Wednesday, November 29, 2017

MOC's (Maintenance of Certification) update from the American Academy of Neurology (AAN) deserves review.

AAN President Ralph L. Sacco, MD, reported in his President's Column, December 2017, that "AAN is Working Hard to Modify ABPN Maintenance of Certification (MOC)" -- not, in my opinion, hard enough and not with the enthusiasm necessary to get the job done. Here's why:

1) In The Weinmann Report (, Friday, April 17, 2015, it was disclosed that IRS Form 990 for 2012 had reported that Larry R. Faulkner, MD, president and CEO of ABPN (American Board of Psychiatry and Neurology) was paid $843,591 for base compensation, retirement, and non-taxable benefits.

2) If we now compare that with Schedule J (Form 990) for 2015, we see that Dr. Faulkner's total compensation reportedly was $936,000. Six other ABPN persons were also paid above $250,000 including three whose compensation was well above $300,000.

3) If we study the AAN Schedule J, Form 990, for 2015 we see Executive Director Rydell's total compensation listed as $765,415. Five other persons are listed between $312,000 and $397,000.

The point to shout from rooftops loud enough for IRS and FTC to hear is that these financial figures are what motivates and drives MOC --- there's no way this kind of money will come from ordinary rank and file dues alone.The MOC gimmick is needed to make this pot boil. ABMS boards, along with their collegial societies and academies, are generating more generous self-payments from tax-exempt structures than they would were they for-profit companies. IRS should have investigated long ago -- what has held them back?  

Sacco said in his editorial that AAN's goals are to develop strategies to further understanding of health care disparities among individuals suffering with neurological conditions, that AAN wants to identify an approach to reduce these disparities, and to develop methods to improve our awareness re bias in health care outcomes of the neurological patient. He did not disclose financial disparities such as MOC fees that enrich ABPN and its enablers. 

In his November 2017 editorial Sacco talked about the December 4th meeting wherein he said "the societies will host a summit with representatives from ABMS and specialty boards, the Accreditation Council for Graduate Medical Education, Federation of State Medical Boards, Council of Medical Specialty Societies, and American Medical Association ... AAN recognizes these hassles of recertification ...  " 

Sacco mentions how these hassles "can contribute to burnout... " and says that AAN wants "to help you prepare for MOC." Actually, it appears more likely than not that all of the post-graduate organizations that sponsor MOC are doing so for self-serving financial purposes -- never in the history of medicine have administrative fees generated as much income as now. MOC proponents cannot afford to water down the fees that rank-and-file physicians will pay. If they did that then the hefty remunerations listed above would be severely trimmed. 

Our conclusion: MOC is a financially slick and clever maneuver on the brink of implosion. It should be replaced with more friendly methods of continuing medical education -- as matters stand now MOC proponents are treating physician colleagues as cannon fodder to be milked in support of narrow self-serving financial and power-driven interests.

Thursday, November 9, 2017

"Trickle Down" economics

Questions have come our way about "trickle down" economics. i.e., will it work if companies invest, expand their businesses, and hire more workers. In theory, were it to follow this format, it would. The problem is that there is no way to enforce "trickle down," previously tried and sold to the public by at least one previous administration. Here's why: employers and owners are free to skim off the profit and invest it either in the USA or abroad. There is no requirement to expand the local factory, increase production, or allow increased profits to "trickle down" anywhere other than to  corporate owners personal use. In the debate and reconciliation process we await in Congress we'll listen carefully to whatever details about "trickle down" either side cares to reveal. We suggest that our readers e-mail or write their Members of Congress to ask how they expect to enforce "trickle down" to make sure that the concept isn't siphoned off and translated into personal emolument to feed CFCs  (corporate fat cats) at the top. 

Wednesday, November 8, 2017


Today's post is not a political piece: it is a theatre review of a remarkable one woman show. Here's the scoop: a few years ago, Diane Barnes, MD, San Rafael, California, was working comfortably as a radiologist until, suddenly and unpredictably, she suffered a brain hemorrhage from a ruptured aneurysm. Although she sustained considerable damage to speech, she eventually recovered without paralysis and regained linguistic competence. The show dramatizes her story and at the same time provides astonishing insight into neurological recovery, e.g., how at one time while fighting her way through dysphasic speech she'd find herself thinking she was speaking while instead she was uttering gibberish ("word salad," in technical neurological speak). She was able to return to radiology but in due course found she had thespian talent. The show depicts her transference to her new life. She'll appear through December 9, 2017, at The Marsh, 1062 Valencia Street, San Francisco (tickets are available via or 415-282-3055). 

UPDATE: The run for Diane Barnes' show, My Stroke of Luck,  has been extended: same place, same time, shows will resume 1/4 to 2/3 Thurs 8 PM, Sat 5 PM and Sun 1/21 and 1/28 at 2 PM. Don't miss it especially if you're involved in neuroscience either as a clinician or researcher.