Re: AAFP SAMs or other Modules

[Guest guest]

i will be taken off insurance panel by the quickest, highest paying insurance

carrier in my city if i am not board certified..

hows that?

beef..steak

grace

>

> 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 & #39;t really seem too weighty.

>

[Guest guest]

has already lost one or two of the better paying contracts because of this... and our local Blues, the 500 lbs. Gorilla in our room, perhaps as much as 60-70% of our commercial market is in their control..... So, Excellus BC/BS has given her the Big Threat, Arm Twist stating that she has until their next recert period period with them to make this go away or she is toast with them.....

Still sounds likes defacto licensing and market control, Anti-Trust like, collusion like control for that matter.... It should be illegal for insurance carriers to keep doctors off panel as long as they meet whatever their state's guidelines are to legal practice. End of story. But worse yet, the folks at the boards, they all know the real deal, the drill here and yet they continue to pretend that what they do, has no influence or impact on such super important matters as who survives or dies. And IMHO, I believe it all plays right into their hands and that they actually like it this way.... How many busy FP's, IM's, and Ped's would bother to deal with all of this CCHIT if it didn't mean their possibly being driven into the poor house???? That's Bull and that's Bullying.

To: Sent: Monday, November 28, 2011 6:41 PMSubject: Re: AAFP SAMs or other Modules

i will be taken off insurance panel by the quickest, highest paying insurance carrier in my city if i am not board certified..hows that?beef..steakgrace>> 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 & #39;t really seem too weighty.>

[Guest guest]

, We are specialists, specialists in Family Medicine.    Part of being a specialist means that we are Board Certified in that Specialty.  TO be Board Certified, you must past some tests.  We are hardly the only specialty that requires this.  Without our Board Certification, we are nothing more than General Practitioners.  Insurance companies have every right to contract with whomever they want.  They are trying to sell quality physicians to the employers.  If they only contracted with General Practitioners, who’s knowledge base is completely unknown, well, they may not appear so appealing to the employers buying the insurance.  It’s not just family physicians that are required to be Board Certified, its’ everyone.  You have a compound fracture of your femur with a shattered patella.  You want a person who calls himself an orthopedist to do the surgery?  Or someone who is a Board Certified Orthopedist.  You are having a heart attack.  You want someone who calls himself a cardiologist doing your catheterization and angioplasty with stenting?  Or a Board Certified Cardiologist? Now, there may be some who say they have met lousy Board Certified doctors.  True.  It doesn’t mean that person will have a good bedside manner.  It doesn’t mean they aren’t an alcoholic or drug addict or suffering from depression.    It doesn’t mean they are perfect and never make mistakes.  But it does guarantee a certain minimum level of knowledge.    Right now it is the only way we have to measure knowledge. I could go to 1000 hours of CME.  Does it make me knowledgeable in my area?  No.  I could sign in and leave.  I could sleep.  I could take courses in just about anything that has nothing to do with the patients and diseases that I treat.  Just saying you do CME doesn’t prove what you know and what you don’t. But the bottom line is taking exams to become Board Certified and stay Board Certified isn’t going anywhere.  Complaining about it doesn’t do any good as it isn’t going to change.  We had to take many tests to even become doctors.  This is not at all novel.  I had to take SATs to get into a good college.  I had to take MCATs to get into medical school.  I had to take 3 levels of exams to become licensed to be a doctor.  And then I had to take the Board Exams.  You want an Fellowship or Certificate of secondary specialty, guess what, you have to take a test to prove you know what you say you know.  If you didn’t want to have to take tests, why become doctors?                                                                                               Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of BleiweissSent: Monday, November 28, 2011 10:42 PMTo: Subject: Re: Re: AAFP SAMs or other Modules has already lost one or two of the better paying contracts because of this... and our local Blues, the 500 lbs. Gorilla in our room, perhaps as much as 60-70% of our commercial market is in their control..... So, Excellus BC/BS has given her the Big Threat, Arm Twist stating that she has until their next recert period period with them to make this go away or she is toast with them..... Still sounds likes defacto licensing and market control, Anti-Trust like, collusion like control for that matter.... It should be illegal for insurance carriers to keep doctors off panel as long as they meet whatever their state's guidelines are to legal practice. End of story. But worse yet, the folks at the boards, they all know the real deal, the drill here and yet they continue to pretend that what they do, has no influence or impact on such super important matters as who survives or dies. And IMHO, I believe it all plays right into their hands and that they actually like it this way.... How many busy FP's, IM's, and Ped's would bother to deal with all of this CCHIT if it didn't mean their possibly being driven into the poor house???? That's Bull and that's Bullying. To: Sent: Monday, November 28, 2011 6:41 PMSubject: Re: AAFP SAMs or other Modules i will be taken off insurance panel by the quickest, highest paying insurance carrier in my city if i am not board certified..hows that?beef..steakgrace>> 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 & #39;t really seem too weighty.>

[Guest guest]

Kathy,

It's not the concept of a test that bothers me so much... It is the entirely over the top, modules and expensive various ways of obtaining this life blood certification that bothers me so..... At some point its time to say; "Enough is Enough Already".... No less to have some disconnected board that certainly seems to not understand or relate to the day to day realities of those that they presently have way too much power and authority over, and without any public voice from those that they wield this power over....

Every year I must take a take home open book exam, a class that is both classroom as well as On-Ice, and at the end of the day, take a closed book exam as well and all just to be allowed to Officiate Amatuer Ice Hockey while coaches and others don't have to take classes but every 3 to 4 years.... There comes a point where we are going way beyond the means and intention of the original mandate.... Oh and that is just to be a level 2 or 3.... If I want to apply for level 4 (top level one can obtain) I would have to take a skills based exam based mainly upon my skating abilities and perhaps an even tougher closed book exam. Now I have no problem being tested most years but this year I am still attempting to recover from my coliltis and an entire summer of slugging around sick and on Prednisone making me even more weirded out swollen and far too over weight like never before....

BUT, Unlike many certified test and one day annual required clinic attending Level 4's out there... I have attended three 3 1/2 day long weekend USA Hockey run Officiating Camps in just about 12 years time span.... I was taught, endoctrinated into a professional mindset and better understanding and trained to a mental and personal level most of those tested but never classroomed, truly On-Ice Taught and Trained Officials could ever begin to understand..... A practical application and interpretation of the facts, rules are but rules and facts are but facts ( be they like mine or yours) to be memorized and spit back out..... But the actual practical understanding and the implications and applications of them are something completely different. And it was with the actual real and valid classwork that I started the journey in 1998 to become the professional I am

today... and all to officiate kids and adults in an amatuer sport... Not the crap on some test and not the crap in most CME classes either....

How about modestly funded and priced, actual classes, Real and Valid classes, tests not even need apply... To really have to emerse oneself in such classes, available in at least a few large cities in all states much like my officiating classes run and created by these supposedly so well versed and worth of passing judgement boards... Just the living together, eating together, taking class together, sweating together and having good interactive exchanges of ideas, theories and concepts, and sharing real life examples from interesting, great, aweful stressful, messed up and awesome games all the folks in that room have officiated over the last few years both outside of the actual classes no less stimulated back to memory and shared and debated in open forums in class as various parts of lessons brought them to mind and added to the lively debate; This was so much more worthy of certification of a certain

level obtained and so much more informative and worthy of learning you can't hold a candle to it....

And if there is anything life has taught me in all of my pursuits in many different fields and skills.... and that is this: Life long learners are just that life long learners and those that are NOT, simply are NOT..... If someone is passionate about what they do and what they want to learn, they will do it all of their very own, nobody has to hold a gun to their head or attempt to threaten their livelihood and their basic right to have equal access to the life blood Money, Dollars that might make unfair choices based on matter other than ability or knowledge.....

Lastly, why not have a stitching part of the exam, a health form for mental, emotional, lack of delussional thoughts and practices, an eye sight chart and exam, shakey hands, and other procedure, practicals???? I can think of an entire load of equally worthy of review standards that don't have darn thing to do with handing over data from a Certified Meaningless Use EMR, which is now FORCED Upon any and all docs who care to apply for certification???? Or have we all forgotten that little fact here???? My wife and I are very strong supporters and protectors of privacy and civil rights... Requiring her, us to have to start opening up access to the supposedly de-intentfied data, is In OUR shared and Mutual humble opinion WAY overstepping the boundaries of their original mandate and powers that they were granted by those that are screened and tested by them....

So if my wife and all the rest of you had specific books to read and prepare yourself for class and had to go to day and or sleep away doctors training camp and school like I did thru USA Hockey and from that took a semi-reasonable closed book exam proctored by semi-normal people like the professors (fellow well respected and still practicing in the field doctors like the semi pro, pro and collegiate officials that came and taught some of our classes) who taught the classes and folks like could bring some tissues and sugar snacks, coffee, juice and soda into the rooms without being shot, and that attending such a great well taught set of classes then "Certified" a doctor to claim such for about 7-10 years and it didn't cost an arm and leg that so many docs actually are starting to have problems affording (like Us!!!) and that there were even scholarships for hard hit docs too.... Now that would be

an awesome way to help keep people sharp and checked out and properly taught and worthy of being "Certified".....

Lastly, if and when the boards start taking back their certification, refusing to allow their intellectual property and certification to be misused by greed ill intended insurance carriers, willing to take them to court as many times as it takes to stop abusing any and all docs and ruining their good neutral name and standing... then perhaps I could regain the respect I had for the board only less than 10 years ago.....

To: Sent: Monday, November 28, 2011 11:56 PMSubject: RE: Re: AAFP SAMs or other Modules

,

We are specialists, specialists in Family Medicine. Part of being a specialist means that we are Board Certified in that Specialty. TO be Board Certified, you must past some tests. We are hardly the only specialty that requires this. Without our Board Certification, we are nothing more than General Practitioners. Insurance companies have every right to contract with whomever they want. They are trying to sell quality physicians to the employers. If they only contracted with General Practitioners, who’s knowledge base is completely unknown, well, they may not appear so appealing to the employers buying the insurance. It’s not just family physicians that are required to be Board Certified, its’ everyone.

You have a compound fracture of your femur with a shattered patella. You want a person who calls himself an orthopedist to do the surgery? Or someone who is a Board Certified Orthopedist. You are having a heart attack. You want someone who calls himself a cardiologist doing your catheterization and angioplasty with stenting? Or a Board Certified Cardiologist?

Now, there may be some who say they have met lousy Board Certified doctors. True. It doesn’t mean that person will have a good bedside manner. It doesn’t mean they aren’t an alcoholic or drug addict or suffering from depression. It doesn’t mean they are perfect and never make mistakes. But it does guarantee a certain minimum level of knowledge. Right now it is the only way we have to measure knowledge.

I could go to 1000 hours of CME. Does it make me knowledgeable in my area? No. I could sign in and leave. I could sleep. I could take courses in just about anything that has nothing to do with the patients and diseases that I treat. Just saying you do CME doesn’t prove what you know and what you don’t.

But the bottom line is taking exams to become Board Certified and stay Board Certified isn’t going anywhere. Complaining about it doesn’t do any good as it isn’t going to change. We had to take many tests to even become doctors. This is not at all novel. I had to take SATs to get into a good college. I had to take MCATs to get into medical school. I had to take 3 levels of exams to become licensed to be a doctor. And then I had to take the Board Exams. You want an Fellowship or Certificate of secondary specialty, guess what, you have to take a test to prove you know what you say you know.

If you didn’t want to have to take tests, why become doctors?

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 BleiweissSent: Monday, November 28, 2011 10:42 PMTo: Subject: Re: Re: AAFP SAMs or other Modules

has already lost one or two of the better paying contracts because of this... and our local Blues, the 500 lbs. Gorilla in our room, perhaps as much as 60-70% of our commercial market is in their control..... So, Excellus BC/BS has given her the Big Threat, Arm Twist stating that she has until their next recert period period with them to make this go away or she is toast with them.....

Still sounds likes defacto licensing and market control, Anti-Trust like, collusion like control for that matter.... It should be illegal for insurance carriers to keep doctors off panel as long as they meet whatever their state's guidelines are to legal practice. End of story. But worse yet, the folks at the boards, they all know the real deal, the drill here and yet they continue to pretend that what they do, has no influence or impact on such super important matters as who survives or dies. And IMHO, I believe it all plays right into their hands and that they actually like it this way.... How many busy FP's, IM's, and Ped's would bother to deal with all of this CCHIT if it didn't mean their possibly being driven into the poor house???? That's Bull and that's Bullying.

