The Estimated Cost of Maintenance of Certification.

BACKGROUND: Maintenance of Certification (MOC) is a controversial topic in medicine for many different reasons. Studies have suggested that there may be associations between fewer negative outcomes and participation in MOC. However, MOC still remains controversial because of its cost. We sought to determine the estimated cost of MOC to the average orthopaedic surgeon, including fees and time cost, defined as the market value of the physician's time. METHODS: We calculated the total cost of MOC to be the sum of the fees required for applications, examinations, and other miscellaneous fees as well as the time cost to the physician and staff. Costs were calculated for the oral, written, and American Board of Orthopaedic Surgery Web-based Longitudinal Assessment (ABOS WLA) MOC pathways based on the responses of 33 orthopaedic surgeons to a survey sent to a state orthopaedic society. RESULTS: We calculated the average orthopaedic surgeon's total cost in time and fees over the decade-long period to be $71,440.61 ($7,144.06 per year) for the oral examination MOC pathway and $80,391.55 ($8,039.16 per year) for the written examination pathway. We calculated the cost of the American Board of Orthopaedic Surgery web-based examination pathway to be $69,721.04 ($6,972.10 per year). CONCLUSIONS: The actual cost of MOC is much higher than just the fees paid to organizations providing services. The majority of the cost comes in the form of time cost to the physician. The ABOS WLA was implemented to alleviate the anxiety of a high-stakes examination and to encourage efficient longitudinal learning. We found that the ABOS WLA pathway does save time and money when compared with the written examination pathway when review courses and study periods are taken. We believe that future policy changes should focus on decreasing physician time spent completing MOC requirements, and decreasing the cost of these requirements, while preserving the model of continued evidence-based medical education.

Health Care Lobbying, Political Action Committees, and Spine Surgery.

STUDY DESIGN: Retrospective review. OBJECTIVE: The aim of this study was to analyze the political contributions and strategies of the Political Action Committee (PACs) lobbying for the political interests of spine surgeons. SUMMARY OF BACKGROUND DATA: In 2016, a presidential election year, $514,224,628 was spent on health care lobbying. Only 16% ($85,061,148) was on behalf of health professionals providing care. Below we chronicle the overlapping contributions between the three different physician-based Political Action Committee (PAC) lobbying entities as it relates specifically to spine surgery. METHODS: Data were abstracted for the PACs of the American Association of Neurological Surgeons (AANS), American Association of Orthopedic Surgeons (AAOS), and the North American Spine Society (NASS). These data were obtained using OpenSecrets (opensecrets.org), and the Federal Election Commission (fec.gov) website. All data points were collected biannually from 2006 to 2018 and statistically analyzed as appropriate. RESULTS: In 2016, the AAOS PAC contributed $2,648,218, the AANS PAC $348,091, and the NASS PAC $183,612. After accounting for respective group size, the AAOS spent >2.34 times that of the AANS. Orthopedists were 3.84 times (95% confidence interval 3.42-4.3) more likely to donate to their PAC than neurosurgeons (P < 0.001) during the 2016 election. The majority of contributions among the three different lobbyist organizations were to federal candidates, followed by fundraising committees, and finally to the national party. Eighty-eight percent of AANS donations went to Republican candidates, whereas AAOS and NASS were 63% and 67%, respectively. From 2008 to 2016, the AAOS PAC had a highest political contributions spend per active member of parent organization ($126.39) as compared to AANS ($80.52) and NASS ($17.81). The AAOS had five surgeons for every donor to the AAOS PAC, whereas the AANS had 14 surgeons and NASS 38 members per each donor. The AANS had a higher percentage of Republican donations with 78.9% of donations going to Republicans as compared to 61.8% of AAOS contributions and 67.9% of NASS contributions. CONCLUSION: Spine surgery is unique in that three different physician-based lobbyist organizations seek to influence legislative priorities with the AAOS having the most substantial fiscal impact and greatest participation. Choreography of donation strategies is essential to maximize physician voice at the policy level. LEVEL OF EVIDENCE: 5.

Safeguarding cancer research funding by European charities amidst the COVID-19 pandemic.

The COVID-19 outbreak has affected cancer research and cancer care. European cancer charities need to reconsider strategies for safeguarding income and supporting cancer researchers, in times when sustaining cancer research funding is more crucial than ever.

