RE: Re: AAFP SAMs or other Modules

[Guest guest]

I am picking up this thread again, since I just got back from my first ABFM meeting. This is an article in the JABFM from about a year ago explaining fully how the test is created and the items validated. It is more complete than I coudl say here, and

I can say that the testing committee is reevaluating the philosophy of the how the items are picked. Currently the algorithum starts by organ systems, with the percentage of question based on the percentage of patient visits to the aggregate of family docs

based on NAMCS data. So if this data shows that 15 % of all family medicine visits relate to GI complaints than 15% of questions will, and there is more granularity after that. The questions then are scaled to run from ones that are expected to be gotten correct

by everyone, to ones that only one or maybe no one will get correct, since that is the only way to judge true knowledge. It gets harder from here to explain, but as I said before, there is a high power test designer incharge who you call to get more detail.

If you wish, I will give you his name. Maybe read the article first.

The other more important news, is that there is a way to use MU or perhpas HYH to get part 4 credit. If you do a " Self directed PIM', and you report your finding prior to and after completing meaningul use, you will get credit.

How's that?

Jim

From: [ ] On Behalf Of [edwardsronaldj@...]

Sent: Thursday, August 11, 2011 9:54 PM

To:

Subject: Re: Re: AAFP SAMs or other Modules

Jim, how is the recert exam created? I took it last month and thought it was way off track. Too many of the questions dealt with topics that are rarely encountered and that I havent thought about since medical school. What were the goals of the creators

of the exam?

On Thu, Aug 11, 2011 at 10:16 PM, Bleiweiss

wrote:

Sharlene and ,

Thanks for chimming in.... I too want it to be said again, This is NOT about bashing Jim our one and only ace in this fox hole probably (are there any others there with you Jim???). Please try to slug your ways thru to the bottom

and read my last reply.... In the ending I feel I really start to get to the root causes of most if not almost all of this and other similar problems.... It is a trauma abuse response of compliance and buying into the horribly painful crap that your tormentor

has been hitting you over the head with day after day, year after year.... An entire profession that is just about defeated and completely learned helpless (a form of enviornmentally caused depression and a model from which to better understand such a thing)

by those that have the most to hide no less ill gottenly gain from all of you... us. This has been my growing hypothesis about the lack of spine and backbone to stand up for yourself, ourselves in primary care for quite sometime now....

I believe this theory to be extremely sound and valid and would love to be able to form means of investigating and testing it's validity and significance. But if nothing else if each and everyone of you were to start to try to use

this as your perspective from which to view things like P4P, Meaningless Use, Full and Required, Reward and Punishment but unproven Free Market EMR's and E-Rx'ing that is choking a very popular program and shutting it down, crashing it... And possibly because

the Rx Vendor Middlemen making the big bucks in the middle are not doing their job well either (not proven but was floated as part of the problems, Rx's not being there at local places that faxes worked for the last 10 years for example). Just in general,

when ever someone other than a modest sized doctor in actual practice comes up with some NEW fango'ed HUGE, expensive has their hands in someone's and usually OURS TOO pockets, or means we work now for some promise of another " delayed " reward on the otherside...

STOP!!!! Question, and wonder who is this coming from and what are they REALLY after besides my hard work and my hard earned money off of my practice and profession????

The insurance industry always finds scapegoats to blame no matter what the line of business or products.... Sure there are always some folks who try to scam the system and get away with some crap... but the vast majority of folks just want to file

a claim, be helped or made whole and try to get back on with their lives again.... Most people are NOT scammers and insurance frauds.... What they do to each and every primary care doctor every day, NOW THAT IS A FRAUD and a crime of epic porportion for sure....

We are just the most visable and the most vulnerable victims to be used and abused by this Horribly Unethical Industry because the gov't set up the playing field so unlevel and unfairly.... We have almost NO power or clout and they have almost all of it, we

have almost NO laws that protect our interests against them, while they have almost all of the one's that really count... They hold the purse strings and we never do so it is Trickle down to us and beg for a meal from them.....

This is a traumatising, abusive, misuse of power and authority relationship and other players are playing into it for their own less than ideal or ethical reasons too. Like the CMS and AMA collusion to control the fees in favor of the AMA favorite

children while starving out Cinderella over in the corner and beating her and emtionally abusing her as well.... But one can never break free of Gaslighting, Mobbing and other forms of emotional abuse if and until they are really able to see, accept it for

what it is, and then have their eyes open so they can never again see things the old way... And as with all abuse victims one of the hardest parts to swallow was your own part in the dysfunctional dance you were engaged in with your abuser and tormentor...

It is hard to accept and hard to swallow and that pain keeps many abuse victims in denial...

And so it is my firm belief that we are suffering from a profession wide form of gaslighting, mobbing and abuse.... And one of the Red Flags of Mobbing is that the person singled out by the group for the abuse (like mass work place abuse of one person

usually started by someone who is competing with them, or is their boss or one who the victim is in charge of yes, both ways...) is usually pretty darn GOOD at what they do, there really is very little merit to what is happening to them once the surface crap

is peeled away.... This is the work of someone or someones who want or feel the need to ruin someone to get them out of the way for one reason or another....

And so primary care gets to wear the dunce cap and the Cone of Shame, be the sacrificial lamb and the scapegoat for all these other " Stakeholders " and greedy leeches... Think about and let me know what you think.... I believe those of you here are

independent enough thinkers to give this a fair shake... Take care and Be Well.... And Jim I do respect you very, very much... I really do. Unfortunately because of the board's disconnect, you are our only means of communicating with them.... That is part

of the larger problem.... no conversation, no meetings across the country, no comment and feedback period, no long defendable, presentable research project to present showing just how Great and Valid it is and how wonderful they really are.... Those with great

stuff tend to come out and talk, Show their faces... While those who are affraid and not sure of themselves, or are not coming from a good, ethical or defendable place, those kind of folks tend to stay removed and hide... Play Exhaulted Leader...

Demi-God.

To:

Sent: Thursday, August 11, 2011 8:14 PM

Subject: Re: AAFP SAMs or other Modules

Jim, For a slightly more abbreviated version of what is saying, below is a copy of my message to you from 5/24, to which I did not see a response. I'm really not trying to beat up on you, honestly. It sounds as if you have the best of intentions

and our (small practices') best interests at heart. But your analogy likening choosing not to fly and choosing not to be board certified is not fair. You wrote, " I can choose to put up with the TSA and fly, or I can drive. I can choose to put up with the ABFM,

or not be boarded. " I'm sure that there are some careers where refusing to fly would be the end, but not most, and certainly not ours. But, since insurance companies have started requiring board certification to be on their panel of physicians, letting our

board cert. lapse is the equivalent of saying we will never participate with the major insurers again. Certainly, I would LIKE to say that, but the awful truth is that it is not financially feasible for most of us. I know for a fact it would spell the end

of my current practice. So, board certification is no longer a marker of special qualifications, it is a minimum requirement to practice. And it is SO frustrating when someone comes along and invents a whole new process that is extremely onerous, yet necessary

for us to comply with, at a time when a large proportion of us beleaguered family docs are already feeling on the verge of collapse. I am getting chest pain and choked up just typing this, and I guess that's just what and I want the Board to know. If,

as you say, they have heard all this before, WHY AREN'T THEY LISTENING?!? It appears that we are not their constituents. I read their last newsletter, in which they claimed to be listening and responding to our needs, but nothing I saw made anything significantly

easier. I guess I would just like to know that our " insider " is going to give them that feedback.---Respectfully, Sharlene---