To: Sent: Monday, November 28, 2011 6:41 PMSubject: Re: AAFP SAMs or other Modules

i will be taken off insurance panel by the quickest, highest paying insurance carrier in my city if i am not board certified..hows that?beef..steakgrace>> 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 & #39;t really seem too weighty.>

[Guest guest]

, First off, sorry you haven’t been feeling well.  Colitis responds to stress dude…..you need a big chill!  Maybe we have an explanation for these long posts now; prednisone can do that. OK, now I have read this, some of it 2 to 3 times.  I really don’t get what you are saying this time.  The Board of the ABFM is made of practicing doctors.  Our own Jim Kennedy is one of them.  One of my colleagues here in NJ was on the Board of the Board for a few years.   It is not expensive to get CME.  You only need 25 hours in group setting every 3 years.  The state meetings are usually a very cheap way to get group CME.  The rest can be thorugh the journals which are free with AAFP membership.  They also prepare you for the Boards.  Yes the process is expensive but averaged over 10 years it’s not that expensive.  I pay more every year in my Medical Staff Dues for my hospital privileges, something insurance contracts also require.  Please don’t suggest more testing.  Oral and procedural testing would be far more expensive.  But when we graduate from residency, the residency director is saying we are capable of doing these procedures.  So in a way, it’s being done, just not retested.  I don’t think anyone wants that.  I think requiring hospital privileges is the insurance companies way of hoping someone is watching doctors for physical or emotional impairment that could jeopardize their ability to practice.  I won’t say that works.  We also have to swear to the fact we are not disabled or impaired for our medical license.  But I think if you are significantly impaired, you will have problems passing the Boards and that is some of what the Board testing accomplishes.  As far as owning intellectual property.  My hospital also requires Board Certification to be on staff.  Do I really want the insurance companies and hospitals creating their own tests to see if I am competent?  That would be ridiculous.  Do I want my state creating their own tests?  No I would rather just take the National Board of Medical Examination or whatever that 3 part test was called to get a license.  This is a help, not a hindrance.  Could you imagine having to take a separate test for every state you ever moved to to get  a license? I think, instead of wasting effort protesting the fact that there are National Standards and they aren’t necessarily a bad thing, we can maybe focus on why some good doctors don’t pass the Boards and find ways to help them.  Isn’t that the real issue? Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of BleiweissSent: Tuesday, November 29, 2011 1:26 AMTo: Subject: Re: Re: AAFP SAMs or other Modules Kathy, It's not the concept of a test that bothers me so much... It is the entirely over the top, modules and expensive various ways of obtaining this life blood certification that bothers me so..... At some point its time to say; " Enough is Enough Already " .... No less to have some disconnected board that certainly seems to not understand or relate to the day to day realities of those that they presently have way too much power and authority over, and without any public voice from those that they wield this power over.... Every year I must take a take home open book exam, a class that is both classroom as well as On-Ice, and at the end of the day, take a closed book exam as well and all just to be allowed to Officiate Amatuer Ice Hockey while coaches and others don't have to take classes but every 3 to 4 years.... There comes a point where we are going way beyond the means and intention of the original mandate.... Oh and that is just to be a level 2 or 3.... If I want to apply for level 4 (top level one can obtain) I would have to take a skills based exam based mainly upon my skating abilities and perhaps an even tougher closed book exam. Now I have no problem being tested most years but this year I am still attempting to recover from my coliltis and an entire summer of slugging around sick and on Prednisone making me even more weirded out swollen and far too over weight like never before.... BUT, Unlike many certified test and one day annual required clinic attending Level 4's out there... I have attended three 3 1/2 day long weekend USA Hockey run Officiating Camps in just about 12 years time span.... I was taught, endoctrinated into a professional mindset and better understanding and trained to a mental and personal level most of those tested but never classroomed, truly On-Ice Taught and Trained Officials could ever begin to understand..... A practical application and interpretation of the facts, rules are but rules and facts are but facts ( be they like mine or yours) to be memorized and spit back out..... But the actual practical understanding and the implications and applications of them are something completely different. And it was with the actual real and valid classwork that I started the journey in 1998 to become the professional I am today... and all to officiate kids and adults in an amatuer sport... Not the crap on some test and not the crap in most CME classes either.... How about modestly funded and priced, actual classes, Real and Valid classes, tests not even need apply... To really have to emerse oneself in such classes, available in at least a few large cities in all states much like my officiating classes run and created by these supposedly so well versed and worth of passing judgement boards... Just the living together, eating together, taking class together, sweating together and having good interactive exchanges of ideas, theories and concepts, and sharing real life examples from interesting, great, aweful stressful, messed up and awesome games all the folks in that room have officiated over the last few years both outside of the actual classes no less stimulated back to memory and shared and debated in open forums in class as various parts of lessons brought them to mind and added to the lively debate; This was so much more worthy of certification of a certain level obtained and so much more informative and worthy of learning you can't hold a candle to it.... And if there is anything life has taught me in all of my pursuits in many different fields and skills.... and that is this: Life long learners are just that life long learners and those that are NOT, simply are NOT..... If someone is passionate about what they do and what they want to learn, they will do it all of their very own, nobody has to hold a gun to their head or attempt to threaten their livelihood and their basic right to have equal access to the life blood Money, Dollars that might make unfair choices based on matter other than ability or knowledge..... Lastly, why not have a stitching part of the exam, a health form for mental, emotional, lack of delussional thoughts and practices, an eye sight chart and exam, shakey hands, and other procedure, practicals???? I can think of an entire load of equally worthy of review standards that don't have darn thing to do with handing over data from a Certified Meaningless Use EMR, which is now FORCED Upon any and all docs who care to apply for certification???? Or have we all forgotten that little fact here???? My wife and I are very strong supporters and protectors of privacy and civil rights... Requiring her, us to have to start opening up access to the supposedly de-intentfied data, is In OUR shared and Mutual humble opinion WAY overstepping the boundaries of their original mandate and powers that they were granted by those that are screened and tested by them.... So if my wife and all the rest of you had specific books to read and prepare yourself for class and had to go to day and or sleep away doctors training camp and school like I did thru USA Hockey and from that took a semi-reasonable closed book exam proctored by semi-normal people like the professors (fellow well respected and still practicing in the field doctors like the semi pro, pro and collegiate officials that came and taught some of our classes) who taught the classes and folks like could bring some tissues and sugar snacks, coffee, juice and soda into the rooms without being shot, and that attending such a great well taught set of classes then " Certified " a doctor to claim such for about 7-10 years and it didn't cost an arm and leg that so many docs actually are starting to have problems affording (like Us!!!) and that there were even scholarships for hard hit docs too.... Now that would be an awesome way to help keep people sharp and checked out and properly taught and worthy of being " Certified " ..... Lastly, if and when the boards start taking back their certification, refusing to allow their intellectual property and certification to be misused by greed ill intended insurance carriers, willing to take them to court as many times as it takes to stop abusing any and all docs and ruining their good neutral name and standing... then perhaps I could regain the respect I had for the board only less than 10 years ago..... To: Sent: Monday, November 28, 2011 11:56 PMSubject: RE: Re: AAFP SAMs or other Modules , We are specialists, specialists in Family Medicine. Part of being a specialist means that we are Board Certified in that Specialty. TO be Board Certified, you must past some tests. We are hardly the only specialty that requires this. Without our Board Certification, we are nothing more than General Practitioners. Insurance companies have every right to contract with whomever they want. They are trying to sell quality physicians to the employers. If they only contracted with General Practitioners, who’s knowledge base is completely unknown, well, they may not appear so appealing to the employers buying the insurance. It’s not just family physicians that are required to be Board Certified, its’ everyone. You have a compound fracture of your femur with a shattered patella. You want a person who calls himself an orthopedist to do the surgery? Or someone who is a Board Certified Orthopedist. You are having a heart attack. You want someone who calls himself a cardiologist doing your catheterization and angioplasty with stenting? Or a Board Certified Cardiologist? Now, there may be some who say they have met lousy Board Certified doctors. True. It doesn’t mean that person will have a good bedside manner. It doesn’t mean they aren’t an alcoholic or drug addict or suffering from depression. It doesn’t mean they are perfect and never make mistakes. But it does guarantee a certain minimum level of knowledge. Right now it is the only way we have to measure knowledge. I could go to 1000 hours of CME. Does it make me knowledgeable in my area? No. I could sign in and leave. I could sleep. I could take courses in just about anything that has nothing to do with the patients and diseases that I treat. Just saying you do CME doesn’t prove what you know and what you don’t. But the bottom line is taking exams to become Board Certified and stay Board Certified isn’t going anywhere. Complaining about it doesn’t do any good as it isn’t going to change. We had to take many tests to even become doctors. This is not at all novel. I had to take SATs to get into a good college. I had to take MCATs to get into medical school. I had to take 3 levels of exams to become licensed to be a doctor. And then I had to take the Board Exams. You want an Fellowship or Certificate of secondary specialty, guess what, you have to take a test to prove you know what you say you know. If you didn’t want to have to take tests, why become doctors? Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of BleiweissSent: Monday, November 28, 2011 10:42 PMTo: Subject: Re: Re: AAFP SAMs or other Modules has already lost one or two of the better paying contracts because of this... and our local Blues, the 500 lbs. Gorilla in our room, perhaps as much as 60-70% of our commercial market is in their control..... So, Excellus BC/BS has given her the Big Threat, Arm Twist stating that she has until their next recert period period with them to make this go away or she is toast with them..... Still sounds likes defacto licensing and market control, Anti-Trust like, collusion like control for that matter.... It should be illegal for insurance carriers to keep doctors off panel as long as they meet whatever their state's guidelines are to legal practice. End of story. But worse yet, the folks at the boards, they all know the real deal, the drill here and yet they continue to pretend that what they do, has no influence or impact on such super important matters as who survives or dies. And IMHO, I believe it all plays right into their hands and that they actually like it this way.... How many busy FP's, IM's, and Ped's would bother to deal with all of this CCHIT if it didn't mean their possibly being driven into the poor house???? That's Bull and that's Bullying. To: Sent: Monday, November 28, 2011 6:41 PMSubject: Re: AAFP SAMs or other Modules i will be taken off insurance panel by the quickest, highest paying insurance carrier in my city if i am not board certified..hows that?beef..steakgrace>> 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 & #39;t really seem too weighty.>

[Guest guest]

I appreciate Jim's postings and his efforts at improving the Board

Certification process. He seems like a good guy, and I'm in the same life stage,

being 63. I'm facing some of the life same life and practice choices associated

with that. My age may give some historical perspective on how the process we

now have evolved. These are just my feelings and ventings, I'm not really trying

to think I can actually change anything.

I agree with 's posts on the matter of the way the test is conceived and

administered. The whole process is antiquated, and extremely cumbersome and

burdensome. It's an old concept with some new digital stuff sort of slathered

on to make it look more modern. It does not take true advantage of the

connectivity and communication and sharing of the pertinent data that could and

should be possible in today's modern digital world.

It seems like the whole process is really for the benefit of " Family Medicine "

as a larger whole, particularly in preserving it's place in the world of

academia and government funding, rather than to benefit any individual

diplomate, or even I dare say, to actually benefit the population of patients we

are supposed to be serving, or at least that is somewhat of a secondary goal.

The reasons for that have an historical basis.

Of course no one will actually admit to this, but if you look at the history of

how we got this recertification process, the preservation of the entity of

Family Medicine in the academic and government funding world was the real reason

we got all this stuff, not so much for delivering the actual patient care. The

medical academic world in the universities was reluctantly forced to accept

Family Medicine as part of their system under the threat of their funding being

cut back when there was more political support for sending out barefoot family

doctors that were then seen as the answer to the maldistribution of healthcare

in the U.S. in the 1970s. Nowadays, I think we've lost most of that support,

in that it is perceived by those controlling the purse strings, that PA's, NP's

and others can do the job. I mean no offense to any PA's and NP's on the list.

Just stating my perceptions of where things are these days.

>

> Kathy,

> It's not the concept of a test that bothers me so much... It is the entirely

over the top, modules and expensive various ways of obtaining this life blood

certification that bothers me so..... At some point its time to say; " Enough is

Enough Already " .... No less to have some disconnected board that certainly seems

to not understand or relate to the day to day realities of those that they

presently have way too much power and authority over, and without any public

voice from those that they wield this power over....

[Guest guest]

Thank You for your Support,

BUT, most of what I need a chill from is Not here but in other really dysfunctional areas of my private life where Palllin Wanna Be, Grizzlie Bears with Lipstick who have literally fabricated complete basely lies that quite literally might be more about their own denial, problems even Projection in one horrible case of her own misbehaviors and acting out, lack of boundaries and appropriateness have lead to probably 3/4's of my regular, continuous stress. And yes I do believe that it has a whole heck of a lot to do with the irritations that lead to visable bleeding coming out of my body which itself became very stressful and worrisome.... Oh and the worst of these Grizzlie Bear Hockey Mom's is a cop, a Captian in our local Sheriff's Dept making her completely false and fabricated crap all the more supposedly crediable. When in fact it was

only in support of her fellow Momma Grizzlie who was constantly attempting to take me out at the knees because this nice man and good coach had the audacity to come into "Their Association" as a dad and coach with his own 2000 birth year goaltender, who was a direct threat to her own puggy less athletic cub.... Who from day one I tried to treat with the same support, care and intense positive hard work coaching style to help him become the best he could be even though he could be my son's direct competition one day down the road.... And I praised him well and often because at times he certainly deserved it and all kids need that kind of thing... Oh and both of these wonderful women were Both Board Members who should have had my back and been defending me, running interference for me, supporting me (if even needed, other than the Grizzlies, the majority of the parents and players and I got along super well even to this day, as kids and parent come up to

me with huge hugs and firm handshakes and kind words of "We Miss You" and "We too should have gotten out of here like you and your son did, these folks are just insane. They play Blood Sports social politics of the worst sort) instead of being the hidden, behind the scene, lied to, manipulated like a betrayed spouse, Gaslighting me, and playing me for a sucker.... I'm sorry I tried to be a great coach and good adult friend, teacher, role model, uncle like person in your child's life....

That is my Main Trauma, almost PTSD like after two years in a row and it is called "Mobbing" and if you google it you will learn more than you ever want about this horrible form of social abuse and trauma. That is the cause of the auto-immune response of stress of my own body beating up it's own Large Intenstine as I try to behave and act like a better person than them, swallowing a heck of a lot more than any person should have to do so, while being assaulted in name and character for doing nothing but good things for 15 kids and their families.... And it is almost always brought upon a person who is at least go if not even fairly well above average at what they do, which then leads lesser more insecure people to lash out in an attempt to ruin those that they percieve as some sort of a threat to them or

their status quo....

