzwords are commonplace, there is no way to get around the fact that two professionals should hold the same “qualification” yet be held to completely different standards – one being unable to practice if he doesn’t jump through the new hoops, or pay more fees.

    Thank you for your message and effort in drawing more attention to this issue.

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  2. It would be nice to be able to print this article to paper or PDF (like I printed Stempniak’s article that linked to this one), but in Firefox, Chrome, and IE (Win 10) the verbiage in the left column superimposes on the text of interest, spoiling the print.

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    • You are quite right! It certainly does. I’ve never tried to print before. I designed this site many, many years ago at this point and I never included a separate stylesheet for printing; it’s overdue for an update design-wise as well.

      Sorry about that! The best alternative would be to use a readability feature or plugin like Chrome’s “Reader Mode,” which will convert the webpage to just well-formatted article text and ignore sidebars/footers (and then print that, which works). Or to highlight the text in the main column, copy it, paste it elsewhere, and then print (which is a big hassle).

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