Years ago I flew to Washington D.C. for a meeting.  I redeemed some points on a credit card and upgraded to first class.  Woo hoo!  On the return trip I sat next to a professional looking woman and asked her what she did for a living.  She responded that she owned and operated a consulting business that helped manufacturers comply with new consumer product safety rules and regulations.  ”Wow,” I said….”and what did you do before that?”

“I ran the Consumer Product Safety Commission in Washington, D.C., ” she said as a matter of fact.  She probably did not appreciate the uncontrolled laughter that followed.  What a racket.  Invent new rules and regs that no one knows about or understands then charge them to figure out what you just did to them!  This is nothing but delayed extortion but I have also heard rackets like this referred to as a cottage industry.  Think of this as a type of parasite company that profits from the actions of the mother ship.

Cottage industries are common place these days.  They are not that hard to find or identify if you are looking for them.  All you have to do is identify some government agency or accreditation cartel and surrounding this will be all sorts of parasitic individuals and companies that have found “an angle,” or a way to capitalize on the morass of laws or regulations or rules.

No where is this more common than in the medical business.  Countless firms provide their services to help you learn new Medicare codes or companies that provide conferences or continued education for coding or billing practices consistent with new rules and regulations.  That new rules and regs are issued every year guarantees that these companies will fill the ballrooms at large hotels with those hoping to avoid running afoul of whatever authority might threaten non-compliance and the resulting penalties.

Continuing medical education is another racket that guarantees a large revenue stream to academicians in medicine, many of which are impossibly poor communicators and most of which are conducting research that only the government would fund.  This is another topic by itself I’ll address soon.

All of the above is leading up to the following:  the Journal of the Association of American Physicians and Surgeons has outed a huge racket:  the American Board of Medical Specialties.  This is the outfit that issues that special stamp that physicians increasingly have to have:  board certification.   This process is extraordinarily costly (I know because I went through this fiasco in 1990).  By the time you pay the board and the various cottage industries that have sprung up to help get through this you have spent an incredible amount of money.

In the July, 2011 edition of their  journal (available online free of charge, here) Martin Dubravec, M.D. brilliantly dissects the cartel and cottage parasite, the ABMS.  Though their assets are north of 57 million dollars (whoa! that’s right) their thirst for loot has not been slaked (note that not satisfied with making everyone pay to become board certified, they were able to float board recertification for many specialties!).  Their latest ploy is to team up with state licensure boards to require “maintenance of certification” status in order to preserve a medical license.  Make no mistake.  If the ABMS says” it’s not about the money, it’s about maintaining the quality of medicine practiced”…….well…’s about the money!  The ABMS knows that no one would do this voluntarily so they figure that they’ll justmake everyone do it!

If Dr. Dubravec’s article is widely read and circulated the ABMS may find that they have overplayed their hand.  This article is a bold factual outing of medical gangsters for which shame is not possible.  Congratulations to the author and AAPS for publishing it.  I eagerly await the AMA’s rebuttal!

G. Keith Smith, M.D.