BTW, the Bull rumors that started from this have been feedback looped around, back to where my son and I went to get away from the Bull to the point that others there now have similar reasons (they think) to feel uneasy and concerned about us both, especially me as parent and coach when in fact I have 15 years of continous service to the local hockey community in coaching and officiating for our kids, even before we had kids, kids of our own in the program..... It was just the right thing to do and personally I love it and it is simply what I do, this is my passion and my love.... Working with the kids and using the sport as a means to bridge the years between us, this common denominator that we share.... that makes us almost equals, I am from their line, I sat on that

bench 40 years ago, and stood in their skates just as they do today..... Generativity which is a sign of personal growth and maturity then bottled up, and rejected and made out to be something horrible, the kettle calling the tea pot black and all for very selfish, unfair, inappropriate, immature, dysfunctional and possibly even at least a bit mentally ill, cause and origins.

And until just about a week ago I had to sit in the stands and watch my son struggle because he is a goalie and majority of coaches were raised skaters and most of us skaters, players, don't know the first thing about how to raise and mentor, teach a goalie.... But since our son became a goalie, I made it my mission to fill-in this gap that almost all coaches have, and really learn how to be a good goalie coach and try to stay half a step ahead of his development. But Thank Goodness, this one wonderful man who is my son's head coach was at least willing to tune-out what he heard and he heard an earful unfortunately, and gave me half a chance to show him what I can do, and that I had to prove my personal decency of all things.... Me, Us,

the starve our values and ethics micro solo practice Mom and Pop parents business people... How insane and offensive. And yet I saw and understood this as the opportunity that it was to finally get back out there with a new group and show who and what I could do and be, and am.... Thank You Coach Tony!!!!

That is my real personal pain for the better part of three years and going now. And finally one good man was willing to ignore what he heard from at least half a dozen really not so nice people who engage in such inappropriate spread of such nasty, toxic social crap.....

I am more ADD than Roid raging now.... BUT I will fully admit that back in the middle of the summer when I was on 40 mgs daily Yes, I was straining to control myself in many ways of behavior and it was very concerning and upsetting. Now I am down to about 17 1/2 mgs and slowly dropping as my docs and I have finally found a maintainance drug that works without making me more sick than the disease does.... Now I do not feel that "Pressured" feeling, almost like I would imagine pressured feels in a Manic like episode.... Back then I did fall for the side effects once or twice and my appologies to those in my path at the time..... But now, I feel much more like my normal ADD like self.... So that good really works for me med is:

"Apriso" extended time released Mesalamine... Now day long marriage to my bathroom on it thank goodness. Finally!!!! It is almost like I am taking nothing which is great and what anyone would hope for.... BUT, unfortunately it is on the third tier of our NYS Bridge Plan for folks with Pre-Exisiting conditions like both of us.... and their "wonderful" third tier means, Get This: 100% Co-Pay!!! So we are looking at just about $300 per month for this drug even as I did the right thing and tried a number of less expensive similar meds and failed on them. My doc and I both did the right thing trying the normal less expensive generic types first but No Good for Me.... We are attempting to get samples for our office but it may be tough for a solo FP's office to get this more marketed to GI's Med.... BTW is it not fraud to refer to something as "Co" when there is nothing "Co" about it, no cost sharing what so ever???? Co-Pay means a consistant cost

perhaps at various levels and Co-Insurance means a consistant percentage sharing.... But to call it a 100% co-pay sure feels fraudulant and misleading to me.....

BTW and this is the last part of this long post on my personal stress and health problems (and thanks for all of your concerns as friends fellow medical people of the best kind) in only a bit more than a week and three practices our son has just about regained all of his previous, past season form, skills and habits.... He made such an incredible snatch out of mid air with his glove hand, when he was just about completely down and out, ESPN should have put it on the High Light Reel this morning, I swear.... he was completely down to the far left side and pipe after just making one save on a teammate coming in on a shooting drill that was supposed to end on the single shot, no

rebounds..... But half messing around and perhaps a bit frustrated as Adam is starting to find himself and is starting to shut the door a bit more now..... this player went for the rebound (not part of the drill really) and tried to score while he had my son down and out, and dead to rights and move to Adam's right to try and get the majority of the open right side for easy pickin's.... Well Adam threw out this amazingly super fast glove out of nowhere, tracked to his mitt, his entire body thrown out that way, head turned to properly track it all the way to his mitt and WOMP!!!.... that wonderful snappy thud of a strong shot hitting the webbing of the pocket of his glove hand.... There was a moment of stunned silence followed by the entire team and coaching staff cheering and smacking their sticks on the ice in a players form of applaudes.... Obviously I was super proud and it was the first amazing snatch he has

made since perhaps Sept if not this July at Goalie Camp.... That was the kid, this amazing little 11 year old whose father sat in the stands last April at travel team try-outs and at Goalie Camp this past July, almost with tears in my eyes because in only two years and his doing the hard work with me and a few other better than myself goalie coaches had turned himself into a "Real Goaltender" worthy of real respect from friends and foe alike... Who had put the local hockey community of Notice that "He is here and he has Arrived". At times I still can't believe it is him.... the little boy who stuggled and at times was so frustrated when first trying to skate as a player... that I felt was not going to want to stick with it, and look at him now... And it was Him that did what it took to reach this first really impressive plateau, he did the work, the sweat and the achy muscles, the drills and the dry land work too.... He has clearly earned what he

has accomplished so far.... and clearly deserves whatever it can reap...

And so not only did he and I have to work the work and do the drills together but we also had to try to get past all the crap of those abusive, mentally ill, mean, undermining, anti-kid, anti-sportsmanship, dysfunctional selfish big "B's". And what a horrible thing to have to get yourself no less your 9 to 11 year old son thru.... What an F'ed up set of life lessons to have to teach a great wonderful child, with mood issues of a modest amount of his own to begin with.... He had enough on his plate already, and we as the grown-ups were supposed to be better than this, and to create a positive and nurturing envirornment for all the kids and not this blood sport,

back stabbing, lying and manipulative, highly unfair personally very painful and traumatizing place that the Grizzlies created and imposed upon me and him the past few years.... and in facing such amazingly messed up crap, making such nice and impressive gains all the more sweet for both of us... And so their toxicity almost followed us here, it did as a matter of fact.... and so he and I were almost denied what he clearly had earned and deserves all over again up and until this past week or so... And all because one good man, had the decency to listen to me, hear me out and not PRE- JUDGE me from previous laid down and put in place and motion, Toxic gossip.... And simply allowed Me and therefore my Son as well, to show who were were and what we could do if only allowed to be ourselves and do what we can do with a modest amount of rope and opportunity.... So I end this super long post in honor of a

wonderful kind, soft spoken but none the less "Gutsy" man, our Head Coach, Tony... Thank Coach Tony.... To Coach Tony... Thank You.

and Adam

To: Sent: Tuesday, November 29, 2011 7:43 AMSubject: RE: Re: AAFP SAMs or other Modules

,

First off, sorry you haven’t been feeling well. Colitis responds to stress dude…..you need a big chill! Maybe we have an explanation for these long posts now; prednisone can do that.

OK, now I have read this, some of it 2 to 3 times. I really don’t get what you are saying this time. The Board of the ABFM is made of practicing doctors. Our own Jim Kennedy is one of them. One of my colleagues here in NJ was on the Board of the Board for a few years. It is not expensive to get CME. You only need 25 hours in group setting every 3 years. The state meetings are usually a very cheap way to get group CME. The rest can be thorugh the journals which are free with AAFP membership. They also prepare you for the Boards. Yes the process is expensive but averaged over 10 years it’s not that expensive. I pay more every year in my Medical Staff Dues for my hospital privileges, something insurance contracts also require.

Please don’t suggest more testing. Oral and procedural testing would be far more expensive. But when we graduate from residency, the residency director is saying we are capable of doing these procedures. So in a way, it’s being done, just not retested. I don’t think anyone wants that.

I think requiring hospital privileges is the insurance companies way of hoping someone is watching doctors for physical or emotional impairment that could jeopardize their ability to practice. I won’t say that works. We also have to swear to the fact we are not disabled or impaired for our medical license. But I think if you are significantly impaired, you will have problems passing the Boards and that is some of what the Board testing accomplishes.

As far as owning intellectual property. My hospital also requires Board Certification to be on staff. Do I really want the insurance companies and hospitals creating their own tests to see if I am competent? That would be ridiculous. Do I want my state creating their own tests? No I would rather just take the National Board of Medical Examination or whatever that 3 part test was called to get a license. This is a help, not a hindrance. Could you imagine having to take a separate test for every state you ever moved to to get a license?

I think, instead of wasting effort protesting the fact that there are National Standards and they aren’t necessarily a bad thing, we can maybe focus on why some good doctors don’t pass the Boards and find ways to help them. Isn’t that the real issue?

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 BleiweissSent: Tuesday, November 29, 2011 1:26 AMTo: Subject: Re: Re: AAFP SAMs or other Modules

Kathy,

It's not the concept of a test that bothers me so much... It is the entirely over the top, modules and expensive various ways of obtaining this life blood certification that bothers me so..... At some point its time to say; "Enough is Enough Already".... No less to have some disconnected board that certainly seems to not understand or relate to the day to day realities of those that they presently have way too much power and authority over, and without any public voice from those that they wield this power over....

Every year I must take a take home open book exam, a class that is both classroom as well as On-Ice, and at the end of the day, take a closed book exam as well and all just to be allowed to Officiate Amatuer Ice Hockey while coaches and others don't have to take classes but every 3 to 4 years.... There comes a point where we are going way beyond the means and intention of the original mandate.... Oh and that is just to be a level 2 or 3.... If I want to apply for level 4 (top level one can obtain) I would have to take a skills based exam based mainly upon my skating abilities and perhaps an even tougher closed book exam. Now I have no problem being tested most years but this year I am still attempting to recover from my coliltis and an entire summer of slugging around sick and on Prednisone making me even more weirded out swollen and far too over weight like never

before....

BUT, Unlike many certified test and one day annual required clinic attending Level 4's out there... I have attended three 3 1/2 day long weekend USA Hockey run Officiating Camps in just about 12 years time span.... I was taught, endoctrinated into a professional mindset and better understanding and trained to a mental and personal level most of those tested but never classroomed, truly On-Ice Taught and Trained Officials could ever begin to understand..... A practical application and interpretation of the facts, rules are but rules and facts are but facts ( be they like mine or yours) to be memorized and spit back out..... But the actual practical understanding and the implications and applications of them are something completely different. And it was with the actual real and valid classwork that I started the journey in 1998 to

become the professional I am today... and all to officiate kids and adults in an amatuer sport... Not the crap on some test and not the crap in most CME classes either....

How about modestly funded and priced, actual classes, Real and Valid classes, tests not even need apply... To really have to emerse oneself in such classes, available in at least a few large cities in all states much like my officiating classes run and created by these supposedly so well versed and worth of passing judgement boards... Just the living together, eating together, taking class together, sweating together and having good interactive exchanges of ideas, theories and concepts, and sharing real life examples from interesting, great, aweful stressful, messed up and awesome games all the folks in that room have officiated over the last few years both outside of the actual classes no less stimulated back to memory and shared and debated in open forums in class as various parts of lessons brought them to mind and added to the lively debate; This was so much more

worthy of certification of a certain level obtained and so much more informative and worthy of learning you can't hold a candle to it....

And if there is anything life has taught me in all of my pursuits in many different fields and skills.... and that is this: Life long learners are just that life long learners and those that are NOT, simply are NOT..... If someone is passionate about what they do and what they want to learn, they will do it all of their very own, nobody has to hold a gun to their head or attempt to threaten their livelihood and their basic right to have equal access to the life blood Money, Dollars that might make unfair choices based on matter other than ability or knowledge.....

Lastly, why not have a stitching part of the exam, a health form for mental, emotional, lack of delussional thoughts and practices, an eye sight chart and exam, shakey hands, and other procedure, practicals???? I can think of an entire load of equally worthy of review standards that don't have darn thing to do with handing over data from a Certified Meaningless Use EMR, which is now FORCED Upon any and all docs who care to apply for certification???? Or have we all forgotten that little fact here???? My wife and I are very strong supporters and protectors of privacy and civil rights... Requiring her, us to have to start opening up access to the supposedly de-intentfied data, is In OUR shared and Mutual humble opinion WAY overstepping the boundaries of their original mandate and powers that they were granted by those that are screened and tested by

them....

So if my wife and all the rest of you had specific books to read and prepare yourself for class and had to go to day and or sleep away doctors training camp and school like I did thru USA Hockey and from that took a semi-reasonable closed book exam proctored by semi-normal people like the professors (fellow well respected and still practicing in the field doctors like the semi pro, pro and collegiate officials that came and taught some of our classes) who taught the classes and folks like could bring some tissues and sugar snacks, coffee, juice and soda into the rooms without being shot, and that attending such a great well taught set of classes then "Certified" a doctor to claim such for about 7-10 years and it didn't cost an arm and leg that so many docs actually are starting to have problems affording (like Us!!!) and that there were even scholarships for hard

hit docs too.... Now that would be an awesome way to help keep people sharp and checked out and properly taught and worthy of being "Certified".....

Lastly, if and when the boards start taking back their certification, refusing to allow their intellectual property and certification to be misused by greed ill intended insurance carriers, willing to take them to court as many times as it takes to stop abusing any and all docs and ruining their good neutral name and standing... then perhaps I could regain the respect I had for the board only less than 10 years ago.....

