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11 Reasons Physicians Hate Maintenance of Certification

11 Reasons Physicians Hate Maintenance of Certification

  • ©Valeri Potapova/Shutterstock.com
  • ©SamarttiW/Shutterstock.com
    One of the top complaints revolves around the expenses associated with meeting MOC requirements.
  • Besides the cost to maintain certifications, physicians are concerned about where those fees are actually going. *
  • Photo: ©StillFx/Shutterstock.com
    Physicians also dislike the time commitments required to successfully complete MOC. It adds another burden to their already tight schedules and takes time away from patient care. *
  • ©MegaFlopp/Shutterstock.com
    Physicians have serious concerns about the quality of the program and believe other educational methods, such as CME, may be more effective.
  • When MOC was first introduced, the intent was to improve quality and patient care. Yet many physicians feel the program has strayed from this goal.
  • ©GPointStudio/Shutterstock.com
    Depending on the specialty, recertification requirements may vary considerably and prove difficult to interpret. Travel requirements add to the inconvenience as well.
  • ©Keith A Frith/Shutterstock.com
    Physicians question the efficacy of such a cumbersome process, especially when empirical evidence is lacking.
  • Many physicians feel MOC requires them simply going through the motions and lacks a way to measure true competence.
  • ©FJStudio/Shutterstock.com
    The grandfathered and exempted statuses granted to some physicians are seen as unfair.
  • ©Lightspring/Shutterstock.com
    Another major concern is that MOC requirements are intensely scrutinizing one group of practitioners to the exclusion of others.
  • The burden created by MOC requirements are pushing some physicians to leave the profession altogether.

Despite the relative newness of maintenance of certification (MOC), it has developed a rather controversial reputation among physicians. Many say the requirements can be excessively burdensome and physicians often question the true intent of the various certification boards.

Here are the top 11 reasons physicians hate MOC. Feel free to add you think we've forgotten below.

Click here to download a PDF of this slideshow.

*Paul Teirstein runs the National Board of Physicians and Surgeons, which offers an alternative to MOC.

Steph Weber is a freelance writer hailing from the Midwest. She writes about healthcare, finance, and small business, but finds her passion for the medical field growing in sync with the ever-changing healthcare laws.

Source: 
Physicians Practice

Comments

Every Doctor I know including myself hates their profession now...and its all due to the multitude of middlemen getting in between the physician-patient relationship. Whether it be insurance companies who refuse to pay for our services if we are not board certified, to agencies who have contracts for all the jobs and they decide whether we will work and or not and they decide that an ABEM is worth more than an ABFM or an ABIM even though ABFM and the ABIM doc are paid less they are still required to see the next patient...they can't say "nope, out of my expertise, they will have to wait for that ABEM to get here in a few days. Also if you work for agency who is paid $430.00/hr for our services but they give us $130.00/hr and if we complain then we can never work for them again and they have 95% of all the contracts in the Unitied States.... Schumacher, Emcare, Teamhealth, Comphealth etc..and all of their sub-companies...It doesn't even matter if you are Board Certified or suffer through MOC...at the end of the day all of these entities who have decided they want a piece of the doctor-patient relationship determine whether we will even get a job or continue to work that day or how many days per month they will "let us work." They also hire us at a set hourly rate, but poof after 3 months "they decide" our rate is not going to be cut in half and the remainder of our pay will be through the RVU system. That is just theft. There is no way for us to prove they kept the money we worked for...and worse, if we don't up-code the charts then they report us to our Boards and our State Medical Board for incomplete charting and we get fined, sent to California to take some record keeping class and now its on our record for ever, which means another reason they use to give us a lower hour rate...and of course this doesn't include all the cost of the classes, the cost of lost work while talking the classes, the airfare, hotel rental car, airport parking, hotel parking. If we have our own private practice then the insurance companies will not pay us...I have a check from Medicaid for an office visit...38 cents! The stamp to send me that check cost more than that. Blue-Cross Blue Shield and Aetna do the same thing though...they know for us to take even one day off to go to court would cost us more than the $199.62 they just stole. Then there is the office staff who is secretly keeping all of our years of patient data...ie addresses, phone numbers, ..and one day we notice our practice is slowly getting smaller, patients don't show up...and its because our staff person sold out patient info. to her friend or she herself has opened her own practice and sent a recruiter out to hire on of us real doctors with the bogus story that the clinic is owned by a corporation and they will pay us an hour rate so see their patients...and every one in the corporation seems to be related to one another and one day you find out that the clinic is not owned by any physician...the only real physician is you...but they, another entity has come between the doctor-patient relationship and stolen some other doctors practice and hired you to work for them to see these patients and now they are making money off of your license and MOC isn't going to help you, neither is the DEA, and neither is your state medical board....in fact your medical board may even sanction you for working for a non-physician...even though they can credential us, we aren't allowed to credential them...so what do we do? Is there a board to fight for us? Is there any where we can all ban together to stomp out all of these leeches who have driven up the cost of medical care. If we got rid of the middlemen then the cost of care would come down substantially. So if I decide to not take my re-cert what happens to me...I won't be able to get a job.. and its' because the insurance companies will refuse to pay the higher rate for my services so no agency is going to give me "their job"....anybody have any ideas what I am supposed to do for work? And yes, you are right, they are higher more and more midlevel's to do our work and they don't have to take any re-certifications or go to school as long as we did...sometimes I can't even have their job because my ABFM certification is too low on the totem pole...and that's what gets me...I have to spend all this money and time to re-cert for something that to everyone else is considered useless.

