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eXXcellence in Women's HealthCareFrom: Gordon Goldman (obgyndoc@swbell.net)Tue Oct 30 19:41:13 2007
Had a very interesting interchange with Dr. Gant at the District VII meeting regarding this. The Foundation is designed to promote the 'lifelong learning' concept which is part of the new 'Maintenance of Certification' program. The Foundation provides the lifelong learning program to residents in OBGyn at no cost through their program directors. Those who participate are sent literature and testing (Q&A) materials quarterly at no charge, in attempt to get them familiar with the MOC program when they enter practice. There are also programs and educational materials for patients and practicing physicians on the web site (http://www.exxcellence.org). I have only browsed the site, so not familiar with all of its content. Specifically with regard to the letter some of us received, Norman was adamant that he had strenuously objected to that solicitation, but was 'overruled' by the board of the Foundation. He has no vote and is only 'exofficio' to the board of the Foundation. He did not like the letter, either. While many of us (myself included) do not like what is happening with the Board Certification process, it is happening in all specialties and I am told that ours is probably the least onerous and least expensive of all of them. ABMS/FSMB has mandated this process and the ABOG has fought it until it became evident that if we did not do it ourselves, it would be imposed upon us and the process might be much worse and more expensive (ask some of your internist and pediatric colleagues about it). Finally, in the not too distant future (probably within the next five years) the FSMB will mandate Board Certification and MOC as a prerequisite to state licensure. The question of who regulates the regulators is a good one and I don't know that anyone has the answer for that, or if there is an answer. I don't know if any of that helps, but that is about all I could find out. I also inquired with regard to the 39 completed weeks of gestation for elective MIL. That goes back to Practice Bulletin #10 (1999 but reaffirmed/revised usually every three years). It is based on science from large studies showing significant greater risk of prematurity in <39week gestations. There is a disclaimer on the bulletin that it is not to be used as a 'standard' but only as a guideline. It is one of those things that the lawyers have bastardized into a standard (ala 30 minute rule). The ACOG Obstetrical Practice Committee will be meeting the 15-16th of this month. I have submitted a request to them that a specific statement be made in the reaffirmation of this document with specific statement that the 39 week rule not be used as a 'standard' for MIL. In part, the letter reads, " I am fully aware of the disclaimer on the Practice Bulletin. I certainly agree understand the reasons for the 39 weeks completed gestation statement and am in agreement with it. However, I would ask the Committee to consider a more specific statement to the effect that if individuals and/or institutions consider the 39 weeks completed gestation to be the basis of any policy for elective MIL, consideration must be given to clinical judgments of the individual physician and reasonable patient requests. " Will keep you posted.
-- Gordon M. Goldman, M.D., FACOG Private Practice, St. Louis, Mo.
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