To: Sent: Monday, November 28, 2011 11:56 PMSubject: RE: Re: AAFP SAMs or other Modules

,

We are specialists, specialists in Family Medicine. Part of being a specialist means that we are Board Certified in that Specialty. TO be Board Certified, you must past some tests. We are hardly the only specialty that requires this. Without our Board Certification, we are nothing more than General Practitioners. Insurance companies have every right to contract with whomever they want. They are trying to sell quality physicians to the employers. If they only contracted with General Practitioners, who’s knowledge base is completely unknown, well, they may not appear so appealing to the employers buying the insurance. It’s not just family physicians that are required to be Board Certified, its’ everyone.

You have a compound fracture of your femur with a shattered patella. You want a person who calls himself an orthopedist to do the surgery? Or someone who is a Board Certified Orthopedist. You are having a heart attack. You want someone who calls himself a cardiologist doing your catheterization and angioplasty with stenting? Or a Board Certified Cardiologist?

Now, there may be some who say they have met lousy Board Certified doctors. True. It doesn’t mean that person will have a good bedside manner. It doesn’t mean they aren’t an alcoholic or drug addict or suffering from depression. It doesn’t mean they are perfect and never make mistakes. But it does guarantee a certain minimum level of knowledge. Right now it is the only way we have to measure knowledge.

I could go to 1000 hours of CME. Does it make me knowledgeable in my area? No. I could sign in and leave. I could sleep. I could take courses in just about anything that has nothing to do with the patients and diseases that I treat. Just saying you do CME doesn’t prove what you know and what you don’t.

But the bottom line is taking exams to become Board Certified and stay Board Certified isn’t going anywhere. Complaining about it doesn’t do any good as it isn’t going to change. We had to take many tests to even become doctors. This is not at all novel. I had to take SATs to get into a good college. I had to take MCATs to get into medical school. I had to take 3 levels of exams to become licensed to be a doctor. And then I had to take the Board Exams. You want an Fellowship or Certificate of secondary specialty, guess what, you have to take a test to prove you know what you say you know.

If you didn’t want to have to take tests, why become doctors?

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 BleiweissSent: Monday, November 28, 2011 10:42 PMTo: Subject: Re: Re: AAFP SAMs or other Modules

has already lost one or two of the better paying contracts because of this... and our local Blues, the 500 lbs. Gorilla in our room, perhaps as much as 60-70% of our commercial market is in their control..... So, Excellus BC/BS has given her the Big Threat, Arm Twist stating that she has until their next recert period period with them to make this go away or she is toast with them.....

Still sounds likes defacto licensing and market control, Anti-Trust like, collusion like control for that matter.... It should be illegal for insurance carriers to keep doctors off panel as long as they meet whatever their state's guidelines are to legal practice. End of story. But worse yet, the folks at the boards, they all know the real deal, the drill here and yet they continue to pretend that what they do, has no influence or impact on such super important matters as who survives or dies. And IMHO, I believe it all plays right into their hands and that they actually like it this way.... How many busy FP's, IM's, and Ped's would bother to deal with all of this CCHIT if it didn't mean their possibly being driven into the poor house???? That's Bull and that's Bullying.

To: Sent: Monday, November 28, 2011 6:41 PMSubject: Re: AAFP SAMs or other Modules

i will be taken off insurance panel by the quickest, highest paying insurance carrier in my city if i am not board certified..hows that?beef..steakgrace>> 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 & #39;t really seem too weighty.>

[Guest guest]

So ....you aren't interested in a Tea Party invite:)

From:

Bleiweiss ;

To:

< >;

Subject:

Re: Re: AAFP SAMs or other Modules

Sent:

Tue, Nov 29, 2011 3:58:33 PM

Thank You for your Support,

BUT, most of what I need a chill from is Not here but in other really dysfunctional areas of my private life where Palllin Wanna Be, Grizzlie Bears with Lipstick who have literally fabricated complete basely lies that quite literally might be more about their own denial, problems even Projection in one horrible case of her own misbehaviors and acting out, lack of boundaries and appropriateness have lead to probably 3/4's of my regular, continuous stress. And yes I do believe that it has a whole heck of a lot to do with the irritations that lead to visable bleeding coming out of my body which itself became very stressful and worrisome.... Oh and the worst of these Grizzlie Bear Hockey Mom's is a cop, a Captian in our local Sheriff's Dept making her completely false and fabricated crap all the more supposedly crediable. When in fact it was

only in support of her fellow Momma Grizzlie who was constantly attempting to take me out at the knees because this nice man and good coach had the audacity to come into " Their Association " as a dad and coach with his own 2000 birth year goaltender, who was a direct threat to her own puggy less athletic cub.... Who from day one I tried to treat with the same support, care and intense positive hard work coaching style to help him become the best he could be even though he could be my son's direct competition one day down the road.... And I praised him well and often because at times he certainly deserved it and all kids need that kind of thing... Oh and both of these wonderful women were Both Board Members who should have had my back and been defending me, running interference for me, supporting me (if even needed, other than the Grizzlies, the majority of the parents and players and I got along super well even to this day, as kids and

parent come up to

me with huge hugs and firm handshakes and kind words of " We Miss You " and " We too should have gotten out of here like you and your son did, these folks are just insane. They play Blood Sports social politics of the worst sort) instead of being the hidden, behind the scene, lied to, manipulated like a betrayed spouse, Gaslighting me, and playing me for a sucker.... I'm sorry I tried to be a great coach and good adult friend, teacher, role model, uncle like person in your child's life....

That is my Main Trauma, almost PTSD like after two years in a row and it is called " Mobbing " and if you google it you will learn more than you ever want about this horrible form of social abuse and trauma. That is the cause of the auto-immune response of stress of my own body beating up it's own Large Intenstine as I try to behave and act like a better person than them, swallowing a heck of a lot more than any person should have to do so, while being assaulted in name and character for doing nothing but good things for 15 kids and their families.... And it is almost always brought upon a person who is at least go if not even fairly well above average at what they do, which then leads lesser more insecure people to lash out in an attempt to ruin those that they percieve as some sort of a threat to them or

their status quo....

BTW, the Bull rumors that started from this have been feedback looped around, back to where my son and I went to get away from the Bull to the point that others there now have similar reasons (they think) to feel uneasy and concerned about us both, especially me as parent and coach when in fact I have 15 years of continous service to the local hockey community in coaching and officiating for our kids, even before we had kids, kids of our own in the program..... It was just the right thing to do and personally I love it and it is simply what I do, this is my passion and my love.... Working with the kids and using the sport as a means to bridge the years between us, this common denominator that we share.... that makes us almost equals, I am from their line, I sat on that

bench 40 years ago, and stood in their skates just as they do today..... Generativity which is a sign of personal growth and maturity then bottled up, and rejected and made out to be something horrible, the kettle calling the tea pot black and all for very selfish, unfair, inappropriate, immature, dysfunctional and possibly even at least a bit mentally ill, cause and origins.

And until just about a week ago I had to sit in the stands and watch my son struggle because he is a goalie and majority of coaches were raised skaters and most of us skaters, players, don't know the first thing about how to raise and mentor, teach a goalie.... But since our son became a goalie, I made it my mission to fill-in this gap that almost all coaches have, and really learn how to be a good goalie coach and try to stay half a step ahead of his development. But Thank Goodness, this one wonderful man who is my son's head coach was at least willing to tune-out what he heard and he heard an earful unfortunately, and gave me half a chance to show him what I can do, and that I had to prove my personal decency of all things.... Me, Us,

the starve our values and ethics micro solo practice Mom and Pop parents business people... How insane and offensive. And yet I saw and understood this as the opportunity that it was to finally get back out there with a new group and show who and what I could do and be, and am.... Thank You Coach Tony!!!!

That is my real personal pain for the better part of three years and going now. And finally one good man was willing to ignore what he heard from at least half a dozen really not so nice people who engage in such inappropriate spread of such nasty, toxic social crap.....

I am more ADD than Roid raging now.... BUT I will fully admit that back in the middle of the summer when I was on 40 mgs daily Yes, I was straining to control myself in many ways of behavior and it was very concerning and upsetting. Now I am down to about 17 1/2 mgs and slowly dropping as my docs and I have finally found a maintainance drug that works without making me more sick than the disease does.... Now I do not feel that " Pressured " feeling, almost like I would imagine pressured feels in a Manic like episode.... Back then I did fall for the side effects once or twice and my appologies to those in my path at the time..... But now, I feel much more like my normal ADD like self.... So that good really works for me med is:

" Apriso " extended time released Mesalamine... Now day long marriage to my bathroom on it thank goodness. Finally!!!! It is almost like I am taking nothing which is great and what anyone would hope for.... BUT, unfortunately it is on the third tier of our NYS Bridge Plan for folks with Pre-Exisiting conditions like both of us.... and their " wonderful " third tier means, Get This: 100% Co-Pay!!! So we are looking at just about $300 per month for this drug even as I did the right thing and tried a number of less expensive similar meds and failed on them. My doc and I both did the right thing trying the normal less expensive generic types first but No Good for Me.... We are attempting to get samples for our office but it may be tough for a solo FP's office to get this more marketed to GI's Med.... BTW is it not fraud to refer to something as " Co " when there is nothing " Co " about it, no cost sharing

what so ever???? Co-Pay means a consistant cost

perhaps at various levels and Co-Insurance means a consistant percentage sharing.... But to call it a 100% co-pay sure feels fraudulant and misleading to me.....

BTW and this is the last part of this long post on my personal stress and health problems (and thanks for all of your concerns as friends fellow medical people of the best kind) in only a bit more than a week and three practices our son has just about regained all of his previous, past season form, skills and habits.... He made such an incredible snatch out of mid air with his glove hand, when he was just about completely down and out, ESPN should have put it on the High Light Reel this morning, I swear.... he was completely down to the far left side and pipe after just making one save on a teammate coming in on a shooting drill that was supposed to end on the single shot, no

rebounds..... But half messing around and perhaps a bit frustrated as Adam is starting to find himself and is starting to shut the door a bit more now..... this player went for the rebound (not part of the drill really) and tried to score while he had my son down and out, and dead to rights and move to Adam's right to try and get the majority of the open right side for easy pickin's.... Well Adam threw out this amazingly super fast glove out of nowhere, tracked to his mitt, his entire body thrown out that way, head turned to properly track it all the way to his mitt and WOMP!!!.... that wonderful snappy thud of a strong shot hitting the webbing of the pocket of his glove hand.... There was a moment of stunned silence followed by the entire team and coaching staff cheering and smacking their sticks on the ice in a players form of applaudes.... Obviously I was super proud and it was the first amazing snatch

he has

made since perhaps Sept if not this July at Goalie Camp.... That was the kid, this amazing little 11 year old whose father sat in the stands last April at travel team try-outs and at Goalie Camp this past July, almost with tears in my eyes because in only two years and his doing the hard work with me and a few other better than myself goalie coaches had turned himself into a " Real Goaltender " worthy of real respect from friends and foe alike... Who had put the local hockey community of Notice that " He is here and he has Arrived " . At times I still can't believe it is him.... the little boy who stuggled and at times was so frustrated when first trying to skate as a player... that I felt was not going to want to stick with it, and look at him now... And it was Him that did what it took to reach this first really impressive plateau, he did the work, the sweat and the achy muscles, the drills and the dry land work too.... He has

clearly earned what he

has accomplished so far.... and clearly deserves whatever it can reap...

And so not only did he and I have to work the work and do the drills together but we also had to try to get past all the crap of those abusive, mentally ill, mean, undermining, anti-kid, anti-sportsmanship, dysfunctional selfish big " B's " . And what a horrible thing to have to get yourself no less your 9 to 11 year old son thru.... What an F'ed up set of life lessons to have to teach a great wonderful child, with mood issues of a modest amount of his own to begin with.... He had enough on his plate already, and we as the grown-ups were supposed to be better than this, and to create a positive and nurturing envirornment for all the kids and not this blood sport,

back stabbing, lying and manipulative, highly unfair personally very painful and traumatizing place that the Grizzlies created and imposed upon me and him the past few years.... and in facing such amazingly messed up crap, making such nice and impressive gains all the more sweet for both of us... And so their toxicity almost followed us here, it did as a matter of fact.... and so he and I were almost denied what he clearly had earned and deserves all over again up and until this past week or so... And all because one good man, had the decency to listen to me, hear me out and not PRE- JUDGE me from previous laid down and put in place and motion, Toxic gossip.... And simply allowed Me and therefore my Son as well, to show who were were and what we could do if only allowed to be ourselves and do what we can do with a modest amount of rope and opportunity.... So I end this super long post in honor of a

wonderful kind, soft spoken but none the less " Gutsy " man, our Head Coach, Tony... Thank Coach Tony.... To Coach Tony... Thank You.

and Adam

To: Sent: Tuesday, November 29, 2011 7:43 AMSubject: RE: Re: AAFP SAMs or other Modules

,

First off, sorry you haven’t been feeling well. Colitis responds to stress dude…..you need a big chill! Maybe we have an explanation for these long posts now; prednisone can do that.

OK, now I have read this, some of it 2 to 3 times. I really don’t get what you are saying this time. The Board of the ABFM is made of practicing doctors. Our own Jim Kennedy is one of them. One of my colleagues here in NJ was on the Board of the Board for a few years. It is not expensive to get CME. You only need 25 hours in group setting every 3 years. The state meetings are usually a very cheap way to get group CME. The rest can be thorugh the journals which are free with AAFP membership. They also prepare you for the Boards. Yes the process is expensive but averaged over 10 years it’s not that expensive. I pay more every year in my Medical Staff Dues for my hospital privileges, something insurance contracts also require.

