Maintenance of Certification Not in Patient’s or Physician’s Best Interest

slideshow imageDear Fellow Physicians,

Nationwide, physicians from a variety of specialties have voiced their views on the pitfalls and merits of Board Recertification and Maintenance of Certification (MOC). And as you can see, our polling results are even more telling than those obtained by the New England Journal of Medicine. As our polling includes MOC for all physicians – not only those who are grandfathered – it further supports the need for change.

After one year of voting, it’s very clear that the vast majority of practicing physicians oppose the current MOC process. After thousands of votes, only 1.6% wish to maintain the current system, while 4.7% supported reform and 93.7% voted to abolish the requirements altogether. Had this been a political poll, it would be a landslide victory against the current MOC process. Yet Board leadership continues to ignore the collective voice of the nation’s practicing physician.

We have been contacted by leadership of the ABIM and various other Boards, and had several discussions with them about reforming the MOC process; however, despite the momentum gathering among our rapidly growing community, they all have conveyed an unwillingness to negotiate or compromise on any level, supporting their position with irrelevant propaganda.

While most polled physicians want MOC abolished, we feel that the system’s self-evaluation of medical knowledge modules can be worthwhile. We recommend that one open-book, open-colleague module be required within a 2-year period, and that it count for all MOC, CME and Maintenance of Licensure (MOL) requirements. We take issue with the rest of the MOC process: the Practice Improvement Modules and Patient and Peer Reviews amount to little more than busy work, and the costly, time-consuming Secure Examination – which requires time off from work and enormous amount of preparation – is clinically irrelevant and has no place in the life of a practicing physician.

Of course, these criticisms are a sticking point with the Boards, which derive income directly from this part of MOC. In fact, while the ABIM claims they make no money from MOC and that their board members receive a minimal stipend to attend meetings and write test questions, they report that each exam question costs $4,000 to create (through “stringent psychometric testing”) and that the Chair of the ABIM makes a salary of $1,000 a day. This math might explain how the ABIM has increased its financial reserves with MOC by 13 million dollars from 2006 – 2007 – a number which no doubt continues to grow with each year and with each additional modification to MOC. And like over-zealous extremists wrapped in the flag, the ABIM leadership clings dearly to the Secure Examination, boasting how they voluntarily submit to being tested as part of their own requirements to being ABIM board members. (For more eye-opening Tax Return and financial information about the ABIM and all the Boards, please refer to the “The Boards – Tax Returns” link above.)

We are all for staying current with medical changes, but the onerous MOC program is no way to achieve this. It’s a money-making juggernaut with scant data to support any benefit for improving physician’s skills or ensuring patient better care and safety. And it lacks reasonable financial transparency.

If the ABIM, ABMS and FSMB have their way, MOC (soon to become CMOC, or Continuous MOC) will be an every-2-year cycle – which, according to the ABIM, will “simplify and streamline the process” and ultimately be tied into MOL.

We need to act collectively, and believe the time to act was yesterday. The number-one disease afflicting physicians is apathy and it’s the main reason our profession is trouble.

Our goals remain clear:

  1. 1. MOC should not be associated with hospital privileges.
  2. 2. MOC should not be associated with insurance reimbursements or network participation.
  3. 3. MOC should not be required for Maintenance of Licensure.
  4. 4. MOC should not require time away from patient care and the office.
  5. 5. MOC should represent how physicians practice medicine: i.e., open-book and open-colleague.
  6. 6. MOC should not be mandatory.

Please click on all links and review the rest of our website. Educate yourselves. Get involved in your community and at the state level and forward this website to ALL your colleagues.

It’s imperative that each physician get involved in the following manner:

  1. 1) Organize with colleagues to petition your hospital to eliminate MOC as a requirement for maintaining your hospital privileges.
  2. 2) Do the same with your individual boards, as they are already collaborating with health plans to base reimbursement on MOC requirements.
  3. 3) Approach your city and state medical organizations, as they are attempting to tie MOC to MOL.

MOC + MOL = BIG TROUBLE. If MOC gets tied to MOL then it no longer remains a voluntary process. It becomes mandatory.

Lastly but perhaps most crucial: Pressure your board to simplify the process as we have outlined. They should welcome and encourage constructive comments from their diplomates.

Many in our organization have proposed legal action against the various Boards, and/or the creation of an alternative board to a monopoly whose actions qualify as unfair business practice. These alternatives are a last resort. What we propose is a reasonable and fair modification of the current MOC into an every-2-year cycle, requiring only one self-evaluation module per cycle to count for all MOC, CME and MOL requirements, and the elimination of PIMs, Peer and Patient Reviews and the Secure Examination. It’s unreasonable to require practicing physicians aged 40, 50, 60 and 70 to jump through these clinically irrelevant hoops.

What we propose is fair and in the best interests of our patients and profession. But it’s going to take all of us make an impact.

Please get involved and feel free to share ideas by e-mailing us directly at this site or by joining the ongoing discussion on the largest online physician network, SERMO (see “Join The Discussion” link above).

We will continue to make this an open process.

Thank you again for your support.