Jim, Please let the Board(ABFM)know that I am absolutely FURIOUS with them for coming up with such a ridiculously complex and time-consuming scheme for maintenance of certification!!! Do other specialty boards put their diplomates through

this kind of ordeal? I feel that we ordinary physicians have been completely sold out by people who must have no idea what a struggle it is just

to survive in today's practice environment. I have no problem with reading to keep up with the problems I encounter from day to day, earning some CME credits of my own choosing, and taking occasional tests. In fact, I would rather take a day-long test EVERY

YEAR than keep up with this MOC!! And I'll bet there is absolutely no evidence that doing all of this will make us better family doctors. If I didn't have to be board certified to participate with most

insurance companies, I would absolutely let my certification lapse. And if I ever go CASH ONLY, which it looks like I will need to, since I have no intention of becoming part of an ACO, I will definitly drop it!---Sharlene---

> Helen,

> The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I am now on the ABFP, I can tell you that the board is working to make Part IV modules more meaningful. For instance giving credit for PQRI, and I am pushing to give credit for doing

Meaningful use. This is very difficult to actualize, since the behind the scenes work is huge and expensive, but I do believe it will happen.

>

> The Part !! modules really don't take too much time, if you know how to work through them. It is much more cost effective to do the 10 year cert than the lesser, and you will have to change eventually anyway. The purpose of the Patient simulations is to get

everyone ready for them being on the recertification exam by 2014.

>

> The way I take the SAM's is to just take the test, if you miss a question, you will directed to the resource where the answer is found and you can review those questions and then answer them again. Took me a couple of hours to do the last one, and I think

I even learned a little.

>

> There is a Part IV module now that sort of replicates the Meaning Use data collection. You get to pick several areas of data that you are already, hopefully, collecting for Meaningful Use and you can use the data already collected. The others, such as the

DM one, does take time, about 3 months to complete, since you have to survey your records, make an improvement and then resurvey the patients to see if you made any improvements.

>

> BTW,The website was recently changed and is much better. The other thing I can tell you is the ABFP, as opposed to the AAFP, is really on your side, and has tremendous resources to help you. Don't be afraid to call or communicate with the help line.I met

the folks that run this and they are top notch and committed to helping you work through the recert process. The mission of the ABFP is the be sure that the american public can be certain that the family docs who care for them are competent, and now that I

have seen the way the board works, I believe it is a dedicated effort, and not just a punitive process. There are more and better things coming in the next few years.

>

> Hope that helps,

> ________________________________________

> From: <mailto:%40yahoogroups.com><mailto: <mailto:%40yahoogroups.com>>

[ <mailto:%40yahoogroups.com><mailto: <mailto:%40yahoogroups.com>>]

On Behalf Of Helen Yang [helenwyang@...<mailto:helenwyang%40hotmail.com><mailto:helenwyang@...<mailto:helenwyang%40hotmail.com>>]

> Sent: Wednesday, July 27, 2011 8:38 PM

> To: IMP Group

> Subject: AAFP SAMs or other Modules

>

> Busy with the new IMP, I have done CMEs to keep up the license, but haven't done any of the AAFP modules since the recert. I would have to start doing the Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year track instead of regular

8 years.

>

> We use Kereo as the PM system which could track the diagnosis codes (was told so), but could not provide details such as how many DM with A1C at goal, ect

>

> Could any of you who have done these modules please share your thoughts about these modules and how much time it may take to get them done? Any thoughts on the PPMs MMIMs NTRIC, PORI modules?

>

> Thank you very much for any input.

>

> Helen

>

> ------------------------------------

>

>

[Guest guest]

Thanks for the feedback Jim.

I've been procrastinating on starting the hand washing module. If

"self directed PIM" can be done with HYH, then that's a much better

use of my time.

However, "self directed PIM" doesn't appear anywhere on the ABFM

list of modules for Part IV, list of external modules, nor anywhere

else on the ABFM website. I'll contact one of the two persons

listed and inquire about this further.

Pierce

I am picking up this thread again, since I just got

back from my first ABFM meeting. This is an article in

the JABFM from about a year ago explaining fully how the

test is created and the items validated. It is more

complete than I coudl say here, and I can say that the

testing committee is reevaluating the philosophy of the

how the items are picked. Currently the algorithum

starts by organ systems, with the percentage of question

based on the percentage of patient visits to the

aggregate of family docs based on NAMCS data. So if this

data shows that 15 % of all family medicine visits

relate to GI complaints than 15% of questions will, and

there is more granularity after that. The questions then

are scaled to run from ones that are expected to be

gotten correct by everyone, to ones that only one or

maybe no one will get correct, since that is the only

way to judge true knowledge. It gets harder from here to

explain, but as I said before, there is a high power

test designer incharge who you call to get more detail.

If you wish, I will give you his name. Maybe read the

article first.

The other more important news, is that there is a

way to use MU or perhpas HYH to get part 4 credit. If

you do a "Self directed PIM', and you report your

finding prior to and after completing meaningul use, you

will get credit. How's that?

Jim

From:

[ ] On Behalf Of

[edwardsronaldj@...]

Sent: Thursday, August 11, 2011 9:54 PM

To:

Subject: Re: Re: AAFP SAMs

or other Modules

Jim, how is the recert exam created? I took it

last month and thought it was way off

track. Too many of the questions dealt with

topics that are rarely encountered and that I

havent thought about since medical school. What

were the goals of the creators of the exam?

On Thu, Aug 11, 2011 at 10:16 PM,

Bleiweiss

wrote:

Sharlene and ,

Thanks

for chimming in.... I too want

it to be said again, This is NOT

about bashing Jim our one and

only ace in this fox hole

probably (are there any others

there with you Jim???). Please

try to slug your ways thru to

the bottom and read my last

reply.... In the ending I feel I

really start to get to the root

causes of most if not almost all

of this and other similar

problems.... It is a trauma

abuse response of compliance and

buying into the horribly painful

crap that your tormentor has

been hitting you over the head

with day after day, year after

year.... An entire profession

that is just about defeated and

completely learned helpless (a

form of enviornmentally caused

depression and a model from

which to better understand such

a thing) by those that have the

most to hide no less ill

gottenly gain from all of you...

us. This has been my growing

hypothesis about the lack of

spine and backbone to stand up

for yourself, ourselves in

primary care for quite sometime

now....

I

believe this theory to be

extremely sound and valid and

would love to be able to form

means of investigating and

testing it's validity and

significance. But if nothing

else if each and everyone of you

were to start to try to use this

as your perspective from which

to view things like P4P,

Meaningless Use, Full and

Required, Reward and

Punishment but unproven Free

Market EMR's and E-Rx'ing that

is choking a very popular

program and shutting it down,

crashing it... And possibly

because the Rx Vendor Middlemen

making the big bucks in the

middle are not doing their job

well either (not proven but was

floated as part of the problems,

Rx's not being there at local

places that faxes worked for the

last 10 years for example). Just

in general, when ever someone

other than a modest sized doctor

in actual practice comes up with

some NEW fango'ed HUGE,

expensive has their hands in

someone's and usually OURS TOO

pockets, or means we work now

for some promise of another

"delayed" reward on the

otherside... STOP!!!! Question,

and wonder who is this coming

from and what are they REALLY

after besides my hard work and

my hard earned money off of my

practice and profession????

