The MOC Program’s Story (With Apologies to Lewis Carroll)


… They had not gone far before they saw the MOC Program in the distance, sitting sad and lonely on a little ledge of rock, and as they came nearer, Alice could hear him sighing as if his heart would break. She pitied him deeply. What is his sorrow? she asked the Gryphon, and the Gryphon answered, It’s all his fancy, that: he’s worried that the doctors aren’t qualified, that testing alone is not good enough, not even every 10 years, and that CME requirements are not adequate.

So they went up to the MOC Program, who looked at them with large eyes full of tears, but said nothing.

This here young lady, said the Gryphon, she wants for to know your history, she do.

I’ll tell it her, said the MOC Program in a deep, hollow tone: sit down, both of you, and don’t speak a word till I’ve finished.

So they sat down, and nobody spoke for some minutes. Alice thought to herself, I don’t see how he can EVEN finish, if he doesn’t begin. But she waited patiently.

Once, said the MOC Program at last, with a deep sigh, I was a real Program.

These words were followed by a very long silence, broken only by an occasional exclamation of Hjckrrh! from the Gryphon, and the constant heavy sobbing of the MOC Program.. Alice was very nearly getting up and saying, Thank you sir, for your interesting stroy, but she could not help thinkg there MUST be more to come, so she sat still and said nothing.

When I was little, the MOC Program went on at last, more calmly, though still sobbing a little now and then, I was a real Testing Program. Doctors would take my test and be certified in their specialty for life.

For life? asked Alice. Isn’t that a long time?

It can be, it can be, sighed the MOC Program.

You ought to be ashamed of yourself for asking such a simple question, added the Gryphon, and then they both sat silent and looked at poor Alice, who felt ready to sink into the earth. At last the Gryphon said to the MOC Program, Drive on, old fellow! Don’t be all day about it! and he went on in these words:

Yes, the certification was lifelong then, though you mayn’t believe it–

I never said I didn’t interrupted Alice.

You did, said the MOC Program.

Hold your tongue! added the Gryphon, before Alice could speak again. The MOC Program went on.

Then we found we could get more money, I mean, we could make sure the doctors really knew their stuff, if we repeated the testing every 10 years.

What a curious plan! exclaimed Alice.

That’s enough about testing, the Gryphon interrupted in a very decided tone: tell her something about Maintenance of Certification now.

Ah, that’s the MOC in my name, said the MOC Program. Maintenance of Certification Program in full. I used to worry so much that testing alone, even every ten years, was not good enough to make sure that I received enough money, I mean that the doctors really, really knew their stuff. So I went from a Testing Program to a MOC Program. The MOC Program sighed again.

I had the doctors do additional review modules, and also do research on their patients for me, said the MOC Program.

Research on their patients? exlaimed Alice. Isn’t patient data confidential, and isn’t it illegal for patients to be forced to participate in studies without their consent? What was this research about?

Oh, for example, we would collect data about patient’s blood pressure and cholesterol levels in an arrhythmia clinic…

But heart rhythm doctors are subspecialists and this kind of research is incidental to what they do, let alone intrusive! Alice couldn’t believe what she was hearing.

The MOC Program sighed deeply, and drew the back of one flipper across his eyes. He looked at Alice and tried to speak, but for a minute or two sobs choked his voice. Same as if he had a bone in his throat, said the Gryphon: and it set to work shaking him and punching him in the back. At last the MOC Program recovered his voice, and, with tears running down his cheeks, he went on again:–

You don’t know what it is like to be a Testing Program. Just giving a test every ten years doesn’t pay the bills! When I became a MOC Program, I thought things would be better, but, no, still not good enough.

What more could you ask of those poor doctors? cried Alice.

Every two years, every two years. The MOC Program shook his heavy head and sobbed.  The doctors will have to earn MOC points every two years, or they won’t be certified.

That’s crazy, said Alice. The doctors will be upset, but I don’t know why you are crying about it.

A tear rolled down the cheek of the MOC Program. It’s not enough, it’s never enough. I won’t be happy until all the doctors are spending every minute of their day working on Maintenance of Certification.

Alice said nothing; she had sat down with her face in her hands, wondering if anything would EVER happen in a natural way again.





By mannd

I am a retired cardiac electrophysiologist who has worked both in private practice in Louisville, Kentucky and as a Professor of Medicine at the University of Colorado in Denver. I am interested not only in medicine, but also in computer programming, music, science fiction, fantasy, 30s pulp literature, and a whole lot more.

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