Please don’t suggest more testing. Oral and procedural testing would be far more expensive. But when we graduate from residency, the residency director is saying we are capable of doing these procedures. So in a way, it’s being done, just not retested. I don’t think anyone wants that.

I think requiring hospital privileges is the insurance companies way of hoping someone is watching doctors for physical or emotional impairment that could jeopardize their ability to practice. I won’t say that works. We also have to swear to the fact we are not disabled or impaired for our medical license. But I think if you are significantly impaired, you will have problems passing the Boards and that is some of what the Board testing accomplishes.

As far as owning intellectual property. My hospital also requires Board Certification to be on staff. Do I really want the insurance companies and hospitals creating their own tests to see if I am competent? That would be ridiculous. Do I want my state creating their own tests? No I would rather just take the National Board of Medical Examination or whatever that 3 part test was called to get a license. This is a help, not a hindrance. Could you imagine having to take a separate test for every state you ever moved to to get a license?

I think, instead of wasting effort protesting the fact that there are National Standards and they aren’t necessarily a bad thing, we can maybe focus on why some good doctors don’t pass the Boards and find ways to help them. Isn’t that the real issue?

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 BleiweissSent: Tuesday, November 29, 2011 1:26 AMTo: Subject: Re: Re: AAFP SAMs or other Modules

Kathy,

It's not the concept of a test that bothers me so much... It is the entirely over the top, modules and expensive various ways of obtaining this life blood certification that bothers me so..... At some point its time to say; " Enough is Enough Already " .... No less to have some disconnected board that certainly seems to not understand or relate to the day to day realities of those that they presently have way too much power and authority over, and without any public voice from those that they wield this power over....

Every year I must take a take home open book exam, a class that is both classroom as well as On-Ice, and at the end of the day, take a closed book exam as well and all just to be allowed to Officiate Amatuer Ice Hockey while coaches and others don't have to take classes but every 3 to 4 years.... There comes a point where we are going way beyond the means and intention of the original mandate.... Oh and that is just to be a level 2 or 3.... If I want to apply for level 4 (top level one can obtain) I would have to take a skills based exam based mainly upon my skating abilities and perhaps an even tougher closed book exam. Now I have no problem being tested most years but this year I am still attempting to recover from my coliltis and an entire summer of slugging around sick and on Prednisone making me even more weirded out swollen and far too over weight like never

before....

BUT, Unlike many certified test and one day annual required clinic attending Level 4's out there... I have attended three 3 1/2 day long weekend USA Hockey run Officiating Camps in just about 12 years time span.... I was taught, endoctrinated into a professional mindset and better understanding and trained to a mental and personal level most of those tested but never classroomed, truly On-Ice Taught and Trained Officials could ever begin to understand..... A practical application and interpretation of the facts, rules are but rules and facts are but facts ( be they like mine or yours) to be memorized and spit back out..... But the actual practical understanding and the implications and applications of them are something completely different. And it was with the actual real and valid classwork that I started the journey in

1998 to

become the professional I am today... and all to officiate kids and adults in an amatuer sport... Not the crap on some test and not the crap in most CME classes either....

How about modestly funded and priced, actual classes, Real and Valid classes, tests not even need apply... To really have to emerse oneself in such classes, available in at least a few large cities in all states much like my officiating classes run and created by these supposedly so well versed and worth of passing judgement boards... Just the living together, eating together, taking class together, sweating together and having good interactive exchanges of ideas, theories and concepts, and sharing real life examples from interesting, great, aweful stressful, messed up and awesome games all the folks in that room have officiated over the last few years both outside of the actual classes no less stimulated back to memory and shared and debated in open forums in class as various parts of lessons brought them to mind and added to the lively debate; This was so much more

worthy of certification of a certain level obtained and so much more informative and worthy of learning you can't hold a candle to it....

And if there is anything life has taught me in all of my pursuits in many different fields and skills.... and that is this: Life long learners are just that life long learners and those that are NOT, simply are NOT..... If someone is passionate about what they do and what they want to learn, they will do it all of their very own, nobody has to hold a gun to their head or attempt to threaten their livelihood and their basic right to have equal access to the life blood Money, Dollars that might make unfair choices based on matter other than ability or knowledge.....

Lastly, why not have a stitching part of the exam, a health form for mental, emotional, lack of delussional thoughts and practices, an eye sight chart and exam, shakey hands, and other procedure, practicals???? I can think of an entire load of equally worthy of review standards that don't have darn thing to do with handing over data from a Certified Meaningless Use EMR, which is now FORCED Upon any and all docs who care to apply for certification???? Or have we all forgotten that little fact here???? My wife and I are very strong supporters and protectors of privacy and civil rights... Requiring her, us to have to start opening up access to the supposedly de-intentfied data, is In OUR shared and Mutual humble opinion WAY overstepping the boundaries of their original mandate and powers that they were granted by those that are screened and tested by

them....

So if my wife and all the rest of you had specific books to read and prepare yourself for class and had to go to day and or sleep away doctors training camp and school like I did thru USA Hockey and from that took a semi-reasonable closed book exam proctored by semi-normal people like the professors (fellow well respected and still practicing in the field doctors like the semi pro, pro and collegiate officials that came and taught some of our classes) who taught the classes and folks like could bring some tissues and sugar snacks, coffee, juice and soda into the rooms without being shot, and that attending such a great well taught set of classes then " Certified " a doctor to claim such for about 7-10 years and it didn't cost an arm and leg that so many docs actually are starting to have problems affording (like Us!!!) and that there were even

scholarships for hard

hit docs too.... Now that would be an awesome way to help keep people sharp and checked out and properly taught and worthy of being " Certified " .....

Lastly, if and when the boards start taking back their certification, refusing to allow their intellectual property and certification to be misused by greed ill intended insurance carriers, willing to take them to court as many times as it takes to stop abusing any and all docs and ruining their good neutral name and standing... then perhaps I could regain the respect I had for the board only less than 10 years ago.....

To: Sent: Monday, November 28, 2011 11:56 PMSubject: RE: Re: AAFP SAMs or other Modules

,

We are specialists, specialists in Family Medicine. Part of being a specialist means that we are Board Certified in that Specialty. TO be Board Certified, you must past some tests. We are hardly the only specialty that requires this. Without our Board Certification, we are nothing more than General Practitioners. Insurance companies have every right to contract with whomever they want. They are trying to sell quality physicians to the employers. If they only contracted with General Practitioners, who’s knowledge base is completely unknown, well, they may not appear so appealing to the employers buying the insurance. It’s not just family physicians that are required to be Board Certified, its’ everyone.

You have a compound fracture of your femur with a shattered patella. You want a person who calls himself an orthopedist to do the surgery? Or someone who is a Board Certified Orthopedist. You are having a heart attack. You want someone who calls himself a cardiologist doing your catheterization and angioplasty with stenting? Or a Board Certified Cardiologist?

Now, there may be some who say they have met lousy Board Certified doctors. True. It doesn’t mean that person will have a good bedside manner. It doesn’t mean they aren’t an alcoholic or drug addict or suffering from depression. It doesn’t mean they are perfect and never make mistakes. But it does guarantee a certain minimum level of knowledge. Right now it is the only way we have to measure knowledge.

I could go to 1000 hours of CME. Does it make me knowledgeable in my area? No. I could sign in and leave. I could sleep. I could take courses in just about anything that has nothing to do with the patients and diseases that I treat. Just saying you do CME doesn’t prove what you know and what you don’t.

But the bottom line is taking exams to become Board Certified and stay Board Certified isn’t going anywhere. Complaining about it doesn’t do any good as it isn’t going to change. We had to take many tests to even become doctors. This is not at all novel. I had to take SATs to get into a good college. I had to take MCATs to get into medical school. I had to take 3 levels of exams to become licensed to be a doctor. And then I had to take the Board Exams. You want an Fellowship or Certificate of secondary specialty, guess what, you have to take a test to prove you know what you say you know.

If you didn’t want to have to take tests, why become doctors?

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 BleiweissSent: Monday, November 28, 2011 10:42 PMTo: Subject: Re: Re: AAFP SAMs or other Modules

has already lost one or two of the better paying contracts because of this... and our local Blues, the 500 lbs. Gorilla in our room, perhaps as much as 60-70% of our commercial market is in their control..... So, Excellus BC/BS has given her the Big Threat, Arm Twist stating that she has until their next recert period period with them to make this go away or she is toast with them.....

Still sounds likes defacto licensing and market control, Anti-Trust like, collusion like control for that matter.... It should be illegal for insurance carriers to keep doctors off panel as long as they meet whatever their state's guidelines are to legal practice. End of story. But worse yet, the folks at the boards, they all know the real deal, the drill here and yet they continue to pretend that what they do, has no influence or impact on such super important matters as who survives or dies. And IMHO, I believe it all plays right into their hands and that they actually like it this way.... How many busy FP's, IM's, and Ped's would bother to deal with all of this CCHIT if it didn't mean their possibly being driven into the poor house???? That's Bull and that's Bullying.

To: Sent: Monday, November 28, 2011 6:41 PMSubject: Re: AAFP SAMs or other Modules

i will be taken off insurance panel by the quickest, highest paying insurance carrier in my city if i am not board certified..hows that?beef..steakgrace>> 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 & #39;t really seem too weighty.>

[Guest guest]

Thank-You .... Sometimes I get so wordy that my point gets lost in my creative side.... my passions.... And point in fact, you are the one to bring to the new awareness that so much of this has to do with reasons and purposes that have little if nothing to do with actual improvement of doctoring practices no less patient care.... My point exactly for a well designed "Immersive" 3-4 day long set of Classes and Practical exam procedure room work even without any final exam of some sort.... reach teaching and real positive, interactive in terms of professionals gathered together because they actually want to be there and be mentally and professionally challenged and improved....

Not insulted with a concept that starts with the assumption that you are doing things far less than perfectly, please select from one of the many things you suck or are mediocer at, and use the Meaningless Use EMR that now even the Board itself will FORCE upon you simply to get re-certified, to show that you stinky, far from perfect, in need of our paternalistic Forcing you to do so by Mandate or Else like policy, Module of Proof of improvement in your Incompetent performance.... We have not finished having a proper hearing and airing out at to whether or not MU is even worth it medically or otherwise and yet not our boards are insisting we comply and purchase and use these perhaps BAD tools that many of us are opposed to on very valid clinical and patient care, office work flow reasons???? Just to be able to participate in an exam that starting premise is that those taking it stink or or so

so at best.... Give me a flippin' break.... Who is the one who has issues with communication and public image here???? Me or this Board???? And So was all the care all of you provided "Meaningless" and worthless prior to today's MU EMR's and Board re-Certification then???? The implication itself is demeaning and very insulting, and does nothing to build bridges between the gov't, the boards and the professionals in the field and on the frontlines doing the real day to day dirty work of attempting to care for all Americans in this horrible and dysfunctional system.... If you can imply from the beginning that almost all PCP's stink and are in need of serious improvement as your starting point, then I think they and those of us who support them and see how hard they work and how much they try to care properly, can tell that same insensitive person and board, organization to go "F" yourself.... How dare you start from such a mean and demeaning starting

point for your own diplomates and expect them to like you, respect you all the while you insult them to all of their faces???? Get a flippin' Clue here guys...

But as much as Jim is doing a very decent job, his thoughts and input are basically falling on deaf ears. Also he was suggested and or basically hand picked by someone who was like "connected" to the king makers inside this process still.... What if Dr Mengella was put in his place by some other person instead of someone decent like our IMP minded Jim???? What then??? The lack of transparency and democractic process, due process created by those that are under this organizations authority is a HUGE part of the disconnect and lack of respect as they continue to prove that they are disconnected from those that they are supposed to be supporting and assisting in showing the world their best side and their worthiness for professional status and respect.... Where did that entire concept go and why is it completely not even discussed here, no less a basic mandate for having such status and

authority???

Without some form of democratic and supporting due process to open this organization up to the cleansing light of sunshine, IMPO this kind of disconnect and dissatisfaction will continue to grow and fester..... is this what we all want? Is this what any such board should want or ignore in their blind march to even more of the same disconnected maddness????

To: Sent: Tuesday, November 29, 2011 10:40 AMSubject: Re: AAFP SAMs or other Modules

I appreciate Jim's postings and his efforts at improving the BoardCertification process. He seems like a good guy, and I'm in the same life stage, being 63. I'm facing some of the life same life and practice choices associated with that. My age may give some historical perspective on how the process we now have evolved. These are just my feelings and ventings, I'm not really trying to think I can actually change anything.I agree with 's posts on the matter of the way the test is conceived and administered. The whole process is antiquated, and extremely cumbersome and burdensome. It's an old concept with some new digital stuff sort of slathered on to make it look more modern. It does not take true advantage of the connectivity and communication and sharing of the pertinent data that could and should be possible in today's modern digital world.It seems like the whole process is really for the benefit of "Family Medicine" as a

larger whole, particularly in preserving it's place in the world of academia and government funding, rather than to benefit any individual diplomate, or even I dare say, to actually benefit the population of patients we are supposed to be serving, or at least that is somewhat of a secondary goal. The reasons for that have an historical basis. Of course no one will actually admit to this, but if you look at the history of how we got this recertification process, the preservation of the entity of Family Medicine in the academic and government funding world was the real reason we got all this stuff, not so much for delivering the actual patient care. The medical academic world in the universities was reluctantly forced to accept Family Medicine as part of their system under the threat of their funding being cut back when there was more political support for sending out barefoot family doctors that were then seen as the answer to the maldistribution

of healthcare in the U.S. in the 1970s. Nowadays, I think we've lost most of that support, in that it is perceived by those controlling the purse strings, that PA's, NP's and others can do the job. I mean no offense to any PA's and NP's on the list. Just stating my perceptions of where things are these days.>> Kathy, > It's not the concept of a test that bothers me so much... It is the entirely over the top, modules and expensive various ways of obtaining this life blood certification that bothers me so..... At some point its time to say; "Enough is Enough Already".... No less to have some disconnected board that certainly seems to not understand or relate to the day to day realities of those that

they presently have way too much power and authority over, and without any public voice from those that they wield this power over....