Do choosing wisely recommendations about low-value care target income-generating treatments provided by members? A content analysis of 1293 recommendations.

BACKGROUND: It is unknown to what extent Choosing Wisely recommendations about income-generating treatments apply to members of the society generating the recommendations. The primary aim of this study is to determine the proportion of Choosing Wisely recommendations targeting income-generating treatments, and whether recommendations from professional societies on income-generating treatments are more likely to target members or non-members. The secondary aim is to determine the prevalence of qualified statements, and whether qualified statements are more likely to appear in recommendations targeting income-generating or non-income-generating treatments that apply to members. METHODS: We performed a content analysis of all Choosing Wisely recommendations, with data extracted from Choosing Wisely websites. Two researchers coded recommendations as test or treatment-based, for or against a procedure, containing qualified statements, income-generating and applying to members. Disagreements were resolved by discussion or consultation with a third researcher. A Chi-squared test evaluated whether society recommendations on income-generating treatments were more likely to target members or non-members; and whether qualified statements were more likely to appear in recommendations targeting income-generating or non-income-generating treatments that apply to members. RESULTS: We found 1293 Choosing Wisely recommendations (48.3% tests and 48.6% treatments). Ninety-eight treatment recommendations targeted income-generating treatments (17.8%), and recommendations on income-generating treatments were less likely to target members compared to non-members (15.6% vs. 40.4%, p < 0.001). Nearly half of all recommendations were qualified (41.9%), with a similar proportion of recommendations targeting income-generating and non-income-generating treatments that apply to members containing qualified statements (49.4% vs. 42.0%, p = 0.23). CONCLUSIONS: Many societies provide Choosing Wisely recommendations that minimise impact on their own members. Only 20% of treatment recommendations target income-generating treatments, and of these recommendations mostly target non-members. Many recommendations are also qualified. Increasing the number of recommendations from societies that are unqualified and target member clinicians responsible for de-implementation of low-value and costly treatments should be a priority.

National survey of the Society for Assisted Reproductive Technology membership regarding insurance coverage for assisted reproductive technologies.

OBJECTIVE: To assess the attitudes of Society for Assisted Reproductive Technology (SART) members regarding expanding insurance coverage for patients seeking assisted reproductive technologies (ART) and identify some of the factors that may influence such attitudes. DESIGN: An anonymous online 14-question survey of SART membership; 1,556 surveys were sent through the SART Research Portal from June to December 2017. Questions were incremental in scope, beginning with expanding insurance coverage for ART for vulnerable populations (e.g., fertility preservation for cancer, couples with same recessive gene, fertility preservation for transgender individuals) to extending coverage to include patients who were uninsured for ART. Additional questions assessed attitudes about assuming some fiscal responsibility if mandated insurance were contingent on elective single-embryo transfer (eSET) and lower charges in anticipation of increased number of cases. SETTING: Not applicable. PATIENT(S): Not applicable. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Specific response to 14 survey questions. RESULT(S): The overall response rate was 43.4% (675/1,556). A large majority (>95%) favored insurance for fertility preservation for cancer patients and for avoidance of genetic disorders; 62.3% were supportive of infertility insurance coverage for transgender patients; 78% supported expanding insurance for the broadest segment of the general uninsured population; 76.7% supported expanding insurance contingent on eSET; and 51.3% would consider expanding insurance contingent on lowering charge per cycle in general, but only 23% responded as to what lower charge would be acceptable. Three of four factors were shown by multivariable logistic regression to be predictive of attitudes willing to expand insurance: practice setting (academic > hybrid > private), practicing in a mandated state, and higher annual volume of cases (>500 cycles); these had significant increased adjusted odds ratios ranging from 1.7 to 2.9. A fourth factor, the professional role one had in the practice, was not found to be of significant predictive value. CONCLUSION(S): The great majority of respondents were supportive of expanding insurance for specific segments of vulnerable populations with special needs and for the population who are presently uninsured. Furthermore, the majority of respondents would consider expanding insurance coverage contingent on age-appropriate eSET but have concerns about reduced reimbursement. Those most likely to be willing to expand insurance are those who practice in an academic setting or a mandated state and/or have a high annual volume of cases.

Plastic Surgery-Related Hashtag Utilization on Instagram: Implications for Education and Marketing.