Robin @

It's very time consuming and it costs way too much.

Paul @

MOC requirements are expensive, time consuming, and of no value to clinicians or patients. They in no way measure or assure competence or that physicians provide better care. They make money for the boards, who require and market them, and academicians, who create them.

Gary @

Maintenance of certification (MOC), was long overdue. There are too many Psychiatrists practicing incompetently, that it brings down the 20% that truly work at this hypothesis, artist, profession. Ponder this, how many in the dental profession have more competence than providers of Psychiatric Care. Such reaction sounds more like burn out, furthermore Psychiatric providers should undergo routine exams themselves. So many entering the field have been hazed, sleep deprived to the point of Psychosis, this cannot be in any patient's best interest. It's a lay-up Profession with little to be held accountable for. If nothing else, there should be an overwhelming call for even more checks and balances, re: Psychiatrists that are literally degrading the Profession by flaunting, one's control, over patients that may or in said case do not need a Provider like that ever.

Dan @

I received a letter from abpn saying i should pay over $200 a year, for what??? To keep my records, etc they say. Thanks, but no thanks. The APA, and other educational sites, has been keping my records for free for years and they are available to abpn for review at any time. I think the abpn is attempting to generate an income stream without offering services. They should save money by slashing the salary of the ceo who earns over 800.000 a year in salary plus other benefits or, better yet, the position should be an honorary position.
I also think there is a direct conflict of interest when former apa officionaries who worked on the concept of moc are in the business of offering moc activities for money. The whole business reeks of inbreeding and enrichment of abpn, ceo's and other 'officials' at the expense of practicing physicians.
It is a mockery of our colleagues when Dr. Nora of ABMS thanks them for volunteering their time on the ABMS board while she pockets hundreds of thousands as the CEO of ABMS. Would she remain ceo if it were a volunteer position, as it should be?

Anne @

"I also think there is a direct conflict of interest when former apa officionaries who worked on the concept of moc are in the business of offering moc activities for money"
- Agee!!!

Amelia @

What happened to that "permanent certification" we used to have. I was on the examination team many years and remember the "crowd" we certified the final year. Wow what a joke on us. ! Guys, the professional respect is rapidly dying.

Samuel @

Did someone say bullying?? I totally agree that this too is just more bullying that physicians seem to take without standing up for themselves as professionals. I have recertified three times and no more. I refuse to be a member of the AMA or the AAFP.
Bullying?.....we are no longer even considered physicians. Has anyone noticed that we are referred to as "providers". I didn't go to provider school and refuse to work with people who consider me that.
When are docs going to take back their profession? When are physicians going to strike? When are physicians going to stop falling for the "carrot", that always turns into a "stick"? Have we lost our voice in our profession?. We just keep bending over. We continue to be abused. Do we know how to say "no"?
But we do have a choice....yes, we really do! What MDS are agreeing to is not working for me, and we are losing good docs nationwide.

