Wednesday, July 29, 2015

Maintenance of Certification (MOC) and the IRS: where money and power meet

We've heard a lot lately about MOC and its finances: in 2012 the president and CEO of the American Board of Internal Medicine (ABIM) pulled down $628,952 and of that amount $465,687 was "base compensation" while $44,742 was "bonus and incentive compensation" These figures come from line (i) of Part II,  Schedule J, re "officers, directors, trustees, key employees and highest compensated cmployees" as listed in ABIM's IRS 990 report, 2012. 

On the same line in Schedule J the president and CEO is listed as having received $83,654 in "retirement and other deferred compensation." We aren't told what type of compensation format comprised this prize, e.g., was it "defined benefit," 401-K, or something else?

To that was added $34,869 in "non-taxable benefits."

The total for Line (i) for 2012 was $628,952.

Then comes Line (ii): base compensation was $155,229. "Bonus and incentive compensation" was $14,914. "Retirement and other deferred compensation" was $27,885. "Non-taxable benefits" was $11,623. The total for line (ii) was $209,651.

The total for lines (i) and (ii) is $838,603. Not bad, not bad at all for an internist!

Plus there are 15 others at or near or above the $200,000 level. 

Where does this money come from?

One answer is possibly from donors, e.g., in 2012 the ABIM Foundation contributed $245,000. The Joshiah Macy Jr. Foundation contributed $151,632 while the Medical University of South Carolina contributed $62,789.

Another answer is that the majority of the money comes from MOC, testing, courses, and programs put on by non-board independent but nonetheless contingent organizations that charge for course attendance that in many cases contributes to MOC recertification. The point is that MOC in its current format cannot be sustained without MOC fees paid by doctors who submit to the programs as though they were necessary to maintain certification in a country where CME (Continuing Medical Education) is available in all 50 states.

The continuing clamor to set MOC aside in favor of alternative programs such as NBPAS (National Board of Physicians and Surgeons) is growing. It won't be the first time that lust for power and money brought down a financial empire, this time possibly the American Board of Medical Specialties (ABMS) where, not incidentally, the president and CEO took down annual compensation of $779,487 in 2013 (Form 990, Schedule 3, Part II -- Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees). 

In the ABMS case the declared "base compensation" was $681,188 to which was added $12,500 in "bonus and incentive compensation," $71,000 in "deferred compensation," and $14,799 in "non-taxable benefits." The 990 Form doesn't state if the "deferred compensation" is in the form of "defined benefits" or 401-K or other. 

Finally, our observation that some Form 990s don't include all of the officers, directors, trustees, key employees, and highest compensated employees is quizzical. Why not? 


  1. Surrounded by Arrogance, Jealousy and Lust for Power evil forces are driving too many of us - as Physicians - when as a group we find that too many of our Leaders and Colleagues have lost their footing - today many are choosing to live as Business men and women - not as competent Patient oriented Professionals. In my opinion, the first major decline was with the driving out of the old-fashioned "Doctor" - the bottom on the rung- Family Physician. We fragmented the process of Life- to bury and to replace the true Primary Care providers- the old-fashioned Birth to Death Physician - the Family Physician who once nobly served our local communities . In its stead we have created "high-dollar" Neonatologists, Intensivists, Specialist Pediatricians, Obstetricians, Gynecologists, Internists and the too numerous to list - subspecialists- or body part / organ specialists. Over the past 50 years our Academic institutions and centers along with the Political and Insurance Carriers promoted this evolution - with the resultant overly expensive and poorly managed health care system - based on large brick and mortar facilities. It is no surprise that the ABIM has to promote an artificial support system for the so-called newly created "specialist" individual Physician- to maintain this artificial body of "primary care providers" - in the face of an increasingly absent number of Board certified Family Physicians throughout the majority of the local neighborhoods and communities int the USA. That the ABIM subjects the internists to a costly and painful drawn out process - for Board certification - to obtain membership in a Hospital - is confirmation - that you cannot buy or pay for something that does not exist. No matter how much you try to make "reality" out of "illusions" - with a higher dollar cost or value. Today, there is no glue that can create a Primary Care provider by the pasting together of several internists or sub-specialists. No multiple question test, no matter how thorough it may be can, with certainty, certify a Primary Care Physician. Only experience can do this. Today, we must recognize that there still exists a large number of experienced Physicians who are humble and serve our citizens with honesty. We do not need an artificial test - cheap or expensive - to confirm this. Each one of our Patients know this. We, as responsible Adults, must support them and maintain our experienced Primary Care providers --- not only for our own benefit but also for the benefit of our Society. . Respectfully, George Moskowitz, MD, Board Certified Family Physician, Brooklyn, New York.

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