[Guest guest]

Naaaaaahhhh, I think not... But if I didn't have kids and a business and a hard working doctor wife, I would probably be "Occupying" some place somewhere....

To: Sent: Tuesday, November 29, 2011 11:14 AMSubject: Re: Re: AAFP SAMs or other Modules

So ....you aren't interested in a Tea Party invite:)

; To: < >; Subject: Re: Re: AAFP SAMs or other Modules Sent: Tue, Nov 29, 2011 3:58:33 PM

Thank You for your Support,

BUT, most of what I need a chill from is Not here but in other really dysfunctional areas of my private life where Palllin Wanna Be, Grizzlie Bears with Lipstick who have literally fabricated complete basely lies that quite literally might be more about their own denial, problems even Projection in one horrible case of her own misbehaviors and acting out, lack of boundaries and appropriateness have lead to probably 3/4's of my regular, continuous stress. And yes I do believe that it has a whole heck of a lot to do with the irritations that lead to visable bleeding coming out of my body which itself became very stressful and worrisome.... Oh and the worst of these Grizzlie Bear Hockey Mom's is a cop, a Captian in our local Sheriff's Dept making her completely false and fabricated crap all the more supposedly crediable. When in fact it was only in support of her fellow Momma Grizzlie who

was constantly attempting to take me out at the knees because this nice man and good coach had the audacity to come into "Their Association" as a dad and coach with his own 2000 birth year goaltender, who was a direct threat to her own puggy less athletic cub.... Who from day one I tried to treat with the same support, care and intense positive hard work coaching style to help him become the best he could be even though he could be my son's direct competition one day down the road.... And I praised him well and often because at times he certainly deserved it and all kids need that kind of thing... Oh and both of these wonderful women were Both Board Members who should have had my back and been defending me, running interference for me, supporting me (if even needed, other than the Grizzlies, the majority of the parents and players and I got along super well even to this day, as kids and parent come up to me with huge hugs and firm handshakes and kind

words of "We Miss You" and "We too should have gotten out of here like you and your son did, these folks are just insane. They play Blood Sports social politics of the worst sort) instead of being the hidden, behind the scene, lied to, manipulated like a betrayed spouse, Gaslighting me, and playing me for a sucker.... I'm sorry I tried to be a great coach and good adult friend, teacher, role model, uncle like person in your child's life....

That is my Main Trauma, almost PTSD like after two years in a row and it is called "Mobbing" and if you google it you will learn more than you ever want about this horrible form of social abuse and trauma. That is the cause of the auto-immune response of stress of my own body beating up it's own Large Intenstine as I try to behave and act like a better person than them, swallowing a heck of a lot more than any person should have to do so, while being assaulted in name and character for doing nothing but good things for 15 kids and their families.... And it is almost always brought upon a person who is at least go if not even fairly well above average at what they do, which then leads lesser more insecure people to lash out in an attempt to ruin those that they percieve as some sort of a threat to them or their status quo....

BTW, the Bull rumors that started from this have been feedback looped around, back to where my son and I went to get away from the Bull to the point that others there now have similar reasons (they think) to feel uneasy and concerned about us both, especially me as parent and coach when in fact I have 15 years of continous service to the local hockey community in coaching and officiating for our kids, even before we had kids, kids of our own in the program..... It was just the right thing to do and personally I love it and it is simply what I do, this is my passion and my love.... Working with the kids and using the sport as a means to bridge the years between us, this common denominator that we share.... that makes us almost equals, I am from their line, I sat on that bench 40 years ago, and stood in their skates just as they do

today..... Generativity which is a sign of personal growth and maturity then bottled up, and rejected and made out to be something horrible, the kettle calling the tea pot black and all for very selfish, unfair, inappropriate, immature, dysfunctional and possibly even at least a bit mentally ill, cause and origins.

And until just about a week ago I had to sit in the stands and watch my son struggle because he is a goalie and majority of coaches were raised skaters and most of us skaters, players, don't know the first thing about how to raise and mentor, teach a goalie.... But since our son became a goalie, I made it my mission to fill-in this gap that almost all coaches have, and really learn how to be a good goalie coach and try to stay half a step ahead of his development. But Thank Goodness, this one wonderful man who is my son's head coach was at least willing to tune-out what he heard and he heard an earful unfortunately, and gave me half a chance to show him what I can do, and that I had to prove my personal decency of all things.... Me, Us, the starve our values and ethics micro solo practice Mom and Pop parents

business people... How insane and offensive. And yet I saw and understood this as the opportunity that it was to finally get back out there with a new group and show who and what I could do and be, and am.... Thank You Coach Tony!!!!

That is my real personal pain for the better part of three years and going now. And finally one good man was willing to ignore what he heard from at least half a dozen really not so nice people who engage in such inappropriate spread of such nasty, toxic social crap.....

I am more ADD than Roid raging now.... BUT I will fully admit that back in the middle of the summer when I was on 40 mgs daily Yes, I was straining to control myself in many ways of behavior and it was very concerning and upsetting. Now I am down to about 17 1/2 mgs and slowly dropping as my docs and I have finally found a maintainance drug that works without making me more sick than the disease does.... Now I do not feel that "Pressured" feeling, almost like I would imagine pressured feels in a Manic like episode.... Back then I did fall for the side effects once or twice and my appologies to those in my path at the time..... But now, I feel much more like my normal ADD like self.... So that good really works for me med is: "Apriso" extended time released Mesalamine... Now day long marriage to my

bathroom on it thank goodness. Finally!!!! It is almost like I am taking nothing which is great and what anyone would hope for.... BUT, unfortunately it is on the third tier of our NYS Bridge Plan for folks with Pre-Exisiting conditions like both of us.... and their "wonderful" third tier means, Get This: 100% Co-Pay!!! So we are looking at just about $300 per month for this drug even as I did the right thing and tried a number of less expensive similar meds and failed on them. My doc and I both did the right thing trying the normal less expensive generic types first but No Good for Me.... We are attempting to get samples for our office but it may be tough for a solo FP's office to get this more marketed to GI's Med.... BTW is it not fraud to refer to something as "Co" when there is nothing "Co" about it, no cost sharing what so ever???? Co-Pay means a consistant cost perhaps at various levels and Co-Insurance means a consistant percentage

sharing.... But to call it a 100% co-pay sure feels fraudulant and misleading to me.....

BTW and this is the last part of this long post on my personal stress and health problems (and thanks for all of your concerns as friends fellow medical people of the best kind) in only a bit more than a week and three practices our son has just about regained all of his previous, past season form, skills and habits.... He made such an incredible snatch out of mid air with his glove hand, when he was just about completely down and out, ESPN should have put it on the High Light Reel this morning, I swear.... he was completely down to the far left side and pipe after just making one save on a teammate coming in on a shooting drill that was supposed to end on the single shot, no rebounds..... But half messing around and perhaps a bit frustrated as Adam is starting to

find himself and is starting to shut the door a bit more now..... this player went for the rebound (not part of the drill really) and tried to score while he had my son down and out, and dead to rights and move to Adam's right to try and get the majority of the open right side for easy pickin's.... Well Adam threw out this amazingly super fast glove out of nowhere, tracked to his mitt, his entire body thrown out that way, head turned to properly track it all the way to his mitt and WOMP!!!.... that wonderful snappy thud of a strong shot hitting the webbing of the pocket of his glove hand.... There was a moment of stunned silence followed by the entire team and coaching staff cheering and smacking their sticks on the ice in a players form of applaudes.... Obviously I was super proud and it was the first amazing snatch he has made since perhaps Sept if not this July at Goalie Camp.... That was the kid, this amazing little 11

year old whose father sat in the stands last April at travel team try-outs and at Goalie Camp this past July, almost with tears in my eyes because in only two years and his doing the hard work with me and a few other better than myself goalie coaches had turned himself into a "Real Goaltender" worthy of real respect from friends and foe alike... Who had put the local hockey community of Notice that "He is here and he has Arrived". At times I still can't believe it is him.... the little boy who stuggled and at times was so frustrated when first trying to skate as a player... that I felt was not going to want to stick with it, and look at him now... And it was Him that did what it took to reach this first really impressive plateau, he did the work, the sweat and the achy muscles, the drills and the dry land work too.... He has clearly earned what he has accomplished so far.... and clearly deserves whatever it can

reap...

And so not only did he and I have to work the work and do the drills together but we also had to try to get past all the crap of those abusive, mentally ill, mean, undermining, anti-kid, anti-sportsmanship, dysfunctional selfish big "B's". And what a horrible thing to have to get yourself no less your 9 to 11 year old son thru.... What an F'ed up set of life lessons to have to teach a great wonderful child, with mood issues of a modest amount of his own to begin with.... He had enough on his plate already, and we as the grown-ups were supposed to be better than this, and to create a positive and nurturing envirornment for all the kids and not this blood sport, back stabbing, lying and manipulative, highly unfair personally very painful and

traumatizing place that the Grizzlies created and imposed upon me and him the past few years.... and in facing such amazingly messed up crap, making such nice and impressive gains all the more sweet for both of us... And so their toxicity almost followed us here, it did as a matter of fact.... and so he and I were almost denied what he clearly had earned and deserves all over again up and until this past week or so... And all because one good man, had the decency to listen to me, hear me out and not PRE- JUDGE me from previous laid down and put in place and motion, Toxic gossip.... And simply allowed Me and therefore my Son as well, to show who were were and what we could do if only allowed to be ourselves and do what we can do with a modest amount of rope and opportunity.... So I end this super long post in honor of a wonderful kind, soft spoken but none the less "Gutsy" man, our Head

Coach, Tony... Thank Coach Tony.... To Coach Tony... Thank You.

and Adam

To: Sent: Tuesday, November 29, 2011 7:43 AMSubject: RE: Re: AAFP SAMs or other Modules

,

First off, sorry you haven’t been feeling well. Colitis responds to stress dude…..you need a big chill! Maybe we have an explanation for these long posts now; prednisone can do that.

OK, now I have read this, some of it 2 to 3 times. I really don’t get what you are saying this time. The Board of the ABFM is made of practicing doctors. Our own Jim Kennedy is one of them. One of my colleagues here in NJ was on the Board of the Board for a few years. It is not expensive to get CME. You only need 25 hours in group setting every 3 years. The state meetings are usually a very cheap way to get group CME. The rest can be thorugh the journals which are free with AAFP membership. They also prepare you for the Boards. Yes the process is expensive but averaged over 10 years it’s not that expensive. I pay more every year in my Medical Staff Dues for my hospital privileges, something insurance contracts also require.

Please don’t suggest more testing. Oral and procedural testing would be far more expensive. But when we graduate from residency, the residency director is saying we are capable of doing these procedures. So in a way, it’s being done, just not retested. I don’t think anyone wants that.

I think requiring hospital privileges is the insurance companies way of hoping someone is watching doctors for physical or emotional impairment that could jeopardize their ability to practice. I won’t say that works. We also have to swear to the fact we are not disabled or impaired for our medical license. But I think if you are significantly impaired, you will have problems passing the Boards and that is some of what the Board testing accomplishes.

As far as owning intellectual property. My hospital also requires Board Certification to be on staff. Do I really want the insurance companies and hospitals creating their own tests to see if I am competent? That would be ridiculous. Do I want my state creating their own tests? No I would rather just take the National Board of Medical Examination or whatever that 3 part test was called to get a license. This is a help, not a hindrance. Could you imagine having to take a separate test for every state you ever moved to to get a license?

I think, instead of wasting effort protesting the fact that there are National Standards and they aren’t necessarily a bad thing, we can maybe focus on why some good doctors don’t pass the Boards and find ways to help them. Isn’t that the real issue?

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 BleiweissSent: Tuesday, November 29, 2011 1:26 AMTo: Subject: Re: Re: AAFP SAMs or other Modules

Kathy,

It's not the concept of a test that bothers me so much... It is the entirely over the top, modules and expensive various ways of obtaining this life blood certification that bothers me so..... At some point its time to say; "Enough is Enough Already".... No less to have some disconnected board that certainly seems to not understand or relate to the day to day realities of those that they presently have way too much power and authority over, and without any public voice from those that they wield this power over....

Every year I must take a take home open book exam, a class that is both classroom as well as On-Ice, and at the end of the day, take a closed book exam as well and all just to be allowed to Officiate Amatuer Ice Hockey while coaches and others don't have to take classes but every 3 to 4 years.... There comes a point where we are going way beyond the means and intention of the original mandate.... Oh and that is just to be a level 2 or 3.... If I want to apply for level 4 (top level one can obtain) I would have to take a skills based exam based mainly upon my skating abilities and perhaps an even tougher closed book exam. Now I have no problem being tested most years but this year I am still attempting to recover from my coliltis and an entire summer of slugging around sick and on Prednisone making me even more weirded out swollen and far too over weight like never

before....