Mimi @

Bravo. Stick up for yourself! I like your courage. I am a NP and I am a provider because I am not a physician. I think I provide quality care that is adequate hopefully more than that but when I have a question and I ask a doc I have to say that I can see why they are the doc and I am an NP. This disrespect has got to stop or we will not have any more docs.

Michele @

There is a shortage of psychiatrists and family practice physicians. Salaries are pushing upwards finally for these specialties. Our practice is in demand and finally beginning to be compensated fairly. Yet we allow ourselves to be "bullied" by having to pay to earn what we already have earned (MOC). Let's require CME (gee, we already do) with a series of short learning focused, non-punitive "quizzes" that can be done towards the goal of MOC. I'm all for this if it serves our patients and is not burdensome or focused on making a profit. It's ironic that at same time the APA/ABPN bully us from within our fold, we are allowing more "providers" without medical training to move into our field. Many corporate administrators see APN's as inexpensive psychiatrists and are hiring them at half our salaries. We are finally able to be paid fairly for our expertise and now we are are allowing this? And if the APA/ABPN care about the meaning of being boarded as it relates to quality care of our patients, why not spend their time on this issue? Maybe we need another way of protecting our profession...time for a UNION?

Amelia @

There is a shortage of psychiatrists and family practice physicians. Salaries are pushing upwards finally for these specialties. Our practice is in demand and finally beginning to be compensated fairly. Yet we allow ourselves to be "bullied" by having to pay to earn what we already have earned (MOC). Let's require CME (gee, we already do) with a series of short learning focused, non-punitive "quizzes" that can be done towards the goal of MOC. I'm all for this if it serves our patients and is not burdensome or focused on making a profit. It's ironic that at same time the APA/ABPN bully us from within our fold, we are allowing more "providers" without medical training to move into our field. Many corporate administrators see APN's as inexpensive psychiatrists and are hiring them at half our salaries. We are finally able to be paid fairly for our expertise and now we are are allowing this? And if the APA/ABPN care about the meaning of being boarded as it relates to quality care of our patients, why not spend their time on this issue? Maybe we need another way of protecting our profession...time for a UNION?

Amelia @

Did someone say bullying?? I totally agree that this too is just more bullying that physicians seem to take without standing up for themselves as professionals. I have recertified three times and no more. I refuse to be a member of the AMA or the AAFP.
Bullying?.....we are no longer even considered physicians. Has anyone noticed that we are referred to as "providers". I didn't go to provider school and refuse to work with people who consider me that.
When are docs going to take back their profession? When are physicians going to strike? When are physicians going to stop falling for the "carrot", that always turns into a "stick"? Have we lost our voice in our profession?. We just keep bending over. We continue to be abused. Do we know how to say "no"?
But we do have a choice....yes, we really do! What MDS are agreeing to is not working for me, and we are losing good docs nationwide.

Mimi @

I took MOC boards in Psychiatry and Child Psychiatry 2 years ago in order maintain my double board certifications. Spent over $10,000 in review books, conferences, CME's, tests, fees, more fees, more fees. The deal, I thought, was that I was earning a 10 years certificate. I'm 58 years old, so I thought that would be the end of it. Well, surprise! I get a letter telling me that I have to keep on spending money and valuable time keeping up with the new requirements. Keeping up CME credits is a fair deal. Otherwise, the deal is ridiculous, disrespectful and abusive.

Marka @

I took MOC boards in Psychiatry and Child Psychiatry 2 years ago in order maintain my double board certifications. Spent over $10,000 in review books, conferences, CME's, tests, fees, more fees, more fees. The deal, I thought, was that I was earning a 10 years certificate. I'm 58 years old, so I thought that would be the end of it. Well, surprise! I get a letter telling me that I have to keep on spending money and valuable time keeping up with the new requirements. Keeping up CME credits is a fair deal. Otherwise, the deal is ridiculous, disrespectful and abusive.