The insurance industry

always finds scapegoats to blame

no matter what the line of

business or products.... Sure

there are always some folks who

try to scam the system and get

away with some crap... but the

vast majority of folks just want

to file a claim, be helped or

made whole and try to get back

on with their lives again....

Most people are NOT scammers and

insurance frauds.... What they

do to each and every primary

care doctor every day, NOW THAT

IS A FRAUD and a crime of epic

porportion for sure.... We are

just the most visable and the

most vulnerable victims to be

used and abused by this Horribly

Unethical Industry because the

gov't set up the playing field

so unlevel and unfairly.... We

have almost NO power or clout

and they have almost all of it,

we have almost NO laws that

protect our interests against

them, while they have almost all

of the one's that really

count... They hold the purse

strings and we never do so it is

Trickle down to us and beg for a

meal from them.....

This is a traumatising,

abusive, misuse of power and

authority relationship and other

players are playing into it for

their own less than ideal or

ethical reasons too. Like the

CMS and AMA collusion to control

the fees in favor of the AMA

favorite children while starving

out Cinderella over in the

corner and beating her and

emtionally abusing her as

well.... But one can never break

free of Gaslighting, Mobbing and

other forms of emotional abuse

if and until they are really

able to see, accept it for what

it is, and then have their eyes

open so they can never again see

things the old way... And as

with all abuse victims one of

the hardest parts to swallow was

your own part in the

dysfunctional dance you were

engaged in with your abuser and

tormentor... It is hard to

accept and hard to swallow and

that pain keeps many abuse

victims in denial...

And so it is my firm

belief that we are suffering

from a profession wide form of

gaslighting, mobbing and

abuse.... And one of the Red

Flags of Mobbing is that the

person singled out by the group

for the abuse (like mass work

place abuse of one person

usually started by someone who

is competing with them, or is

their boss or one who the victim

is in charge of yes, both

ways...) is usually pretty darn

GOOD at what they do, there

really is very little merit to

what is happening to them once

the surface crap is peeled

away.... This is the work of

someone or someones who want or

feel the need to ruin someone to

get them out of the way for one

reason or another....

And so primary care gets

to wear the dunce cap and the

Cone of Shame, be the

sacrificial lamb and the

scapegoat for all these other

"Stakeholders" and greedy

leeches... Think about and let

me know what you think.... I

believe those of you here are

independent enough thinkers to

give this a fair shake... Take

care and Be Well.... And Jim I

do respect you very, very

much... I really do.

Unfortunately because of the

board's disconnect, you are our

only means of communicating with

them.... That is part of the

larger problem.... no

conversation, no meetings across

the country, no comment and

feedback period, no long

defendable, presentable research

project to present showing just

how Great and Valid it is and

how wonderful they really

are.... Those with great stuff

tend to come out and talk, Show

their faces... While those who

are affraid and not sure of

themselves, or are not coming

from a good, ethical or

defendable place, those kind of

folks tend to stay

removed and hide... Play

Exhaulted Leader... Demi-God.

From:

sharkinn

To:

Sent:

Thursday, August 11, 2011 8:14

PM

Subject:

Re: AAFP

SAMs or other Modules

Jim, For a slightly

more abbreviated version

of what is saying,

below is a copy of my

message to you from 5/24,

to which I did not see a

response. I'm really not

trying to beat up on you,

honestly. It sounds as if

you have the best of

intentions and our (small

practices') best interests

at heart. But your analogy

likening choosing not to

fly and choosing not to be

board certified is not

fair. You wrote, "I can

choose to put up with the

TSA and fly, or I can

drive. I can choose to put

up with the ABFM, or not

be boarded." I'm sure that

there are some careers

where refusing to fly

would be the end, but not

most, and certainly not

ours. But, since insurance

companies have started

requiring board

certification to be on

their panel of physicians,

letting our board cert.

lapse is the equivalent of

saying we will never

participate with the major

insurers again. Certainly,

I would LIKE to say that,

but the awful truth is

that it is not financially

feasible for most of us. I

know for a fact it would

spell the end of my

current practice. So,

board certification is no

longer a marker of special

qualifications, it is a

minimum requirement to

practice. And it is SO

frustrating when someone

comes along and invents a

whole new process that is

extremely onerous, yet

necessary for us to comply

with, at a time when a

large proportion of us

beleaguered family docs

are already feeling on the

verge of collapse. I am

getting chest pain and

choked up just typing

this, and I guess that's

just what and I want

the Board to know. If, as

you say, they have heard

all this before, WHY

AREN'T THEY LISTENING?!?

It appears that we are not

their constituents. I read

their last newsletter, in

which they claimed to be

listening and responding

to our needs, but nothing

I saw made anything

significantly easier. I

guess I would just like to

know that our "insider" is

going to give them that

feedback.---Respectfully,

Sharlene---

Jim,

Please let the

Board(ABFM)know that I am

absolutely FURIOUS with

them for coming up with

such a ridiculously

complex and time-consuming

scheme for maintenance of

certification!!! Do other

specialty boards put their

diplomates through this

kind of ordeal? I feel

that we ordinary

physicians have been

completely sold out by

people who must have no

idea what a struggle it is

just

to survive in today's

practice environment. I

have no problem with

reading to keep up with

the problems I encounter

from day to day, earning

some CME credits of my own

choosing, and taking

occasional tests. In fact,

I would rather take a

day-long test EVERY YEAR

than keep up with this

MOC!! And I'll bet there

is absolutely no evidence

that doing all of this

will make us better family

doctors. If I didn't have

to be board certified to

participate with most

insurance companies, I

would absolutely let my

certification lapse. And

if I ever go CASH ONLY,

which it looks like I will

need to, since I have no

intention of becoming part

of an ACO, I will

definitly drop

it!---Sharlene---

> Helen,

> The SAM's come from

the ABFP, the AAFP has

nothing to do with

these. Since I am now on

the ABFP, I can tell you

that the board is

working to make Part IV

modules more meaningful.

For instance giving

credit for PQRI, and I

am pushing to give

credit for doing

Meaningful use. This is

very difficult to

actualize, since the

behind the scenes work

is huge and expensive,

but I do believe it will

happen.

>

> The Part !! modules

really don't take too

much time, if you know

how to work through

them. It is much more

cost effective to do the

10 year cert than the

lesser, and you will

have to change

eventually anyway. The

purpose of the Patient

simulations is to get

everyone ready for them

being on the

recertification exam by

2014.

>

> The way I take the

SAM's is to just take

the test, if you miss a

question, you will

directed to the resource

where the answer is

found and you can review

those questions and then

answer them again. Took

me a couple of hours to

do the last one, and I

think I even learned a

little.