BUT, Unlike many certified test and one day annual required clinic attending Level 4's out there... I have attended three 3 1/2 day long weekend USA Hockey run Officiating Camps in just about 12 years time span.... I was taught, endoctrinated into a professional mindset and better understanding and trained to a mental and personal level most of those tested but never classroomed, truly On-Ice Taught and Trained Officials could ever begin to understand..... A practical application and interpretation of the facts, rules are but rules and facts are but facts ( be they like mine or yours) to be memorized and spit back out..... But the actual practical understanding and the implications and applications of them are something completely different. And it was with the actual real and valid classwork that I started the journey in 1998 to

become the professional I am today... and all to officiate kids and adults in an amatuer sport... Not the crap on some test and not the crap in most CME classes either....

How about modestly funded and priced, actual classes, Real and Valid classes, tests not even need apply... To really have to emerse oneself in such classes, available in at least a few large cities in all states much like my officiating classes run and created by these supposedly so well versed and worth of passing judgement boards... Just the living together, eating together, taking class together, sweating together and having good interactive exchanges of ideas, theories and concepts, and sharing real life examples from interesting, great, aweful stressful, messed up and awesome games all the folks in that room have officiated over the last few years both outside of the actual classes no less stimulated back to memory and shared and debated in open forums in class as various parts of lessons brought them to mind and added to the lively debate; This was so much more

worthy of certification of a certain level obtained and so much more informative and worthy of learning you can't hold a candle to it....

And if there is anything life has taught me in all of my pursuits in many different fields and skills.... and that is this: Life long learners are just that life long learners and those that are NOT, simply are NOT..... If someone is passionate about what they do and what they want to learn, they will do it all of their very own, nobody has to hold a gun to their head or attempt to threaten their livelihood and their basic right to have equal access to the life blood Money, Dollars that might make unfair choices based on matter other than ability or knowledge.....

Lastly, why not have a stitching part of the exam, a health form for mental, emotional, lack of delussional thoughts and practices, an eye sight chart and exam, shakey hands, and other procedure, practicals???? I can think of an entire load of equally worthy of review standards that don't have darn thing to do with handing over data from a Certified Meaningless Use EMR, which is now FORCED Upon any and all docs who care to apply for certification???? Or have we all forgotten that little fact here???? My wife and I are very strong supporters and protectors of privacy and civil rights... Requiring her, us to have to start opening up access to the supposedly de-intentfied data, is In OUR shared and Mutual humble opinion WAY overstepping the boundaries of their original mandate and powers that they were granted by those that are screened and tested by

them....

So if my wife and all the rest of you had specific books to read and prepare yourself for class and had to go to day and or sleep away doctors training camp and school like I did thru USA Hockey and from that took a semi-reasonable closed book exam proctored by semi-normal people like the professors (fellow well respected and still practicing in the field doctors like the semi pro, pro and collegiate officials that came and taught some of our classes) who taught the classes and folks like could bring some tissues and sugar snacks, coffee, juice and soda into the rooms without being shot, and that attending such a great well taught set of classes then "Certified" a doctor to claim such for about 7-10 years and it didn't cost an arm and leg that so many docs actually are starting to have problems affording (like Us!!!) and that there were even scholarships for hard

hit docs too.... Now that would be an awesome way to help keep people sharp and checked out and properly taught and worthy of being "Certified".....

Lastly, if and when the boards start taking back their certification, refusing to allow their intellectual property and certification to be misused by greed ill intended insurance carriers, willing to take them to court as many times as it takes to stop abusing any and all docs and ruining their good neutral name and standing... then perhaps I could regain the respect I had for the board only less than 10 years ago.....

To: Sent: Monday, November 28, 2011 11:56 PMSubject: RE: Re: AAFP SAMs or other Modules

,

We are specialists, specialists in Family Medicine. Part of being a specialist means that we are Board Certified in that Specialty. TO be Board Certified, you must past some tests. We are hardly the only specialty that requires this. Without our Board Certification, we are nothing more than General Practitioners. Insurance companies have every right to contract with whomever they want. They are trying to sell quality physicians to the employers. If they only contracted with General Practitioners, who’s knowledge base is completely unknown, well, they may not appear so appealing to the employers buying the insurance. It’s not just family physicians that are required to be Board Certified, its’ everyone.

You have a compound fracture of your femur with a shattered patella. You want a person who calls himself an orthopedist to do the surgery? Or someone who is a Board Certified Orthopedist. You are having a heart attack. You want someone who calls himself a cardiologist doing your catheterization and angioplasty with stenting? Or a Board Certified Cardiologist?

Now, there may be some who say they have met lousy Board Certified doctors. True. It doesn’t mean that person will have a good bedside manner. It doesn’t mean they aren’t an alcoholic or drug addict or suffering from depression. It doesn’t mean they are perfect and never make mistakes. But it does guarantee a certain minimum level of knowledge. Right now it is the only way we have to measure knowledge.

I could go to 1000 hours of CME. Does it make me knowledgeable in my area? No. I could sign in and leave. I could sleep. I could take courses in just about anything that has nothing to do with the patients and diseases that I treat. Just saying you do CME doesn’t prove what you know and what you don’t.

But the bottom line is taking exams to become Board Certified and stay Board Certified isn’t going anywhere. Complaining about it doesn’t do any good as it isn’t going to change. We had to take many tests to even become doctors. This is not at all novel. I had to take SATs to get into a good college. I had to take MCATs to get into medical school. I had to take 3 levels of exams to become licensed to be a doctor. And then I had to take the Board Exams. You want an Fellowship or Certificate of secondary specialty, guess what, you have to take a test to prove you know what you say you know.

If you didn’t want to have to take tests, why become doctors?

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 BleiweissSent: Monday, November 28, 2011 10:42 PMTo: Subject: Re: Re: AAFP SAMs or other Modules

has already lost one or two of the better paying contracts because of this... and our local Blues, the 500 lbs. Gorilla in our room, perhaps as much as 60-70% of our commercial market is in their control..... So, Excellus BC/BS has given her the Big Threat, Arm Twist stating that she has until their next recert period period with them to make this go away or she is toast with them.....

Still sounds likes defacto licensing and market control, Anti-Trust like, collusion like control for that matter.... It should be illegal for insurance carriers to keep doctors off panel as long as they meet whatever their state's guidelines are to legal practice. End of story. But worse yet, the folks at the boards, they all know the real deal, the drill here and yet they continue to pretend that what they do, has no influence or impact on such super important matters as who survives or dies. And IMHO, I believe it all plays right into their hands and that they actually like it this way.... How many busy FP's, IM's, and Ped's would bother to deal with all of this CCHIT if it didn't mean their possibly being driven into the poor house???? That's Bull and that's Bullying.

To: Sent: Monday, November 28, 2011 6:41 PMSubject: Re: AAFP SAMs or other Modules

i will be taken off insurance panel by the quickest, highest paying insurance carrier in my city if i am not board certified..hows that?beef..steakgrace>> 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 & #39;t really seem too weighty.>

[Guest guest]

LOL. So you want government bailouts for the common man? Make sure you are on your tetanus shot:)

From:

Bleiweiss ;

To:

< >;

Subject:

Re: Re: AAFP SAMs or other Modules

Sent:

Tue, Nov 29, 2011 4:28:15 PM

Naaaaaahhhh, I think not... But if I didn't have kids and a business and a hard working doctor wife, I would probably be " Occupying " some place somewhere....

To: Sent: Tuesday, November 29, 2011 11:14 AMSubject: Re: Re: AAFP SAMs or other Modules

So ....you aren't interested in a Tea Party invite:)

; To: < >; Subject: Re: Re: AAFP SAMs or other Modules Sent: Tue, Nov 29, 2011 3:58:33 PM

Thank You for your Support,

BUT, most of what I need a chill from is Not here but in other really dysfunctional areas of my private life where Palllin Wanna Be, Grizzlie Bears with Lipstick who have literally fabricated complete basely lies that quite literally might be more about their own denial, problems even Projection in one horrible case of her own misbehaviors and acting out, lack of boundaries and appropriateness have lead to probably 3/4's of my regular, continuous stress. And yes I do believe that it has a whole heck of a lot to do with the irritations that lead to visable bleeding coming out of my body which itself became very stressful and worrisome.... Oh and the worst of these Grizzlie Bear Hockey Mom's is a cop, a Captian in our local Sheriff's Dept making her completely false and fabricated crap all the more supposedly crediable. When in fact it was only in support of her fellow Momma

Grizzlie who

was constantly attempting to take me out at the knees because this nice man and good coach had the audacity to come into " Their Association " as a dad and coach with his own 2000 birth year goaltender, who was a direct threat to her own puggy less athletic cub.... Who from day one I tried to treat with the same support, care and intense positive hard work coaching style to help him become the best he could be even though he could be my son's direct competition one day down the road.... And I praised him well and often because at times he certainly deserved it and all kids need that kind of thing... Oh and both of these wonderful women were Both Board Members who should have had my back and been defending me, running interference for me, supporting me (if even needed, other than the Grizzlies, the majority of the parents and players and I got along super well even to this day, as kids and parent come up to me with huge hugs and firm

handshakes and kind

words of " We Miss You " and " We too should have gotten out of here like you and your son did, these folks are just insane. They play Blood Sports social politics of the worst sort) instead of being the hidden, behind the scene, lied to, manipulated like a betrayed spouse, Gaslighting me, and playing me for a sucker.... I'm sorry I tried to be a great coach and good adult friend, teacher, role model, uncle like person in your child's life....

That is my Main Trauma, almost PTSD like after two years in a row and it is called " Mobbing " and if you google it you will learn more than you ever want about this horrible form of social abuse and trauma. That is the cause of the auto-immune response of stress of my own body beating up it's own Large Intenstine as I try to behave and act like a better person than them, swallowing a heck of a lot more than any person should have to do so, while being assaulted in name and character for doing nothing but good things for 15 kids and their families.... And it is almost always brought upon a person who is at least go if not even fairly well above average at what they do, which then leads lesser more insecure people to lash out in an attempt to ruin those that they percieve as some sort of a threat to them or their status

quo....

BTW, the Bull rumors that started from this have been feedback looped around, back to where my son and I went to get away from the Bull to the point that others there now have similar reasons (they think) to feel uneasy and concerned about us both, especially me as parent and coach when in fact I have 15 years of continous service to the local hockey community in coaching and officiating for our kids, even before we had kids, kids of our own in the program..... It was just the right thing to do and personally I love it and it is simply what I do, this is my passion and my love.... Working with the kids and using the sport as a means to bridge the years between us, this common denominator that we share.... that makes us almost equals, I am from their line, I sat on that bench 40 years ago, and stood in their skates just as they

do

today..... Generativity which is a sign of personal growth and maturity then bottled up, and rejected and made out to be something horrible, the kettle calling the tea pot black and all for very selfish, unfair, inappropriate, immature, dysfunctional and possibly even at least a bit mentally ill, cause and origins.

And until just about a week ago I had to sit in the stands and watch my son struggle because he is a goalie and majority of coaches were raised skaters and most of us skaters, players, don't know the first thing about how to raise and mentor, teach a goalie.... But since our son became a goalie, I made it my mission to fill-in this gap that almost all coaches have, and really learn how to be a good goalie coach and try to stay half a step ahead of his development. But Thank Goodness, this one wonderful man who is my son's head coach was at least willing to tune-out what he heard and he heard an earful unfortunately, and gave me half a chance to show him what I can do, and that I had to prove my personal decency of all things.... Me, Us, the starve our values and ethics micro solo practice Mom

and Pop parents

business people... How insane and offensive. And yet I saw and understood this as the opportunity that it was to finally get back out there with a new group and show who and what I could do and be, and am.... Thank You Coach Tony!!!!

That is my real personal pain for the better part of three years and going now. And finally one good man was willing to ignore what he heard from at least half a dozen really not so nice people who engage in such inappropriate spread of such nasty, toxic social crap.....

I am more ADD than Roid raging now.... BUT I will fully admit that back in the middle of the summer when I was on 40 mgs daily Yes, I was straining to control myself in many ways of behavior and it was very concerning and upsetting. Now I am down to about 17 1/2 mgs and slowly dropping as my docs and I have finally found a maintainance drug that works without making me more sick than the disease does.... Now I do not feel that " Pressured " feeling, almost like I would imagine pressured feels in a Manic like episode.... Back then I did fall for the side effects once or twice and my appologies to those in my path at the time..... But now, I feel much more like my normal ADD like self.... So that good really works for me med is: " Apriso " extended time released Mesalamine...

Now day long marriage to my

bathroom on it thank goodness. Finally!!!! It is almost like I am taking nothing which is great and what anyone would hope for.... BUT, unfortunately it is on the third tier of our NYS Bridge Plan for folks with Pre-Exisiting conditions like both of us.... and their " wonderful " third tier means, Get This: 100% Co-Pay!!! So we are looking at just about $300 per month for this drug even as I did the right thing and tried a number of less expensive similar meds and failed on them. My doc and I both did the right thing trying the normal less expensive generic types first but No Good for Me.... We are attempting to get samples for our office but it may be tough for a solo FP's office to get this more marketed to GI's Med.... BTW is it not fraud to refer to something as " Co " when there is nothing " Co " about it, no cost sharing what so ever???? Co-Pay means a consistant cost perhaps at various levels and Co-Insurance

means a consistant percentage

sharing.... But to call it a 100% co-pay sure feels fraudulant and misleading to me.....