Marka @

Power corrupts. Eventually, we will be asked to pay on a daily basis so that a website won't blacklist us. Enough already! It is abundantly apparent that the Specialty Medical Boards have become entirely corrupt with only one agenda: to maintain its power and to keep the money coming in. Imagine being able to "earn" an $800,000 salary by spreading lies and fear. Reminds me of the mafia; "Pay up, or else". We do have a choice, and we don't have to "just do as we're told". History is full of examples of people "following orders" with spectacularly tragic outcomes. Stop paying the extortionists! I find it embarrassing to even be associated now with ABPN; I will proudly lapse in 2020 and meanwhile I have joined the NBPAS and whatever the consequences are, I will deal with them. I have written to ABPN and told them just how disgusted I am and that indeed I have no intention of ever associating with them again as they are a disgrace. I received a letter back from Dr. Faulkner stating: "I'm sorry you feel that way, blah, blah." At least I can live with myself. I just wish my colleagues would find some courage and do the right thing.

debbie @

In my practice, I question whether anyone would care whether I was boarded or not? I am and I have recertified on at least one occasion. I am starting to question the need to even bother this go-round? I wouldn't mind taking a test to prove my competence – – but the MOC is just totally out of control. I am ashamed of the people that we allow govern us in our profession. I feel as if many of us have nothing in common with them and their decisions.

Jack @

In my practice, I question whether anyone would care whether I was boarded or not? I am and I have recertified on at least one occasion. I am starting to question the need to even bother this go-round? I wouldn't mind taking a test to prove my competence – – but the MOC is just totally out of control. I am ashamed of the people that we allow govern us in our profession. I feel as if many of us have nothing in common with them and their decisions.

Jack @

Would be interesting to know the background of the people creating and administering the MOC. Any studies done to correlate improvement in clinical care resulting from passing the MOC. How much has being up on the latest in Psychiatry improved or even affected the quality of care we each give our patiients. There are those who are good test takers but not so good clinicians. Consider: DSM 3,4,and5 and the explosion of pharmaceuticals in our profession...how much have they improved the quality of care we give our patients. At best they only treat symptoms...they seldom cure anything. Maybe it is time to have CMEs help us improve our therapeutic/clinical skills . Ii say this from 83 years of practice experience.

Martin @

Would be interesting to know the background of the people creating and administering the MOC. Any studies done to correlate improvement in clinical care resulting from passing the MOC. How much has being up on the latest in Psychiatry improved or even affected the quality of care we each give our patiients. There are those who are good test takers but not so good clinicians. Consider: DSM 3,4,and5 and the explosion of pharmaceuticals in our profession...how much have they improved the quality of care we give our patients. At best they only treat symptoms...they seldom cure anything. Maybe it is time to have CMEs help us improve our therapeutic/clinical skills . Ii say this from 83 years of practice experience.

Martin @

I'm a Psych PA. I have to maintain and retest for two boards: primary care and psych. I'm coming up on my 7th exam plus the 100 cme every two years. It's a scam

Joseph @

it is only for the Boards to make more money!

Helen @

I have no intention of playing this game even though it means losing something I worked very hard to attain. To impose such onerous requirements and fees on those of us that have satisfied all initial requirements for board certification and maintained sufficient CME accrual to satisfy state boards and the AMA/AOA is nothing less than hostage-taking.

Jim @

I agree 100%!

Jonathan @

At whatever risk it entails to my professional credentials, I completed one round of recertification in both of my boards and then decided I have had enough. I earn a good amount of CMEs and make effort to learn whatever I need to in order to care for my patients, and my conscience is certainly clear.

I wish that other psychiatrists would resist MOC because, as the ABIM debacle showed, this is one area where doctors can actually push back and win. We should pay extra for a CME activity because it has a before and after quiz? Our academies are enmeshed with the process, which would seem like a conflict of interest.

John @

The whole idea that MOC is going to be something that improves quality is ridiculous. I agree that we shold get CME credits, but this seems to be a way for the people who came up with the ideas to peddle their products.All in all a travesty, one more thing to add the already long list of stressors,I don't then how they qualify to represent us

Susan @

I believe it's called...racketeering.