>

> There is a Part IV

module now that sort of

replicates the Meaning

Use data collection. You

get to pick several

areas of data that you

are already, hopefully,

collecting for

Meaningful Use and you

can use the data already

collected. The others,

such as the DM one, does

take time, about 3

months to complete,

since you have to survey

your records, make an

improvement and then

resurvey the patients to

see if you made any

improvements.

>

> BTW,The website was

recently changed and is

much better. The other

thing I can tell you is

the ABFP, as opposed to

the AAFP, is really on

your side, and has

tremendous resources to

help you. Don't be

afraid to call or

communicate with the

help line.I met the

folks that run this and

they are top notch and

committed to helping you

work through the recert

process. The mission of

the ABFP is the be sure

that the american public

can be certain that the

family docs who care for

them are competent, and

now that I have seen the

way the board works, I

believe it is a

dedicated effort, and

not just a punitive

process. There are more

and better things coming

in the next few years.

>

> Hope that helps,

>

________________________________________

> From: <mailto:%40yahoogroups.com><mailto: <mailto:%40yahoogroups.com>>

[ <mailto:%40yahoogroups.com><mailto: <mailto:%40yahoogroups.com>>]

On Behalf Of Helen Yang

[helenwyang@...<mailto:helenwyang%40hotmail.com><mailto:helenwyang@...<mailto:helenwyang%40hotmail.com>>]

> Sent: Wednesday,

July 27, 2011 8:38 PM

> To: IMP Group

> Subject:

AAFP SAMs or other

Modules

>

> Busy with the new

IMP, I have done CMEs to

keep up the license, but

haven't done any of the

AAFP modules since the

recert. I would have to

start doing the Part II

SAMs Modules and /or

Part IV modules in order

to stay on the 10 year

track instead of regular

8 years.

>

> We use Kereo as the

PM system which could

track the diagnosis

codes (was told so), but

could not provide

details such as how many

DM with A1C at goal, ect

>

> Could any of you

who have done these

modules please share

your thoughts about

these modules and how

much time it may take to

get them done? Any

thoughts on the PPMs

MMIMs NTRIC, PORI

modules?

>

> Thank you very much

for any input.

>

> Helen

>

>

------------------------------------

>

>

[Guest guest]

Jim,

That sounds great! But when will it be an option for us?

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On Behalf Of Kennedy, Jim

Sent: Thursday, October 06, 2011 12:46 PM

To:

Subject: RE: Re: AAFP SAMs or other Modules

The other more important news, is that there is a way to use MU or

perhpas HYH to get part 4 credit. If you do a " Self directed PIM', and you

report your finding prior to and after completing meaningul use, you will get

credit. How's that?

Jim

.._,___

[Guest guest]

Keep us posted, please, .

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On Behalf Of Pierce

Sent: Thursday, October 06, 2011 3:20 PM

To:

Subject: Re: Re: AAFP SAMs or other Modules

Thanks for the feedback Jim.

I've been procrastinating on starting the hand washing

module. If " self directed PIM " can be done with

HYH, then that's a much better use of my time.

However, " self directed PIM " doesn't appear anywhere on the ABFM list

of modules for Part IV, list of external modules, nor anywhere else on the ABFM

website. I'll contact one of the two persons listed and inquire about

this further.

Pierce

I am picking up this thread again, since I just got back

from my first ABFM meeting. This is an article in the JABFM from about a year

ago explaining fully how the test is created and the items validated. It is

more complete than I coudl say here, and I can say that the testing committee

is reevaluating the philosophy of the how the items are picked. Currently the

algorithum starts by organ systems, with the percentage of question based on

the percentage of patient visits to the aggregate of family docs based on NAMCS

data. So if this data shows that 15 % of all family medicine visits relate to

GI complaints than 15% of questions will, and there is more granularity after

that. The questions then are scaled to run from ones that are expected to be

gotten correct by everyone, to ones that only one or maybe no one will get

correct, since that is the only way to judge true knowledge. It gets harder

from here to explain, but as I said before, there is a high power test designer

incharge who you call to get more detail. If you wish, I will give you his

name. Maybe read the article first.

The other more important news, is that there is a way to use

MU or perhpas HYH to get part 4 credit. If you do a " Self directed PIM',

and you report your finding prior to and after completing meaningul use, you

will get credit. How's that?

Jim

From:

[ ]

On Behalf Of [edwardsronaldj@...]

Sent: Thursday, August 11, 2011 9:54 PM

To:

Subject: Re: Re: AAFP SAMs or other Modules

Jim, how is the recert exam created? I took it last month and thought

it was way off track. Too many of the questions dealt with topics

that are rarely encountered and that I havent thought about since medical

school. What were the goals of the creators of the exam?

Sharlene and ,

Thanks for chimming in.... I too

want it to be said again, This is NOT about bashing Jim our one and only ace in

this fox hole probably (are there any others there with you Jim???). Please try

to slug your ways thru to the bottom and read my last reply.... In the ending I

feel I really start to get to the root causes of most if not almost all of this

and other similar problems.... It is a trauma abuse response of compliance and

buying into the horribly painful crap that your tormentor has been hitting you

over the head with day after day, year after year.... An entire profession that

is just about defeated and completely learned helpless (a form of

enviornmentally caused depression and a model from which to better understand

such a thing) by those that have the most to hide no less ill gottenly gain

from all of you... us. This has been my growing hypothesis about the lack of

spine and backbone to stand up for yourself, ourselves in primary care for

quite sometime now....

I believe this theory to be

extremely sound and valid and would love to be able to form means of

investigating and testing it's validity and significance. But if nothing else

if each and everyone of you were to start to try to use this as your perspective

from which to view things like P4P, Meaningless Use, Full and Required, Reward

and Punishment but unproven Free Market EMR's and E-Rx'ing that is choking

a very popular program and shutting it down, crashing it... And possibly

because the Rx Vendor Middlemen making the big bucks in the middle are not

doing their job well either (not proven but was floated as part of the

problems, Rx's not being there at local places that faxes worked for the last

10 years for example). Just in general, when ever someone other than a modest

sized doctor in actual practice comes up with some NEW fango'ed HUGE, expensive

has their hands in someone's and usually OURS TOO pockets, or means we work now

for some promise of another " delayed " reward on the otherside...

STOP!!!! Question, and wonder who is this coming from and what are they REALLY

after besides my hard work and my hard earned money off of my practice and

profession????

The insurance industry always finds scapegoats to blame no

matter what the line of business or products.... Sure there are always some

folks who try to scam the system and get away with some crap... but the vast

majority of folks just want to file a claim, be helped or made whole and try to

get back on with their lives again.... Most people are NOT scammers and

insurance frauds.... What they do to each and every primary care doctor every

day, NOW THAT IS A FRAUD and a crime of epic porportion for sure.... We are

just the most visable and the most vulnerable victims to be used and abused by

this Horribly Unethical Industry because the gov't set up the playing field so

unlevel and unfairly.... We have almost NO power or clout and they have almost

all of it, we have almost NO laws that protect our interests against them,

while they have almost all of the one's that really count... They hold the

purse strings and we never do so it is Trickle down to us and beg for a meal

from them.....