BACKGROUND: Recent data suggest patients are seeking aesthetic surgery to improve their appearance on Instagram and other social media. Despite the rising influence of Instagram in plastic surgery, few academic publications address Instagram, let alone evaluate its utilization in plastic surgery. OBJECTIVES: We set out to answer the following three questions: 1) what plastic surgery-related content is being posted to Instagram; 2) who is posting this content; and 3) what specific hashtags are they using? METHODS: Our study queried 21 Instagram plastic surgery-related hashtags. Content analysis was used to qualitatively evaluate each of the nine "top" posts associated with each hashtag (189 posts). Duplicate posts and those not relevant to plastic surgery were excluded. RESULTS: A total of 1,789,270 posts utilized the 21 hashtags sampled in this study. Of the top 189 posts for these 21 queried hashtags, 163 posts met inclusion criteria. Plastic surgeons eligible for membership in American Society for Aesthetic Plastic Surgery (ASAPS) accounted for only 17.8% of top posts, whereas noneligible physicians accounted for 26.4%. All nonplastic surgery trained physicians marketed themselves as "cosmetic surgeons." Nine top posts (5.5%) were by nonphysicians, including dentists, spas with no associated physician, and a hair salon. The majority of these posts were self-promotional (67.1%) as opposed to educational (32.9%). Board-certified plastic surgeons were significantly more likely to post educational content to Instagram as compared to nonplastic surgeons (62.1% vs 38.1%, P = 0.02). CONCLUSIONS: ASAPS eligible board-certified plastic surgeons are underrepresented amongst physicians posting top plastic surgery-related content to Instagram.

Financial Relationships With Industry of Editorial Board Members of the Three Journals of the American Society for Radiation Oncology.

PURPOSE: To quantitate financial conflicts of interest (FCOIs) among radiation oncology peer-reviewers, specifically editorial board members of the 3 American Society for Radiation Oncology journals. METHODS AND MATERIALS: The public Centers for Medicare and Medicaid Services Open Payments database delineates payments in 3 categories (general payments, research funding, and company ownership). After excluding non-US and non-MDs, names of board members were searched. Values of each FCOI were extracted for 2013 to 2015 and compiled. RESULTS: Of 85 board members, 65 (76%) received any form of payment during the overall period. The majority of delivered payments were general payments: 59 (69%) received at least 1 general payment during these 3 years. In each year, 9 board members (11%) received research funding, and 3 board members (4%) reported company ownership. Over the studied period, all board members received a sum total of $5,387,985; this was composed of $665,801 (12%) in general payments, $3,758,968 (70%) in research funding, and $963,216 (18%) in company ownership. The mean general payment and research funding amounts (all members) were $2,621 and $14,741, respectively. Median (interquartile range) general payments and research funding only in board members receiving payments were $419 ($91-$5072) and $56,250 ($13,345-$200,000), respectively. When assessing general payments according to amount, the vast majority of editorial board members received lower-quantity or no such payments, along with a smaller proportion that received higher-volume payments. The most frequent sources of general payments were Varian, Elekta, and Bristol-Myers Squibb. Merck and Varian were the most frequent funding sources for research payments. CONCLUSIONS: In this population, the majority of FCOIs were general payments, but research funding comprised the highest monetary sums. Large-volume FCOIs do not apply to the vast majority of editorial board members, implying that the maintained integrity of academic peer-review is likely not influenced to a large extent by FCOIs.

Introducing the International Confederation of Plastic Surgery Societies: ICOPLAST.

This article describes the formation of the International Confederation of Plastic Surgery Societies (ICOPLAST) as a novel, transparent, dynamic, and proactive confederation of national plastic surgery societies. ICOPLAST aspires to provide a voice for the entire international community of plastic surgeons. ICOPLAST has been designed to benefit the patient, plastic surgery as a profession, and each individual plastic surgeon. Its principal objective is to enhance international communication, education, and advocacy processes to ultimately improve patient outcomes for plastic surgery patients globally. The new ICOPLAST's focus is to add true value for patients. ICOPLAST's evolution, philosophy, governance, and bylaws are explained and all societies worldwide are encouraged and cordially invited to join. An open and warm invitation is provided. Additional information is found at www.ICOPLAST.org.

Resident Involvement in Professional Otolaryngology Organizations: Current Trends in the United States.