Deborah @

I entirely agree. I have long thought that this is as much related to revenue as it is to"quality".
Besides, I know of no published studies linking MOC to clinical competence....
Daniel D Cowell,MD

Daniel @

There is a kind of competence that is promoted here, but I wouldn't say its exactly clinical. Its a dysfunctional pseudo adaptation to something obnoxious. It is much like being bullied, when you think about it. Another thing that it enables is cheating, or at least duplicity. It is possible to pass some tests without even reading the materials. Another potentially deceptive idea, is that the drug companies sponsor the research that creates the data that create the questions themselves. . Never before has "science" seemed so unreliable, in my opinion. So we have unreliable testing about unreliable data that is handled in an unreliable manner, but with mandatory participation because of maintenance of a medical license. I believe it is time to make CME's optional, and not in just some states, but in all states. .
David Fedders, MD

David @

Bottom line.......It's all a rouse for the folks running the boards to make money.
Just as EHR and the Meaningful Use requirements are a way for the government to monitor our every activity to find ways to cut down on payments to clinicians..........under the guise of "quality"

Any time the 'quality' word comes up, look out for your wallet...!

The other moniker that is ridiculous is "Privacy" There is no privacy when insurance claims, diagnoses and medications prescribed are all over cyberspace for everyone related in any way to providing or billing for medical services (even equipment) can view.

hank @

It's just another jobs creation program, then an income tax stream for the people employed by the boards.

Joseph @

I fully agree. I refuse to do this.

Robin @

I already take numerous CME classes via Audio Digest, NetCME.com, and occasional meeting attendance. It is interesting we receive NO credit for reading books, doing research, etc.
The MOC is just totally confusing and requiring some type of peer reference testing and opinions of patients, which I don't get. Those of us in private practice do not have colleagues around the hallways that can sign forms. I am forced to hand out evaluation forms to kids and teens which I am not sure is appropriate. Now I have find a way to get the peer testing CME which is costly, then pay $2500 to take a test that 99% of people pass, and I have to take time away from the office to test. Clearly this MOC was made up by people who do not own and manage a practice.

MICHAEL @

I am a Board certified Child Neurologist and have taken the general Pediatric Board 3 times and stopped when MOC came on board. I dont need the board to practice but did spend 3 years in a pretty grueling internship and residency and I think that test should still follow me.

Pretty soon, they may make you start doing something to keep your MD. How would we all like that?

We have all the power and use none of it while the c suites of the wotld have no real power, only what we give them.

I don't let anyone call me a provider. That is a very slippery slope. If we stopped writing orders the whole thing would come to a grinding halt.

Mary @

I love the idea of a grinding halt and refusing to be called a provider. It's like we are all being conscripted into being drones for corporate interests complete with the non-descript, bland title of provider.
Change the vocabulary and let's start owning the conversation.

Stefanie @

Words are important. No "provider", no "client".

Amelia @

Atlas Shrugged

Joseph @

I am a Board certified Child Neurologist and have taken the general Pediatric Board 3 times and stopped when MOC came on board. I dont need the board to practice but did spend 3 years in a pretty grueling internship and residency and I think that test should still follow me.

Pretty soon, they may make you start doing something to keep your MD. How would we all like that?

We have all the power and use none of it while the c suites of the wotld have no real power, only what we give them.

I don't let anyone call me a provider. That is a very slippery slope. If we stopped writing orders the whole thing would come to a grinding halt.

Mary @

I am a Board certified Child Neurologist and have taken the general Pediatric Board 3 times and stopped when MOC came on board. I dont need the board to practice but did spend 3 years in a pretty grueling internship and residency and I think that test should still follow me.

Pretty soon, they may make you start doing something to keep your MD. How would we all like that?

We have all the power and use none of it while the c suites of the wotld have no real power, only what we give them.

I don't let anyone call me a provider. That is a very slippery slope. If we stopped writing orders the whole thing would come to a grinding halt.

Mary @

I am a Board certified Child Neurologist and have taken the general Pediatric Board 3 times and stopped when MOC came on board. I dont need the board to practice but did spend 3 years in a pretty grueling internship and residency and I think that test should still follow me.

Pretty soon, they may make you start doing something to keep your MD. How would we all like that?

We have all the power and use none of it while the c suites of the wotld have no real power, only what we give them.

I don't let anyone call me a provider. That is a very slippery slope. If we stopped writing orders the whole thing would come to a grinding halt.