This is a traumatising, abusive, misuse of power and

authority relationship and other players are playing into it for their own less

than ideal or ethical reasons too. Like the CMS and AMA collusion to control

the fees in favor of the AMA favorite children while starving out Cinderella

over in the corner and beating her and emtionally abusing her as well.... But

one can never break free of Gaslighting, Mobbing and other forms of emotional

abuse if and until they are really able to see, accept it for what it is, and

then have their eyes open so they can never again see things the old way... And

as with all abuse victims one of the hardest parts to swallow was your own part

in the dysfunctional dance you were engaged in with your abuser and

tormentor... It is hard to accept and hard to swallow and that pain keeps many

abuse victims in denial...

And so it is my firm belief that we are suffering from a

profession wide form of gaslighting, mobbing and abuse.... And one of the Red

Flags of Mobbing is that the person singled out by the group for the abuse

(like mass work place abuse of one person usually started by someone who is

competing with them, or is their boss or one who the victim is in charge of

yes, both ways...) is usually pretty darn GOOD at what they do, there really is

very little merit to what is happening to them once the surface crap is peeled

away.... This is the work of someone or someones who want or feel the need to

ruin someone to get them out of the way for one reason or another....

And so primary care gets to wear the dunce cap and the Cone

of Shame, be the sacrificial lamb and the scapegoat for all these other

" Stakeholders " and greedy leeches... Think about and let me know what

you think.... I believe those of you here are independent enough thinkers to

give this a fair shake... Take care and Be Well.... And Jim I do respect you

very, very much... I really do. Unfortunately because of the board's

disconnect, you are our only means of communicating with them.... That is part

of the larger problem.... no conversation, no meetings across the country, no

comment and feedback period, no long defendable, presentable research project

to present showing just how Great and Valid it is and how wonderful they really

are.... Those with great stuff tend to come out and talk, Show their faces...

While those who are affraid and not sure of themselves, or are not coming

from a good, ethical or defendable place, those kind of folks tend to stay

removed and hide... Play Exhaulted Leader... Demi-God.

To:

Sent: Thursday, August 11, 2011 8:14 PM

Subject: Re: AAFP SAMs or other Modules

Jim, For a slightly more abbreviated version of what

is saying, below is a copy of my message to you from 5/24, to which I did not

see a response. I'm really not trying to beat up on you, honestly. It sounds as

if you have the best of intentions and our (small practices') best interests at

heart. But your analogy likening choosing not to fly and choosing not to be

board certified is not fair. You wrote, " I can choose to put up with the

TSA and fly, or I can drive. I can choose to put up with the ABFM, or not be

boarded. " I'm sure that there are some careers where refusing to fly would

be the end, but not most, and certainly not ours. But, since insurance

companies have started requiring board certification to be on their panel of

physicians, letting our board cert. lapse is the equivalent of saying we will

never participate with the major insurers again. Certainly, I would LIKE to say

that, but the awful truth is that it is not financially feasible for most of

us. I know for a fact it would spell the end of my current practice. So, board

certification is no longer a marker of special qualifications, it is a minimum

requirement to practice. And it is SO frustrating when someone comes along and

invents a whole new process that is extremely onerous, yet necessary for us to

comply with, at a time when a large proportion of us beleaguered family docs

are already feeling on the verge of collapse. I am getting chest pain and

choked up just typing this, and I guess that's just what and I want the

Board to know. If, as you say, they have heard all this before, WHY AREN'T THEY

LISTENING?!? It appears that we are not their constituents. I read their last

newsletter, in which they claimed to be listening and responding to our needs,

but nothing I saw made anything significantly easier. I guess I would just like

to know that our " insider " is going to give them that

feedback.---Respectfully, Sharlene---

Jim, Please let the Board(ABFM)know that I am absolutely

FURIOUS with them for coming up with such a ridiculously complex and

time-consuming scheme for maintenance of certification!!! Do other specialty

boards put their diplomates through this kind of ordeal? I feel that we

ordinary physicians have been completely sold out by people who must have no

idea what a struggle it is just

to survive in today's practice environment. I have no problem with reading to

keep up with the problems I encounter from day to day, earning some CME credits

of my own choosing, and taking occasional tests. In fact, I would rather take a

day-long test EVERY YEAR than keep up with this MOC!! And I'll bet there is

absolutely no evidence that doing all of this will make us better family

doctors. If I didn't have to be board certified to participate with most

insurance companies, I would absolutely let my certification lapse. And if I

ever go CASH ONLY, which it looks like I will need to, since I have no

intention of becoming part of an ACO, I will definitly drop it!---Sharlene---

> Helen,

> The SAM's come from the ABFP, the AAFP has nothing to do with these. Since

I am now on the ABFP, I can tell you that the board is working to make Part IV

modules more meaningful. For instance giving credit for PQRI, and I am pushing

to give credit for doing Meaningful use. This is very difficult to actualize,

since the behind the scenes work is huge and expensive, but I do believe it

will happen.

>

> The Part !! modules really don't take too much time, if you know how to

work through them. It is much more cost effective to do the 10 year cert than

the lesser, and you will have to change eventually anyway. The purpose of the

Patient simulations is to get everyone ready for them being on the recertification

exam by 2014.

>

> The way I take the SAM's is to just take the test, if you miss a question,

you will directed to the resource where the answer is found and you can review

those questions and then answer them again. Took me a couple of hours to do the

last one, and I think I even learned a little.

>

> There is a Part IV module now that sort of replicates the Meaning Use data

collection. You get to pick several areas of data that you are already,

hopefully, collecting for Meaningful Use and you can use the data already

collected. The others, such as the DM one, does take time, about 3 months to

complete, since you have to survey your records, make an improvement and then

resurvey the patients to see if you made any improvements.

>

> BTW,The website was recently changed and is much better. The other thing I

can tell you is the ABFP, as opposed to the AAFP, is really on your side, and

has tremendous resources to help you. Don't be afraid to call or communicate

with the help line.I met the folks that run this and they are top notch and

committed to helping you work through the recert process. The mission of the

ABFP is the be sure that the american public can be certain that the family

docs who care for them are competent, and now that I have seen the way the

board works, I believe it is a dedicated effort, and not just a punitive

process. There are more and better things coming in the next few years.

>

> Hope that helps,

> ________________________________________

> From: <mailto:%40yahoogroups.com><mailto: <mailto:%40yahoogroups.com>>

[ <mailto:%40yahoogroups.com><mailto: <mailto:%40yahoogroups.com>>]

On Behalf Of Helen Yang [helenwyang@...<mailto:helenwyang%40hotmail.com><mailto:helenwyang@...<mailto:helenwyang%40hotmail.com>>]

> Sent: Wednesday, July 27, 2011 8:38 PM

> To: IMP Group

> Subject: AAFP SAMs or other Modules

>

> Busy with the new IMP, I have done CMEs to keep up the license, but

haven't done any of the AAFP modules since the recert. I would have to start

doing the Part II SAMs Modules and /or Part IV modules in order to stay on the

10 year track instead of regular 8 years.

>

> We use Kereo as the PM system which could track the diagnosis codes (was

told so), but could not provide details such as how many DM with A1C at goal,

ect

>

> Could any of you who have done these modules please share your thoughts

about these modules and how much time it may take to get them done? Any

thoughts on the PPMs MMIMs NTRIC, PORI modules?

>

> Thank you very much for any input.

