A recent essay by The Aspie Corner about "how the Professional Class Kills Desire for Decent Employment" spurred a comment by me along the same vein (artery?)

https://caucus99percent.com/comment/267482#comment-267482

Employers keep telling us there aren't enough people graduating with the right skills, which even basic research would tell anyone willing to look into it that the bosses are full of shit.

In medicine, at least as administered in the good ole US, we have this sham called maintenance of certification (MOC) which applies to all clinical disciplines and some (most?) of the non-clinical ones. This is in the discipline in which a person is certified to practice, through one of the accredited Boards of Medical Specialties, must PROVE they are capable to practice their specialty. That requirement is in addition to the required number of continuing medical education (CME) hours each state annually requires to maintain a medical license. These MOC classes ain't cheap. Who receives the fees for such testing? If you said the specialty board requiring such testing, then you win the prize.

I wish to expound on that as a way to illustrate that medicine will not be purged of evil by Medicare-for-all/single-payer (MFA) any more than the demise of Medusa will purge the Democratic party of corruption.

MFA is THE WILL of the people, though not the establishment. Adoption of MFA will cure 90% of what's wrong with medicine--but there will be perhaps 10%, or perhaps more, requiring eliminating before we can say that "the house is in order". Big Pharma ties to FDA and similar issues make up a large chunk of the remainder. A smaller chunk, MOC, as alluded to above makes up a smaller but significant chunk leading to elevated fees, even under a government-implemented plan.

This is the hypocrisy of American Medicine authored by a practicing physician, writing in KevinMD is an excellent, though per force incomplete statement of some of the faults in medicine which may survive the change to MFA:

Physicians and patients are fighting a growing hypocrisy in American medicine. Examples abound, such as criticism that doctors are overprescribing antibiotics and contributing to resistance, while insurance companies simultaneously incentivize their members to use telemedicine programs or urgent cares instead of visiting their primary care physician.

Telemedicine, or putting you life in the hands of Robbie the Robot is about as impersonal and flawed as medicine can be. Basically a patient communicates with a physician, or nurse, or physician's assistant or the receptionist--whomever is on the other side of the Skype. The physician (assuming you get the best of the tele-offerings) will then see you and hear you. But the physician cannot smell, touch or witness the small mannerisms or hear the verbal nuances afforded by telecommunications. Admittedly Robbie the Robot interactions may be necessary in regions far removed from actual physician location, but this is numerically a very small proportion of the population so bereft of actual proximity to "real" doctors.

The examinations provided to patients are severely limited. Let's say a "back patient", i.e., somebody with a lower lumbar issue, which in fact may not be spinal at all, is tele-examined (a horrible but real issue). The remote examiner will likely ask the individual to stand up, bend forward and touch his/her toes. Maybe even watch the person walk (almost always wearing shoes, which conceal a variety of issues). But the back examination is far more complex that that simplified, glaringly incomplete evaluation can provide. If I were to deal with the proper examination of the back, it would require a book chapter written for physicians, to validly deal with this malapropism of "Telemedicine".

Another quote from this fine article, all of which needs reading to fully appreciate is:

Another example of hypocrisy in American medicine is the mandate that physicians who have trained for 11-plus years maintain board certification, a costly and burdensome program, to receive hospital privileges while nurses become “Doctors of Nurse Practice” through 100 percent online programs and become credentialed for independent practice in many states. Why even bother going to medical school and incurring hundreds of thousands of dollars in debt when para-physician programs abound with far less requirements and regulations?

Moving on. More detail on MOC

Family medicine is the medical specialty that provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system, and every disease entity. When you or a family member needs health care or medical treatment, you want a highly qualified doctor dedicated to providing outstanding care. When you choose a doctor who is board-certified, you can be confident he or she meets nationally recognized standards for education, knowledge, experience, and skills to provide high-quality care in a specific medical specialty.

The following excerpt is also applicable to any medical discipline, not just family practice.

I believe in those who practice a “womb-to-tomb” approach in providing continuity of care for an individual throughout their life cycle.

In my particular case, epilepsy, multiple sclerosis, spinal disabilities, psst-traumatic psychosocial issues (and more, all of which I have personally treated) do simply not go away, such as a sore throat.
Although most of the neurologic/neurosurgical disorders with which I dealt with during a 38+ year career, do not begin at birth, I applied that belief in consistency of follow-up from date of incidence to date of death. Yes, I am a medical dinosaur, as are a minority of currently practicing physicians do not have the same belief/practice.

What is wrong with MOC exams also shares many of the problems of Robbie the Robot medicine:

the [MOC] exam itself in no way measured the diversity of skills required of an excellent family physician. Over three hundred multiple choice questions each providing a few data and clinical points about a particular patient and based on that limited information, the test taker is asked to choose the “best” evidence-based treatment option or “most likely” diagnosis. Absent are the nuances of patient demeanor in the exam room or how they respond on history-taking, the subtleties of a hands-on physical assessment. No information was provided about whether this particular patient has a family involved in their care, or what finances they have to afford the “best” treatment option when insurance won’t cover, or their willingness to comply with what is recommended. A phone app could easily answer these exam questions with a search that takes less than twenty seconds, yet our cell phones were taken away and locked up. Your test content implies a family physician has to know all the details, the numbers and the drug interactions committed to memory without the benefit of the technology tools we, along with many of our patients, use every day.

Now, honing onto the MOC comes another view of its worthlessness. This is where the wallet raiding comes in:

Maintenance of certification (MOC) for something as significant as the practice of medicine seems like a harmless enough idea. But for physicians across the country who dedicate thousands of hours to study, earn licensure, achieve board certification, and practice medicine, MOC is not only unnecessary but also a resource-consuming mandate that does nothing to improve patient outcomes and quality of care.

According to the American Board of Medical Specialty’s (ABMS’) own website: “Board certification is a voluntary process, and one that is very different from medical licensure … Board certification demonstrates a physician’s exceptional expertise in a particular specialty and/or subspecialty of medical practice.” In other words, physicians who pursue board certification self-identify as professionals committed to ongoing learning and subject-matter mastery...

The Medical Credentialing System in 2014 reported revenues of more than $2.5 billion — $1 billion of which is attributed to ABMS entities alone. The American Board of Internal Medicine (ABIM) is the largest of ABMS’ credentialing agencies and is responsible for credentialing one-quarter of all physicians.

Drilling down further into those numbers is eye-opening. ABIM reports $58 million in revenue for 2015, nearly $27 million of which came from MOC fees. With $30 million spent on salaries and benefits that year and only $6.3 million on actually administering the MOC, one could easily draw the conclusion that the push for MOC is nothing more than self-serving largesse. Well, that and the luxury three-bedroom condominium purchased in downtown Philadelphia in December 2007. The money these boards collect and spend — on expenses like first-class, cross-country airfare for their staff — just adds to physicians’ ire over MOC mandates.

In California, at least, being board certified is mandatory to practice in a hospital under your specialty. For neurosurgeons, this meant that if your board certification was not up to date, you could not operate.

The future of medicine? Prognosis bleak.

[video:https://www.youtube.com/watch?v=LZMmV6xXYFw]