My hospital system, like many hospital and academic medical centers in America, provides an open-access journal subscription to the New England Journal of Medicine (NEJM) for it’s doctors on their private intranet. While I do not know the price of this subscription (I’m sure it’s substantial), in the past I have thought it was a nice gesture by our hospital staff to keep doctors current with the latest medical information from the medical journal with the highest impact factor.
Now, I’m not so sure.
New conflict of interests between the NEJM and my hospital have arisen that make me question the wisdom of this policy of free subscriptions provided to doctors, not only our institution, but all other medical centers that offer such an free subscriptions to their medical staff. As they say, there’s no such thing as a free lunch.
Especially when the lunch being served supports tying Maintenance of Certification to maintaining doctors’ hospital privileges.
On 7 April 2014, the New England Journal of Medicine launched their NEJM Knowledge+ website, a product of the NEJM Group, a division of the Massachusetts Medical Society, that breathlessly markets their own costly version of preparing for the ABIM’s MOC process to their readership. A tiny sliver of their exhaustive marketing even promotes the use of their product during the few remaining non-medical hours of a physician’s day:
"Whenever you’ve got a moment to lean back and reflect, Internal Medicine Board Review is there with you – whether it’s in line at the supermarket, in the parking lot while waiting for your child’s soccer practice to let out, or during an unplanned minute between patients."
Never is there a mention what NOT passing the ABIM MOC testing means to doctors and their families. Never is mentioned that since the advent of MOC re-certification, the financial reserves of the ABIM and ABIM Foundation have increased substantially; in 2006 and 2007, the ABIM transferred $13 million to its "foundation." Never is there a mention that reserves of this magnitude demand accountability to physicians upon which their system has been foisted without any unbiased scientific evidence of its merits. Never is there a mention of the cozy financial relationship that exists between Area9 Labs (the manufacturer of the NEJM Group’s new Knowledge+ website), McGraw-Hill publishing, and the NEJM. Never is mentioned how Area9 distributes and markets the web-based physician learning data it collects on the Knowledge+ website.
Most of all, there is never a mention of the ABIM’s unrelenting efforts to link their MOC process to doctors’ hospital privileges and their ability to practice their trade – hence where my concern with the conflict of interest exists when hospitals and medical centers purchase the NEJM free of charge for their physicians. Hospitals don’t need to buy into this manipulation of their staff. Almost every medical group has mechanisms to acquire continuing medical education for their staff that are open and not restricted to the ABIM’s costs and onerous re-certification process. By purchasing paid subscriptions to the NEJM, are our hospitals supporting the ABIM’s proprietary, self-mandated and scientifically unproven educational process that ties passing a test to the maintenance of hospital privileges?
It is very troubling that the NEJM Group has decided to ally with the ABIM in its MOC efforts. The ABIM leadership continues to exist under a non-transparent and unethical conflict of interest policy. The ramifications of the conflicts that existed with former and current members of the ABIM leadership are only now coming to light. This leaves the ABIM’s professional credibility seriously in question with physicians. Is the money that the NEJM Group receives from doctors of all levels of training on their Knowledge+ website worth the damage to their credibility as they ally with the ABIM?
It seems so. After all, the NEJM seems more concerned about its educational subscription fees than the ethics and scientific integrity of the training process they’re promoting.
Because of the clear and present danger that the promotion of the ABIM’s MOC process presents to physicians’ reputations and their ability to practice sound medicine, I recommend immediate termination of free paid subscriptions to the NEJM for physicians at our institution and others like it until the NEJM Group abandons its support of the ABIM’s highly-flawed and manipulative MOC process.
After all, the conflict of interest problems inherent to this cozy institutional arrangement between the ABIM, NEJM Group, and the nation’s hospitals far exceed anything that existed when pharmaceutical representatives supplied doctors with free pens.