Involvement by residents in professional medical organizations can enrich their training, but little data exist regarding the number and types of involvement opportunities available to otolaryngology residents. We sought to fill this gap in knowledge by quantifying the extent to which major otolaryngology-related organizations in the United States provide involvement opportunities to otolaryngology residents. Our analysis included 23 organizations and subspecialty societies. Results showed that many opportunities exist for residents to attend conferences and present research; however, fewer involvement and funding opportunities existed in any other leadership, health policy, or service-learning experiences. These findings were consistent across general and subspecialty societies. Given the many purported benefits of resident involvement in otolaryngology outside of the standard training environment, future efforts may be warranted to increase the number and type of involvement opportunities currently available in professional societies.

Aesthetic Surgery Fellowship Selection Criteria: A National Fellowship Director Survey.

BACKGROUND: Desirable candidate characteristics for aesthetic surgery fellowship applicants remain unknown because of a lack of data in the literature. OBJECTIVES: This study aims to identify the criteria used to select applicants for aesthetic surgery fellowship in the United States. METHODS: A 38-question survey was sent in April 2015 to all directors of fellowships endorsed by the American Society for Aesthetic Plastic Surgery (n = 20) in the United States. The survey investigated various factors including residency training and fellowship interview. A 5-point Likert scale was used to grade 33 influential factors from 1 ("not at all important") to 5 ("essential"); a separate 5-point Likert scale was used for 5 controversial factors from 1 ("very negative impact") to 5 ("very positive impact"). RESULTS: Sixty-five percent (13 out of 20) of directors responsed. The most important factors were letters of recommendation by well-established plastic surgeons (4.6 ± 0.7), interpersonal skills (4.5 ± 0.8), overall interview performance (4.5 ± 0.7), professionalism and ethics (4.4 ± 1.0), and letters of recommendation by aesthetic surgeons (4.4 ± 1.2). The least important factors were Alpha Omega Alpha Honor Medical Society membership (1.8 ± 0.6), postgraduate degrees (1.9 ± 0.9), US Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge (CK)/Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 2 Cognitive Evaluation and USMLE/COMLEX Step 3 score (1.9 ± 0.9), and research fellowships (2.0 ± 0.6). CONCLUSIONS: This study provides data on the aesthetic surgery fellowship directors' perceptions about the criteria important for applicant selection. We trust that fellowship directors, residency programs, and applicants find this data useful as they prepare for the aesthetic surgery fellowship match.

Effect of Geopolitical Forces on Neurosurgical Training in Sub-Saharan Africa.

BACKGROUND: The population of Sub-Saharan Africa suffers from a critical shortage and maldistribution of health care professionals, especially highlighted in surgical subspecialties, such as neurosurgery. In light of The Lancet report and the World Health Organization's directive to provide essential surgical care through the developing world, solutions need to be found to close this training and distribution gap. METHODS: Methods correcting the situation will only succeed if one understands the geopolitical forces which have shaped the distribution of health care in the region and continue to this day. Solutions have evolved from service to service with education. The partnering organizations, the Foundation of International Education in Neurological Surgery and the World Federation of Neurosurgical Societies, have supported neurosurgical training in the developing world, including curriculum, equipment, facilities, certification, and local acceptance, with a goal of developing a self-sustaining program within the developing country. RESULTS: These ideas heavily rely on partnerships to address classic geopolitical forces, including geography, drought, warfare, ethnic tensions, poverty, and lack of training facilities. Each can be addressed through partnerships, such as development of dyads with programs in developed countries and ongoing programs owned by the countries in question, but partnered with multiple international societies, institutions, and universities. CONCLUSIONS: This paper provides both a historic and topical overview of the forces at work which need to be addressed for success in delivering specialized care. This must always result in a self-sustaining program operated by the people of the home country with worldwide support through philanthropy and partnerships.

Competitive Funding Strategies for the Conquer Cancer Foundation of ASCO.