BTW and this is the last part of this long post on my personal stress and health problems (and thanks for all of your concerns as friends fellow medical people of the best kind) in only a bit more than a week and three practices our son has just about regained all of his previous, past season form, skills and habits.... He made such an incredible snatch out of mid air with his glove hand, when he was just about completely down and out, ESPN should have put it on the High Light Reel this morning, I swear.... he was completely down to the far left side and pipe after just making one save on a teammate coming in on a shooting drill that was supposed to end on the single shot, no rebounds..... But half messing around and perhaps a bit frustrated as Adam is

starting to

find himself and is starting to shut the door a bit more now..... this player went for the rebound (not part of the drill really) and tried to score while he had my son down and out, and dead to rights and move to Adam's right to try and get the majority of the open right side for easy pickin's.... Well Adam threw out this amazingly super fast glove out of nowhere, tracked to his mitt, his entire body thrown out that way, head turned to properly track it all the way to his mitt and WOMP!!!.... that wonderful snappy thud of a strong shot hitting the webbing of the pocket of his glove hand.... There was a moment of stunned silence followed by the entire team and coaching staff cheering and smacking their sticks on the ice in a players form of applaudes.... Obviously I was super proud and it was the first amazing snatch he has made since perhaps Sept if not this July at Goalie Camp.... That was the kid, this amazing

little 11

year old whose father sat in the stands last April at travel team try-outs and at Goalie Camp this past July, almost with tears in my eyes because in only two years and his doing the hard work with me and a few other better than myself goalie coaches had turned himself into a " Real Goaltender " worthy of real respect from friends and foe alike... Who had put the local hockey community of Notice that " He is here and he has Arrived " . At times I still can't believe it is him.... the little boy who stuggled and at times was so frustrated when first trying to skate as a player... that I felt was not going to want to stick with it, and look at him now... And it was Him that did what it took to reach this first really impressive plateau, he did the work, the sweat and the achy muscles, the drills and the dry land work too.... He has clearly earned what he has accomplished so far.... and clearly deserves whatever it can

reap...

And so not only did he and I have to work the work and do the drills together but we also had to try to get past all the crap of those abusive, mentally ill, mean, undermining, anti-kid, anti-sportsmanship, dysfunctional selfish big " B's " . And what a horrible thing to have to get yourself no less your 9 to 11 year old son thru.... What an F'ed up set of life lessons to have to teach a great wonderful child, with mood issues of a modest amount of his own to begin with.... He had enough on his plate already, and we as the grown-ups were supposed to be better than this, and to create a positive and nurturing envirornment for all the kids and not this blood sport, back stabbing, lying and manipulative, highly unfair

personally very painful and

traumatizing place that the Grizzlies created and imposed upon me and him the past few years.... and in facing such amazingly messed up crap, making such nice and impressive gains all the more sweet for both of us... And so their toxicity almost followed us here, it did as a matter of fact.... and so he and I were almost denied what he clearly had earned and deserves all over again up and until this past week or so... And all because one good man, had the decency to listen to me, hear me out and not PRE- JUDGE me from previous laid down and put in place and motion, Toxic gossip.... And simply allowed Me and therefore my Son as well, to show who were were and what we could do if only allowed to be ourselves and do what we can do with a modest amount of rope and opportunity.... So I end this super long post in honor of a wonderful kind, soft spoken but none the less " Gutsy " man,

our Head

Coach, Tony... Thank Coach Tony.... To Coach Tony... Thank You.

and Adam

To: Sent: Tuesday, November 29, 2011 7:43 AMSubject: RE: Re: AAFP SAMs or other Modules

,

First off, sorry you haven’t been feeling well. Colitis responds to stress dude…..you need a big chill! Maybe we have an explanation for these long posts now; prednisone can do that.

OK, now I have read this, some of it 2 to 3 times. I really don’t get what you are saying this time. The Board of the ABFM is made of practicing doctors. Our own Jim Kennedy is one of them. One of my colleagues here in NJ was on the Board of the Board for a few years. It is not expensive to get CME. You only need 25 hours in group setting every 3 years. The state meetings are usually a very cheap way to get group CME. The rest can be thorugh the journals which are free with AAFP membership. They also prepare you for the Boards. Yes the process is expensive but averaged over 10 years it’s not that expensive. I pay more every year in my Medical Staff Dues for my hospital privileges, something insurance contracts also require.

Please don’t suggest more testing. Oral and procedural testing would be far more expensive. But when we graduate from residency, the residency director is saying we are capable of doing these procedures. So in a way, it’s being done, just not retested. I don’t think anyone wants that.

I think requiring hospital privileges is the insurance companies way of hoping someone is watching doctors for physical or emotional impairment that could jeopardize their ability to practice. I won’t say that works. We also have to swear to the fact we are not disabled or impaired for our medical license. But I think if you are significantly impaired, you will have problems passing the Boards and that is some of what the Board testing accomplishes.

As far as owning intellectual property. My hospital also requires Board Certification to be on staff. Do I really want the insurance companies and hospitals creating their own tests to see if I am competent? That would be ridiculous. Do I want my state creating their own tests? No I would rather just take the National Board of Medical Examination or whatever that 3 part test was called to get a license. This is a help, not a hindrance. Could you imagine having to take a separate test for every state you ever moved to to get a license?

I think, instead of wasting effort protesting the fact that there are National Standards and they aren’t necessarily a bad thing, we can maybe focus on why some good doctors don’t pass the Boards and find ways to help them. Isn’t that the real issue?

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 BleiweissSent: Tuesday, November 29, 2011 1:26 AMTo: Subject: Re: Re: AAFP SAMs or other Modules

Kathy,

It's not the concept of a test that bothers me so much... It is the entirely over the top, modules and expensive various ways of obtaining this life blood certification that bothers me so..... At some point its time to say; " Enough is Enough Already " .... No less to have some disconnected board that certainly seems to not understand or relate to the day to day realities of those that they presently have way too much power and authority over, and without any public voice from those that they wield this power over....

Every year I must take a take home open book exam, a class that is both classroom as well as On-Ice, and at the end of the day, take a closed book exam as well and all just to be allowed to Officiate Amatuer Ice Hockey while coaches and others don't have to take classes but every 3 to 4 years.... There comes a point where we are going way beyond the means and intention of the original mandate.... Oh and that is just to be a level 2 or 3.... If I want to apply for level 4 (top level one can obtain) I would have to take a skills based exam based mainly upon my skating abilities and perhaps an even tougher closed book exam. Now I have no problem being tested most years but this year I am still attempting to recover from my coliltis and an entire summer of slugging around sick and on Prednisone making me even more weirded out swollen and far too over weight like never

before....

BUT, Unlike many certified test and one day annual required clinic attending Level 4's out there... I have attended three 3 1/2 day long weekend USA Hockey run Officiating Camps in just about 12 years time span.... I was taught, endoctrinated into a professional mindset and better understanding and trained to a mental and personal level most of those tested but never classroomed, truly On-Ice Taught and Trained Officials could ever begin to understand..... A practical application and interpretation of the facts, rules are but rules and facts are but facts ( be they like mine or yours) to be memorized and spit back out..... But the actual practical understanding and the implications and applications of them are something completely different. And it was with the actual real and valid classwork that I started the journey in

1998 to

become the professional I am today... and all to officiate kids and adults in an amatuer sport... Not the crap on some test and not the crap in most CME classes either....

How about modestly funded and priced, actual classes, Real and Valid classes, tests not even need apply... To really have to emerse oneself in such classes, available in at least a few large cities in all states much like my officiating classes run and created by these supposedly so well versed and worth of passing judgement boards... Just the living together, eating together, taking class together, sweating together and having good interactive exchanges of ideas, theories and concepts, and sharing real life examples from interesting, great, aweful stressful, messed up and awesome games all the folks in that room have officiated over the last few years both outside of the actual classes no less stimulated back to memory and shared and debated in open forums in class as various parts of lessons brought them to mind and added to the lively debate; This was so much more

worthy of certification of a certain level obtained and so much more informative and worthy of learning you can't hold a candle to it....

And if there is anything life has taught me in all of my pursuits in many different fields and skills.... and that is this: Life long learners are just that life long learners and those that are NOT, simply are NOT..... If someone is passionate about what they do and what they want to learn, they will do it all of their very own, nobody has to hold a gun to their head or attempt to threaten their livelihood and their basic right to have equal access to the life blood Money, Dollars that might make unfair choices based on matter other than ability or knowledge.....

Lastly, why not have a stitching part of the exam, a health form for mental, emotional, lack of delussional thoughts and practices, an eye sight chart and exam, shakey hands, and other procedure, practicals???? I can think of an entire load of equally worthy of review standards that don't have darn thing to do with handing over data from a Certified Meaningless Use EMR, which is now FORCED Upon any and all docs who care to apply for certification???? Or have we all forgotten that little fact here???? My wife and I are very strong supporters and protectors of privacy and civil rights... Requiring her, us to have to start opening up access to the supposedly de-intentfied data, is In OUR shared and Mutual humble opinion WAY overstepping the boundaries of their original mandate and powers that they were granted by those that are screened and tested by

them....

So if my wife and all the rest of you had specific books to read and prepare yourself for class and had to go to day and or sleep away doctors training camp and school like I did thru USA Hockey and from that took a semi-reasonable closed book exam proctored by semi-normal people like the professors (fellow well respected and still practicing in the field doctors like the semi pro, pro and collegiate officials that came and taught some of our classes) who taught the classes and folks like could bring some tissues and sugar snacks, coffee, juice and soda into the rooms without being shot, and that attending such a great well taught set of classes then " Certified " a doctor to claim such for about 7-10 years and it didn't cost an arm and leg that so many docs actually are starting to have problems affording (like Us!!!) and that there were even

scholarships for hard

hit docs too.... Now that would be an awesome way to help keep people sharp and checked out and properly taught and worthy of being " Certified " .....

Lastly, if and when the boards start taking back their certification, refusing to allow their intellectual property and certification to be misused by greed ill intended insurance carriers, willing to take them to court as many times as it takes to stop abusing any and all docs and ruining their good neutral name and standing... then perhaps I could regain the respect I had for the board only less than 10 years ago.....

To: Sent: Monday, November 28, 2011 11:56 PMSubject: RE: Re: AAFP SAMs or other Modules

,

We are specialists, specialists in Family Medicine. Part of being a specialist means that we are Board Certified in that Specialty. TO be Board Certified, you must past some tests. We are hardly the only specialty that requires this. Without our Board Certification, we are nothing more than General Practitioners. Insurance companies have every right to contract with whomever they want. They are trying to sell quality physicians to the employers. If they only contracted with General Practitioners, who’s knowledge base is completely unknown, well, they may not appear so appealing to the employers buying the insurance. It’s not just family physicians that are required to be Board Certified, its’ everyone.

You have a compound fracture of your femur with a shattered patella. You want a person who calls himself an orthopedist to do the surgery? Or someone who is a Board Certified Orthopedist. You are having a heart attack. You want someone who calls himself a cardiologist doing your catheterization and angioplasty with stenting? Or a Board Certified Cardiologist?

Now, there may be some who say they have met lousy Board Certified doctors. True. It doesn’t mean that person will have a good bedside manner. It doesn’t mean they aren’t an alcoholic or drug addict or suffering from depression. It doesn’t mean they are perfect and never make mistakes. But it does guarantee a certain minimum level of knowledge. Right now it is the only way we have to measure knowledge.

I could go to 1000 hours of CME. Does it make me knowledgeable in my area? No. I could sign in and leave. I could sleep. I could take courses in just about anything that has nothing to do with the patients and diseases that I treat. Just saying you do CME doesn’t prove what you know and what you don’t.

But the bottom line is taking exams to become Board Certified and stay Board Certified isn’t going anywhere. Complaining about it doesn’t do any good as it isn’t going to change. We had to take many tests to even become doctors. This is not at all novel. I had to take SATs to get into a good college. I had to take MCATs to get into medical school. I had to take 3 levels of exams to become licensed to be a doctor. And then I had to take the Board Exams. You want an Fellowship or Certificate of secondary specialty, guess what, you have to take a test to prove you know what you say you know.

If you didn’t want to have to take tests, why become doctors?

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 BleiweissSent: Monday, November 28, 2011 10:42 PMTo: Subject: Re: Re: AAFP SAMs or other Modules

has already lost one or two of the better paying contracts because of this... and our local Blues, the 500 lbs. Gorilla in our room, perhaps as much as 60-70% of our commercial market is in their control..... So, Excellus BC/BS has given her the Big Threat, Arm Twist stating that she has until their next recert period period with them to make this go away or she is toast with them.....

Still sounds likes defacto licensing and market control, Anti-Trust like, collusion like control for that matter.... It should be illegal for insurance carriers to keep doctors off panel as long as they meet whatever their state's guidelines are to legal practice. End of story. But worse yet, the folks at the boards, they all know the real deal, the drill here and yet they continue to pretend that what they do, has no influence or impact on such super important matters as who survives or dies. And IMHO, I believe it all plays right into their hands and that they actually like it this way.... How many busy FP's, IM's, and Ped's would bother to deal with all of this CCHIT if it didn't mean their possibly being driven into the poor house???? That's Bull and that's Bullying.

To: Sent: Monday, November 28, 2011 6:41 PMSubject: Re: AAFP SAMs or other Modules

i will be taken off insurance panel by the quickest, highest paying insurance carrier in my city if i am not board certified..hows that?beef..steakgrace>> 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 & #39;t really seem too weighty.>