>

> Helen

>

> ------------------------------------

>

>

[Guest guest]

Theorectically it is available now. The biggest issue for the next 6 months is it is all done by hand, and the volume could cause them to put you on hold. Within 6 months, the platform agreement with ABIM should be inplace allowing to happen electronically

and seamlessly. So if you are not due by the end of this year to complete a part IV module, I would wait until next year

From: [ ] On Behalf Of Eads [michelle.eads@...]

Sent: Friday, October 07, 2011 9:22 AM

To:

Subject: RE: Re: AAFP SAMs or other Modules

Jim,

That sounds great! But when will it be an option for us?

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

From: [mailto: ]

On Behalf Of Kennedy, Jim

Sent: Thursday, October 06, 2011 12:46 PM

To:

Subject: RE: Re: AAFP SAMs or other Modules

The other more important news, is that there is a way to use MU or perhpas HYH to get part 4 credit. If you do a " Self directed PIM', and you report your finding prior to and after completing

meaningul use, you will get credit. How's that?

Jim

.._,___

[Guest guest]

AS I said in my other post, this is not advertized as yet, but next year would be a better time, unless you just can't wait. You need to call them and ask them if you can do this this year.

I am just finishing the Hypertension one, and it is rather simple, you could try that one.

From: [ ] On Behalf Of Eads [michelle.eads@...]

Sent: Friday, October 07, 2011 9:22 AM

To:

Subject: RE: Re: AAFP SAMs or other Modules

Keep us posted, please, .

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

From: [mailto: ]

On Behalf Of Pierce

Sent: Thursday, October 06, 2011 3:20 PM

To:

Subject: Re: Re: AAFP SAMs or other Modules

Thanks for the feedback Jim.

I've been procrastinating on starting the hand washing module. If " self directed PIM " can be done with HYH, then that's a much better use of my time.

However, " self directed PIM " doesn't appear anywhere on the ABFM list of modules for Part IV, list of external modules, nor anywhere else on the ABFM website. I'll contact one of the two persons listed and inquire about this further.

Pierce

I am picking up this thread again, since I just got back from my first ABFM meeting. This is an article in the JABFM from about a year ago explaining fully how the test is created and the items validated. It is more complete than I coudl

say here, and I can say that the testing committee is reevaluating the philosophy of the how the items are picked. Currently the algorithum starts by organ systems, with the percentage of question based on the percentage of patient visits to the aggregate

of family docs based on NAMCS data. So if this data shows that 15 % of all family medicine visits relate to GI complaints than 15% of questions will, and there is more granularity after that. The questions then are scaled to run from ones that are expected

to be gotten correct by everyone, to ones that only one or maybe no one will get correct, since that is the only way to judge true knowledge. It gets harder from here to explain, but as I said before, there is a high power test designer incharge who you call

to get more detail. If you wish, I will give you his name. Maybe read the article first.

The other more important news, is that there is a way to use MU or perhpas HYH to get part 4 credit. If you do a " Self directed PIM', and you report your finding prior to and after completing meaningul use, you will get credit. How's that?

Jim

From:

[ ] On Behalf Of [edwardsronaldj@...]

Sent: Thursday, August 11, 2011 9:54 PM

To:

Subject: Re: Re: AAFP SAMs or other Modules

Jim, how is the recert exam created? I took it last month and thought it was way off track. Too many of the questions dealt with topics that are rarely encountered and that I havent thought about since medical school. What were the goals of the creators

of the exam?

Sharlene and ,

Thanks for chimming in.... I too want it to be said again, This is NOT about bashing Jim our one and only ace in this fox hole probably (are there any others there with you Jim???). Please try to slug your ways thru to the bottom and

read my last reply.... In the ending I feel I really start to get to the root causes of most if not almost all of this and other similar problems.... It is a trauma abuse response of compliance and buying into the horribly painful crap that your tormentor

has been hitting you over the head with day after day, year after year.... An entire profession that is just about defeated and completely learned helpless (a form of enviornmentally caused depression and a model from which to better understand such a thing)

by those that have the most to hide no less ill gottenly gain from all of you... us. This has been my growing hypothesis about the lack of spine and backbone to stand up for yourself, ourselves in primary care for quite sometime now....

I believe this theory to be extremely sound and valid and would love to be able to form means of investigating and testing it's validity and significance. But if nothing else if each and everyone of you were to start to try to use this

as your perspective from which to view things like P4P, Meaningless Use, Full and Required, Reward and Punishment but unproven Free Market EMR's and E-Rx'ing that is choking a very popular program and shutting it down, crashing it... And possibly because the

Rx Vendor Middlemen making the big bucks in the middle are not doing their job well either (not proven but was floated as part of the problems, Rx's not being there at local places that faxes worked for the last 10 years for example). Just in general, when

ever someone other than a modest sized doctor in actual practice comes up with some NEW fango'ed HUGE, expensive has their hands in someone's and usually OURS TOO pockets, or means we work now for some promise of another " delayed " reward on the otherside...

STOP!!!! Question, and wonder who is this coming from and what are they REALLY after besides my hard work and my hard earned money off of my practice and profession????

The insurance industry always finds scapegoats to blame no matter what the line of business or products.... Sure there are always some folks who try to scam the system and get away with some crap... but the vast majority of folks just want

to file a claim, be helped or made whole and try to get back on with their lives again.... Most people are NOT scammers and insurance frauds.... What they do to each and every primary care doctor every day, NOW THAT IS A FRAUD and a crime of epic porportion

for sure.... We are just the most visable and the most vulnerable victims to be used and abused by this Horribly Unethical Industry because the gov't set up the playing field so unlevel and unfairly.... We have almost NO power or clout and they have almost

all of it, we have almost NO laws that protect our interests against them, while they have almost all of the one's that really count... They hold the purse strings and we never do so it is Trickle down to us and beg for a meal from them.....

This is a traumatising, abusive, misuse of power and authority relationship and other players are playing into it for their own less than ideal or ethical reasons too. Like the CMS and AMA collusion to control the fees in favor of the AMA

favorite children while starving out Cinderella over in the corner and beating her and emtionally abusing her as well.... But one can never break free of Gaslighting, Mobbing and other forms of emotional abuse if and until they are really able to see, accept

it for what it is, and then have their eyes open so they can never again see things the old way... And as with all abuse victims one of the hardest parts to swallow was your own part in the dysfunctional dance you were engaged in with your abuser and tormentor...

It is hard to accept and hard to swallow and that pain keeps many abuse victims in denial...

And so it is my firm belief that we are suffering from a profession wide form of gaslighting, mobbing and abuse.... And one of the Red Flags of Mobbing is that the person singled out by the group for the abuse (like mass work place abuse

of one person usually started by someone who is competing with them, or is their boss or one who the victim is in charge of yes, both ways...) is usually pretty darn GOOD at what they do, there really is very little merit to what is happening to them once

the surface crap is peeled away.... This is the work of someone or someones who want or feel the need to ruin someone to get them out of the way for one reason or another....