Mary @

I am a Board certified Child Neurologist and have taken the general Pediatric Board 3 times and stopped when MOC came on board. I dont need the board to practice but did spend 3 years in a pretty grueling internship and residency and I think that test should still follow me.

Pretty soon, they may make you start doing something to keep your MD. How would we all like that?

We have all the power and use none of it while the c suites of the wotld have no real power, only what we give them.

I don't let anyone call me a provider. That is a very slippery slope. If we stopped writing orders the whole thing would come to a grinding halt.

Mary @

It is interesting the train left the station in 1965-66 with government rules dictating "quality" determinants via Medicare and Medicaid. The profession, AMA and all the specialty board, have delegated the "quality" definition and determinants in exchange for money and influence. I'm 76 and have watched this hijacking process continue. Under the "quality" banner is the ACO's and most of Obama Care.
Unfortunately, but the average independent and busy practitioner has no representative and is being plowed under (or run over and run out) of the profession. The only loss is the patient which we all will be one day.

Sam @

It is interesting the train left the station in 1965-66 with government rules dictating "quality" determinants via Medicare and Medicaid. The profession, AMA and all the specialty board, have delegated the "quality" definition and determinants in exchange for money and influence. I'm 76 and have watched this hijacking process continue. Under the "quality" banner is the ACO's and most of Obama Care.
Unfortunately, but the average independent and busy practitioner has no representative and is being plowed under (or run over and run out) of the profession. The only loss is the patient which we all will be one day.

Sam @

Well said.

John @

The most important election of our lifetimes was 1964. When someone starts whining about how things are now, I always ask them who did they or their parents vote for that year.

Joseph @

MOC: Medicine on Crack. I've learned over the years that no medicine, provider, PCP, equals the best medicine. It's becoming a very slippery slope for both M.D.s etc, and patients. Especially when psychiatry becomes part of the patient's electronic records/monster insurance factories. I once asked my psychiatrist what the meaning of Doctor was: she said I have no idea. "To Teach" is the latin root I said. And in five minutes the buzzer on her desk rang, she sent my scripts, and after paying my $80.00 co-payment I was gone. I think Lewis Thomas spoke of the future back the eighty's. I'm a consumer and you are provider now. Maybe AFCA can start bringing more newly minted foreign doctors who will be glad to have your job for half the money.

Daniel Clasen: Road Scholar

Daniel @

very helpful

sushrut @

CME requirements I think are absolutely necessary. The MOC is not , should not be. However, by far the biggest reason that it exists, or at least started existing is not financial. It was the hue and cry of the commentariat/government/govermentoid bodies , such as PressGainey, Leap Frog, etc., wanting a means to police us docs from killing our patients; which apparently they feel we do routinely (see the latest study showing "medical error is the third leading cause of death in the USA" ; would love to see the actual data on that , and how it was manipulated to look that bad). So, a lot / many /most of our governing bodies themselves started this mess, fearing that if they/we didn't , the government would do it for us. And we would like that even less. And of course the senior members starting it exempted themselves and their peers , otherwise it would never have gotten off the ground. Now, the majority of members, more senior included, such as myself, have to do it , and are rebelling.

Michael @

The above was actually from Daniel, friend of Michael.

Michael @

Actually, I would imagine that medical errors ARE on the rise! As long as "providers" accept "jobs" that require them to "see" more and more "clients", diagnostic and treatment errors are inevitable!

I am disgusted by the "corporate takeover of medicine". From the ridiculous number of useless government and insurance industry middlemen, to the exorbitant salaries of insurance and pharmaceutical industry executives, to the lobbyists who spend billions trying to rig the system, I am sick and tired of the greed and corruption that has seeped into every aspect of health care and now, even our own board organizations.

When Physicians take back the Profession, we can get back to the "Practice of Medicine", i.e., Evaluating, Diagnosing, Educating and Treating our Patients! So where does it end? When do we say, ENOUGH?!?!?!?

Deborah @

Studies are inconclusive MOC improves quality of patient care but it most certainly improves the quantity of money in the certifying bodies bank account, not to mention the way they have it structured is imposing to say the least.

Dennis @

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