PURPOSE: The Conquer Cancer Foundation (CCF), the philanthropic arm of ASCO, is responsible for funding innovative clinical research. CCF wants to broaden its donor base instead of relying predominantly on health-care companies. Our Leadership Development Program (LDP) group was tasked with identifying potential donor sources and making recommendations to increase funding. MATERIALS AND METHODS: We selected three sources to research: the general public, crowdsourcing/social media, and ASCO members. We subsequently focused our efforts on ASCO members, of whom only 2% to 3% are donors to CCF and < 8% are repeat donors. To analyze this low rate, we sent out two separate surveys to various groups of members within ASCO. RESULTS: We identified lack of knowledge as a major deterrent to giving; surprisingly, even those who hold ASCO leadership positions or participated in committees lacked knowledge about CCF funding. Also, the misconception that ASCO is rich and does not need philanthropic support deterred giving; however, respondents would donate if given the right message that stresses the need of continued member-led donations. CONCLUSION: ASCO members, including those in leadership positions, need to be engaged more aggressively to support CCF. Increased education and updating the CCF message is likely to provide the greatest impact on higher member donation, repeated donations, and facilitate CCF's goal of diversifying its donor base away from healthcare companies. Furthermore, we recommend using technology, such as mobile applications, and providing incentives and visibility to major donors.

Sponsorship of National Health Organizations by Two Major Soda Companies.

INTRODUCTION: Obesity is a pervasive public health problem in the U.S. Reducing soda consumption is important for stemming the obesity epidemic. However, several articles and one book suggest that soda companies are using their resources to impede public health interventions that might reduce soda consumption. Although corporate sponsorship by tobacco and alcohol companies has been studied extensively, there has been no systematic attempt to catalog sponsorship activities of soda companies. This study investigates the nature, extent, and implications of soda company sponsorship of U.S. health and medical organizations, as well as corporate lobbying expenditures on soda- or nutrition-related public health legislation from 2011 to 2015. METHODS: Records of corporate philanthropy and lobbying expenditures on public health legislation by soda companies in the U.S. during 2011-2015 were found through Internet and database searches. RESULTS: From 2011 to 2015, the Coca-Cola Company and PepsiCo were found to sponsor a total of 95 national health organizations, including many medical and public health institutions whose specific missions include fighting the obesity epidemic. During the study period, these two soda companies lobbied against 29 public health bills intended to reduce soda consumption or improve nutrition. CONCLUSIONS: There is surprisingly pervasive sponsorship of national health and medical organizations by the nation's two largest soda companies. These companies lobbied against public health intervention in 97% of cases, calling into question a sincere commitment to improving the public's health. By accepting funding from these companies, health organizations are inadvertently participating in their marketing plans.

Geographic and Age-Based Variations in Medicare Reimbursement Among ASSH Members.

Background: The purpose of this study was to investigate how American Society for Surgery of the Hand (ASSH) members' Medicare reimbursement depends on their geographical location and number of years in practice. Methods: Demographic data for surgeons who were active members of the ASSH in 2012 were obtained using information publicly available through the US Centers for Medicare and Medicaid Services (CMS). "Hand-surgeons-per-capita" and average reimbursement per surgeon were calculated for each state. Regression analysis was performed to determine a relationship between (1) each state's average reimbursement versus the number of ASSH members in that state, (2) average reimbursement versus number of hand surgeons per capita, and (3) total reimbursement from Medicare versus number of years in practice. Analysis of variance (ANOVA) was used to detect a difference in reimbursement based on categorical range of years as an ASSH member. Results: A total of 1667 ASSH members satisfied inclusion in this study. Although there was significant variation among states' average reimbursement, reimbursement was not significantly correlated with the state's hand surgeons per capita or total number of hand surgeons in that given state. Correlation between years as an ASSH member and average reimbursement was significant but non-linear; the highest reimbursements were seen in surgeons who had been ASSH members from 8 to 20 years. Conclusions: Peak reimbursement from Medicare for ASSH members appears to be related to the time of surgeons' peak operative volume, rather than any age-based bias for or against treating Medicare beneficiaries. In addition, though geographic variation in reimbursement does exist, this does not appear to correlate with density or availability of hand surgeons.

[Activity and Future Perspective of Local Independent Clinical Trial Group (OGSG)].

Osaka Gastrointestinal Cancer Chemotherapy Study Group (OGSG) was established in 2000 and has been conducting investigator initiated multi-institutional collaboration trials regarding the treatment of gastrointestinal cancer, especially using chemotherapeutic agents. Although organization of OGSG has been renovated to perform post-marketing clinical trials with high quality, OGSG is now facing severe financial crisis because of shortage of donation from pharmaceutical companies. Here, present problems and future perspectives are discussed.