Colleagues, This is a letter I am thinking of composing to our boards as the changeboardrecert.com doesnt seem to be specialty effective and there doesnt seem to be any update to the progress they are making or not making: I am a board certified anesthesiologist who is approaching the 10 year end of the re-certification cycle for MOCA. Over my career including private practice and residency training I have administered over 10,000 anesthetics with a very low complication rate. (I know because I track these statistics.) I am writing this letter after reading the article “Mounting Board Demands Foster Growing Unease” on the front page of Oct 2011’s Anesthesiology News and recently receiving an email regarding the attestation process due this year. In this article there are some valid points made by physicians who have been in practice critical of the MOCA process. I suggest the board of directors read it. There is a statement made by Dr. Warner(past ASA president) on pg 28 claiming unawareness of any anesthesiologists who are critics of the process or that they are just “unclear” on the process. I am quite frankly fed up with all these rules that are mandated onto us by those in power and feel the need to speak up in order to stop the perpetuation of this “ugly monster”. We anesthesiologists are clearly aware of the MOCA requirements of CMEs, proving licensure, getting attestations and references, and taking an examination. We all know pretty soon a simulator experience will become a requirement as well, requiring even more expense and time off. I happened to train at an institution with a simulator and have practiced on one. I am not convinced it is worth the time off or money spent for an experienced anesthesiologist. What I want to know is, who decided these were going to be the requirements? What justification did they have for making these requirements? Were private practioners consulted as to what would be the best tools to help us? After nearing completion of this process, I am voicing my opinion that the physicians in charge of creating this process have not done us justice. This process has done little to improve my practice or patient care, has not changed patient safety one bit, and has been a poor investment of my time and money. If the intent of MOCA is to keep physicians up to date in knowledge and improve patient safety, then having a set number on any type of CME taken fails this standard. Making physicians take time off to cram for an exam that has little to do with their daily practice also fails that standard and creates undue stress and expense for an already stressful profession. Getting references from people who work with you, again, fails that standard and is not only a waste of our time, but yours, it proves nothing! Credentialing at hospitals every couple years covers the reference process. There is no reason for our board to duplicate it. The idea of MOCA is not a bad idea. The execution of it, in my opinion and many of my colleagues, is all wrong. To offer some constructive criticism in how to make it work for practicing anesthesiologists, I suggest first, eliminating the once a decade written exam completely as it is does not prove ability to safely perform anesthesia and does not reflect knowledge of your day to day practice. It takes precious time away from us, and creates unneeded stress and expense. Second, if the idea is to improve knowledge, then an online CME module that specifically focuses on new changes in anesthesia practices and scientific evidence every year in various aspects of anesthesia management be implemented. Have a CME exam taken online after each module to show we have reviewed and learned the material - this is done at our time and convenience and being done online = very low cost and inconvenience. Third, create an up to date website on anesthetic management of all known medical pathology so we can log on and reference it and we can feel secure the information is up to date,accurate, and concise and is immediately available in the “cloud”. This would be THE “go to” reference for all anesthesiologists on-line rather than trying to google it and getting all types of questionable hits in your initial search. The board can cover their costs by charging us a yearly subscription fee. This would be a great tool in the middle of the night when, for example, the emergency exploratory laparotomy comes in on a patient with hereditary angioedema . This should be all that is necessary! It proves we are keeping up to date with changes in knowledge and care. We have enough worries with government and hospital bureaucracy as well as malpractice attorneys. Our livelihood is dependent on being Board Certified as hospitals wont re-credential us if we lose that certification. The general public has little idea what it means to achieve board certification, and the more onerous you make it on the physicians, is not in our or in the general public’s best interest - as the more ridiculous you make it, the more physicians will rather retire or opt out of board certification as an entire national group. We are no longer medical students or residents and do not need to be treated as such! Treat us as the self motivated, learned professionals we have proven ourselves to be. I am putting together a list of anesthesiologists who agree. If there is a large enough outcry from us, the board will have to address it. I have 85 members in my practice, most who have agreed to sign on. I would like to make that number 8500 to send a significant message. Any anesthesiologist who reads this and agrees, please sign the petition. Show it to your partners. If we speak with a large enough and loud enough voice, we can change it for the better. Apathy and inaction will just perpetuate the status quo. IF you disagree, let me hear your reasons. For those in other specialties who agree, feel free to use this as a template to further your cause.

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