Tuesday, June 29, 2010

ABIM, Arora board review and Frontrunners

I guess it's time for an update and a recap on this controversy. Here's what's happened so far:

From Bob Wachter and the WSJ Health blog we learned that the Arora board review company was harvesting questions from old ABIM exams submitted from memory by past attendees who had taken the exam and teaching its review course from these questions.

Over two thousand diplomats of the ABIM who had attended an Arora course (approved for 42 AMA category 1 CME hours) got a letter from ABIM expressing disappointment in their ethics for not blowing the whistle. A copy of this letter is to be maintained in those diplomats' ABIM files. According to comments on a related WSJ Health blog post many of these physicians feel they did nothing wrong, feel their professional record is unfairly besmirched by this letter and are considering legal counsel.

The ABIM sued Arora for teaching from old test questions.

In the discovery process of that suit emails between course attendees and Dr. Arora were examined, and a smaller number of physicians, 135 or so, were targeted for more severe sanctions (more than just the letter). In addition, a few of that latter group were sued by ABIM.

The three principal issues raised in the whole affair were 1) violation of the terms and conditions for candidates taking the exam (not to divulge exam content), 2) that ABIM test questions are proprietary information and 3) cheating. Premises 2 and 3 are questionable and may be topics for other posts.

The case was recently settled in ABIM's favor.

Meanwhile another board review company, Frontrunners, was being sued by ABIM on similar claims.

Frontrunners initiated an anti-trust counter-suit against ABIM.

I was recently informed by an ABIM spokesperson that a magistrate judge has made a recommendation that the suit by ABIM be decided in ABIM's favor and that the counterclaim was dismissed about a year ago. That's pretty much where I left it.

So what's transpired since then?

Frontrunners has issued an update, seemingly in response to the latest comments from ABIM. This came to my attention in the form of three comments to one of my blog posts. These were long and rambling. I have not posted them here. Readers can find the same material at the Frontrunners site. It is vitriolic, so be warned.

For those who don't want to read the whole thing I offer the following short version, as best I understand it, in the form of a point-counterpoint, minus all the accusations:

Point: ABIM cites a judicial opinion favorable to ABIM in their suit against Frontrunners.
Counterpoint: This was a recommendation by a magistrate judge. It was preliminary, and based on the judge's opinion that Frontrunners was hindering discovery efforts. Frontrunners expresses hope that the case will be decided on its merits.

Point: The Frontrunners counterclaim against ABIM was dismissed about a year ago and there is no suit pending at this time.
Counterpoint: Frontrunners, on their web site, states that the dismissal was based on the four year statute of limitations. However, they allege new damages which might be the basis for a refiling. No claim is now pending.

What's my stand in all this? I don't have enough information to come down squarely on one side. Arora's teaching methods concern me. Frontrunners' combativeness concerns me. Some of ABIM's actions concern me. I will be watching with great interest as this drama unfolds.


Anonymous said...

Dr. RW,
Don't forget the other WSJ Blog on this subject where others have posted comments:


The majority of comments, at least from what I have seen, have been strongly against ABIM. Three law firms, probably more are representing doctors against ABIM: Wachler & Associates (Michigan), Ann Bettinger (Florida), and Wood & Smith (New York). It seems to me that ABIM has opened up an incredible Pandora's Box of headaches by their recent actions. It will be interesting to see the final outcome of this affair. Thanks for keeping all of us posted and updated.

Anonymous said...

Dr. RW,
You may already be aware, but there is a new WSJ blog on the Arora/ABIM controversy. ABIM apparently has defined an appeals process and has actually rescinded the letter of reprimand of one doctor in Massachussets because of lack of evidence.


It looks like this affair is going to drag on for quite some time both internally at ABIM as the appeals process runs its course for the sanctioned physicians and maybe externally as ABIM faces lawsuits on a multiplicity of issues.

Anonymous said...

I don't understand why Frontrunner's combativeness concerns you. They got SUED. I think if I got sued I'd be pretty combative also.

Seems to me ABIM is being very inappropriate here. When you take the boards you have to sign an agreement not to disclose content. If you refuse to sign you cannot be boarded. I for one cannot practice without a board certification, which means any agreement I have to sign on condition of certification amounts to coercion. Coerced agreements are definitely not ethical and probably not legal either.

If there were another board organization, it would be different. Getting blackballed by ABIM is like being refused phone service by Ma Bell back when it was the only game in town.

As for the ethics of discussing what is on the exam, there is a big difference between saying the answer to question 16 is A and saying that hemochromatosis is always on the exam and you ought to know it.

At $1700 the recert is a wickedly expensive exam. And it is not as if ABIM does squat for me between exams. I pay big money to take periodic tests and get nothing in return except the privilege of carrying their piece of paper. If they are so interested in the ethics of medicine, and the promotion of quality medicine, why don't they offer board review classes and CME as part of their mission? I had to pay for all the board review materials I used.

ABIM's got nerve talking about ethics.

R. W. Donnell said...

Anon #3,
Thank you for your comment. Points well taken. I've been to many board review courses, ("mainstream" courses affiliated with academic institutions) and the more I think about this the more I realize that all of them draw in one way or another on past exam content. In fact, many faculty at such courses draw on their own test taking experience, or that of their house staff, in developing course content! So the whole thing is ridiculous. The line of demarcation of what is and is not appropriate to discuss is very fuzzy and ABIM has been arbitrary in determining which board review courses to single out. By the way, do you know of any new developments on this front?

Dr. Greg said...

ABIM is very aggressive in their test/trademark protection (read this s very greedy in regards to $$$). However, Frontrunners is very deceptive in their marketing and advertisement and sell a by far inferior and misleading, and often grossly incorrect product. Buyer beware, Frontrunners is not worth $200. Avoid it like the plague.