And so primary care gets to wear the dunce cap and the Cone of Shame, be the sacrificial lamb and the scapegoat for all these other " Stakeholders " and greedy leeches... Think about and let me know what you think.... I believe those of you

here are independent enough thinkers to give this a fair shake... Take care and Be Well.... And Jim I do respect you very, very much... I really do. Unfortunately because of the board's disconnect, you are our only means of communicating with them.... That

is part of the larger problem.... no conversation, no meetings across the country, no comment and feedback period, no long defendable, presentable research project to present showing just how Great and Valid it is and how wonderful they really are.... Those

with great stuff tend to come out and talk, Show their faces... While those who are affraid and not sure of themselves, or are not coming from a good, ethical or defendable place, those kind of folks tend to stay removed and hide... Play Exhaulted Leader...

Demi-God.

To:

Sent: Thursday, August 11, 2011 8:14 PM

Subject: Re: AAFP SAMs or other Modules

Jim, For a slightly more abbreviated version of what is saying, below is a copy of my message to you from 5/24, to which I did not see a response. I'm really not trying to beat up on you, honestly. It sounds as if you have the best

of intentions and our (small practices') best interests at heart. But your analogy likening choosing not to fly and choosing not to be board certified is not fair. You wrote, " I can choose to put up with the TSA and fly, or I can drive. I can choose to put

up with the ABFM, or not be boarded. " I'm sure that there are some careers where refusing to fly would be the end, but not most, and certainly not ours. But, since insurance companies have started requiring board certification to be on their panel of physicians,

letting our board cert. lapse is the equivalent of saying we will never participate with the major insurers again. Certainly, I would LIKE to say that, but the awful truth is that it is not financially feasible for most of us. I know for a fact it would spell

the end of my current practice. So, board certification is no longer a marker of special qualifications, it is a minimum requirement to practice. And it is SO frustrating when someone comes along and invents a whole new process that is extremely onerous, yet

necessary for us to comply with, at a time when a large proportion of us beleaguered family docs are already feeling on the verge of collapse. I am getting chest pain and choked up just typing this, and I guess that's just what and I want the Board to

know. If, as you say, they have heard all this before, WHY AREN'T THEY LISTENING?!? It appears that we are not their constituents. I read their last newsletter, in which they claimed to be listening and responding to our needs, but nothing I saw made anything

significantly easier. I guess I would just like to know that our " insider " is going to give them that feedback.---Respectfully, Sharlene---

Jim, Please let the Board(ABFM)know that I am absolutely FURIOUS with them for coming up with such a ridiculously complex and time-consuming scheme for maintenance of certification!!! Do other specialty boards put their diplomates through

this kind of ordeal? I feel that we ordinary physicians have been completely sold out by people who must have no idea what a struggle it is just

to survive in today's practice environment. I have no problem with reading to keep up with the problems I encounter from day to day, earning some CME credits of my own choosing, and taking occasional tests. In fact, I would rather take a day-long test EVERY

YEAR than keep up with this MOC!! And I'll bet there is absolutely no evidence that doing all of this will make us better family doctors. If I didn't have to be board certified to participate with most

insurance companies, I would absolutely let my certification lapse. And if I ever go CASH ONLY, which it looks like I will need to, since I have no intention of becoming part of an ACO, I will definitly drop it!---Sharlene---

> Helen,

> The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I am now on the ABFP, I can tell you that the board is working to make Part IV modules more meaningful. For instance giving credit for PQRI, and I am pushing to give credit for doing

Meaningful use. This is very difficult to actualize, since the behind the scenes work is huge and expensive, but I do believe it will happen.

>

> The Part !! modules really don't take too much time, if you know how to work through them. It is much more cost effective to do the 10 year cert than the lesser, and you will have to change eventually anyway. The purpose of the Patient simulations is to get

everyone ready for them being on the recertification exam by 2014.

>

> The way I take the SAM's is to just take the test, if you miss a question, you will directed to the resource where the answer is found and you can review those questions and then answer them again. Took me a couple of hours to do the last one, and I think

I even learned a little.

>

> There is a Part IV module now that sort of replicates the Meaning Use data collection. You get to pick several areas of data that you are already, hopefully, collecting for Meaningful Use and you can use the data already collected. The others, such as the

DM one, does take time, about 3 months to complete, since you have to survey your records, make an improvement and then resurvey the patients to see if you made any improvements.

>

> BTW,The website was recently changed and is much better. The other thing I can tell you is the ABFP, as opposed to the AAFP, is really on your side, and has tremendous resources to help you. Don't be afraid to call or communicate with the help line.I met

the folks that run this and they are top notch and committed to helping you work through the recert process. The mission of the ABFP is the be sure that the american public can be certain that the family docs who care for them are competent, and now that I

have seen the way the board works, I believe it is a dedicated effort, and not just a punitive process. There are more and better things coming in the next few years.

>

> Hope that helps,

> ________________________________________

> From:

<mailto:%40yahoogroups.com><mailto: <mailto:%40yahoogroups.com>>

[ <mailto:%40yahoogroups.com><mailto: <mailto:%40yahoogroups.com>>]

On Behalf Of Helen Yang [helenwyang@...<mailto:helenwyang%40hotmail.com><mailto:helenwyang@...<mailto:helenwyang%40hotmail.com>>]

> Sent: Wednesday, July 27, 2011 8:38 PM

> To: IMP Group

> Subject: AAFP SAMs or other Modules

>

> Busy with the new IMP, I have done CMEs to keep up the license, but haven't done any of the AAFP modules since the recert. I would have to start doing the Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year track instead of regular

8 years.

>

> We use Kereo as the PM system which could track the diagnosis codes (was told so), but could not provide details such as how many DM with A1C at goal, ect

>

> Could any of you who have done these modules please share your thoughts about these modules and how much time it may take to get them done? Any thoughts on the PPMs MMIMs NTRIC, PORI modules?

>

> Thank you very much for any input.

>

> Helen

>

> ------------------------------------

>

>

[Guest guest]

Kathy,

I appreciate your common sense. You and I are a lot alike about our feelings, testing etc. I am 61 and almost decided not be boarded again, just for the hassle factor, but also was thinking it would " fun " to be boarded until

I am so demented that I did not care. The people on the board are truely great, smart and thoughtful people who want things to work well and to be as easy as it can be for us. We all have to continue our boards as long as we are on the board, so I am up for

testing next year.

I think the idea of having more specific modules or whatever, is good and many of us have proposed this. The board is split on what to do, but feels that fm docs should still have that broad knowledge. I do little gyn being

male and having my daugther in practice, and I do lots of ortho, so my practice is not usual. Whenever I bring this up, the answer is always, we believe fm docs should still have broad knowledge and you don't have to get 100%.

So, thanks for input.

Jim

From: [ ] On Behalf Of Kathy Saradarian [qualityfp@...]

Sent: Monday, November 28, 2011 5:57 AM

To:

Subject: RE: Re: AAFP SAMs or other Modules

Jim,

I have been meaning to respond to your posts for a while. But I am definitely in the minority and it kept me from jumping right into the conversation. Everyone was being so negative. And

hating the process of recertifying.

So I guess I am the exception. I don’t mind taking the Boards. I don’t love it so I am going to go the 10 year route. But it confirms for me what I am strong in and what I am weak in.

So far, I am pretty aware of which is which, but the time may come that I think I know a subject and have not been keeping up. So it will help me focus. I will admit that I am a good test taker. But come on, we have all had to take many of the tests to

get to where we are.

I have only done 1 SAM. I was in the last group to recertify under the old rules. I did not find the SAM (HTN) that difficult or annoying and again, learned from it. I did struggle in choosing

which modules to take at the Boards. As more and more of our practices are restricted that is going to become more difficult. I will be losing hospital. I don’t do procedures and that includes a lot of the GYN stuff. I don’t see kids under 5 d/t vaccine

issues, not enough to afford the vaccines. I think there should be a “General” FP tract without special focuses.

I did PQRI through the Board site past 2 years. Very helpful. And intend to do it again this year. And then this year, I was doing the MP thing. This is the most awkward thing and the worse

part about the Boards as far as I am concerned. And I still have to get back to it.

So what didn’t I like? #1, all the performance improvement suggestions, of which you had to chose one (topic was DM) were based on paper charts. I felt this was a little absurd as the push

is to get everyone on EHR but putting and extra piece of paper in the chart or a sticker, or whatever were the only suggestions. So I had to pick one, not planning on doing any of them as they didn’t apply. The other thing was that I got annoying reminders

starting less than 3 months later looking for me to review my data to see if I had improved. If I only see the patients every 3-6 months, depending on their diabetes control and co-morbid conditions, it is going to take more than 3 months. I am not going

to hit every DM with the deficiency the first time I see them as there are often other more urgent issues. PI projects take time to see improvement. There are many studies showing that. Look at the PCMH studies. So quit bugging me so quickly.

Just my thoughts. Thanks for being on the Board.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From: [mailto: ]

On Behalf Of Kennedy, Jim

Sent: Thursday, October 06, 2011 2:46 PM

To:

Subject: RE: Re: AAFP SAMs or other Modules

I am picking up this thread again, since I just got back from my first ABFM meeting. This is an article in the JABFM from about a year ago explaining fully how the test is created and the items

validated. It is more complete than I coudl say here, and I can say that the testing committee is reevaluating the philosophy of the how the items are picked. Currently the algorithum starts by organ systems, with the percentage of question based on the percentage

of patient visits to the aggregate of family docs based on NAMCS data. So if this data shows that 15 % of all family medicine visits relate to GI complaints than 15% of questions will, and there is more granularity after that. The questions then are scaled

to run from ones that are expected to be gotten correct by everyone, to ones that only one or maybe no one will get correct, since that is the only way to judge true knowledge. It gets harder from here to explain, but as I said before, there is a high power

test designer incharge who you call to get more detail. If you wish, I will give you his name. Maybe read the article first.

The other more important news, is that there is a way to use MU or perhpas HYH to get part 4 credit. If you do a " Self directed PIM', and you report your finding prior to and after completing

meaningul use, you will get credit. How's that?

Jim

[Guest guest]

I know a doctor who has trouble getting reimbursed from insurers if they are not board certified. Feels like black mail? My friend in insurance claims the insurance company is looking out for me by forcing board certification. How so? Her answer didn't really seem too weighty.

From:

Kennedy, Jim ;

To:

< >;

Subject:

RE: Re: AAFP SAMs or other Modules

Sent:

Mon, Nov 28, 2011 10:52:15 PM

Kathy,

I appreciate your common sense. You and I are a lot alike about our feelings, testing etc. I am 61 and almost decided not be boarded again, just for the hassle factor, but also was thinking it would " fun " to be boarded until

I am so demented that I did not care. The people on the board are truely great, smart and thoughtful people who want things to work well and to be as easy as it can be for us. We all have to continue our boards as long as we are on the board, so I am up for

testing next year.

I think the idea of having more specific modules or whatever, is good and many of us have proposed this. The board is split on what to do, but feels that fm docs should still have that broad knowledge. I do little gyn being

male and having my daugther in practice, and I do lots of ortho, so my practice is not usual. Whenever I bring this up, the answer is always, we believe fm docs should still have broad knowledge and you don't have to get 100%.

So, thanks for input.

Jim

From: [ ] On Behalf Of Kathy Saradarian [qualityfp@...]

Sent: Monday, November 28, 2011 5:57 AM

To:

Subject: RE: Re: AAFP SAMs or other Modules

Jim,

I have been meaning to respond to your posts for a while. But I am definitely in the minority and it kept me from jumping right into the conversation. Everyone was being so negative. And

hating the process of recertifying.

So I guess I am the exception. I don’t mind taking the Boards. I don’t love it so I am going to go the 10 year route. But it confirms for me what I am strong in and what I am weak in.

So far, I am pretty aware of which is which, but the time may come that I think I know a subject and have not been keeping up. So it will help me focus. I will admit that I am a good test taker. But come on, we have all had to take many of the tests to

get to where we are.

I have only done 1 SAM. I was in the last group to recertify under the old rules. I did not find the SAM (HTN) that difficult or annoying and again, learned from it. I did struggle in choosing

which modules to take at the Boards. As more and more of our practices are restricted that is going to become more difficult. I will be losing hospital. I don’t do procedures and that includes a lot of the GYN stuff. I don’t see kids under 5 d/t vaccine

issues, not enough to afford the vaccines. I think there should be a “General†FP tract without special focuses.

I did PQRI through the Board site past 2 years. Very helpful. And intend to do it again this year. And then this year, I was doing the MP thing. This is the most awkward thing and the worse

part about the Boards as far as I am concerned. And I still have to get back to it.

So what didn’t I like? #1, all the performance improvement suggestions, of which you had to chose one (topic was DM) were based on paper charts. I felt this was a little absurd as the push

is to get everyone on EHR but putting and extra piece of paper in the chart or a sticker, or whatever were the only suggestions. So I had to pick one, not planning on doing any of them as they didn’t apply. The other thing was that I got annoying reminders

starting less than 3 months later looking for me to review my data to see if I had improved. If I only see the patients every 3-6 months, depending on their diabetes control and co-morbid conditions, it is going to take more than 3 months. I am not going

to hit every DM with the deficiency the first time I see them as there are often other more urgent issues. PI projects take time to see improvement. There are many studies showing that. Look at the PCMH studies. So quit bugging me so quickly.

Just my thoughts. Thanks for being on the Board.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From: [mailto: ]

On Behalf Of Kennedy, Jim

Sent: Thursday, October 06, 2011 2:46 PM

To:

Subject: RE: Re: AAFP SAMs or other Modules

I am picking up this thread again, since I just got back from my first ABFM meeting. This is an article in the JABFM from about a year ago explaining fully how the test is created and the items

validated. It is more complete than I coudl say here, and I can say that the testing committee is reevaluating the philosophy of the how the items are picked. Currently the algorithum starts by organ systems, with the percentage of question based on the percentage

of patient visits to the aggregate of family docs based on NAMCS data. So if this data shows that 15 % of all family medicine visits relate to GI complaints than 15% of questions will, and there is more granularity after that. The questions then are scaled

to run from ones that are expected to be gotten correct by everyone, to ones that only one or maybe no one will get correct, since that is the only way to judge true knowledge. It gets harder from here to explain, but as I said before, there is a high power

test designer incharge who you call to get more detail. If you wish, I will give you his name. Maybe read the article first.

The other more important news, is that there is a way to use MU or perhpas HYH to get part 4 credit. If you do a " Self directed PIM', and you report your finding prior to and after completing

meaningul use, you will get credit. How's that?

Jim