State-level efforts have popped up as physicians are rallying around what many say are outrageous fees the American Board of Medical Specialties (ABMS) and American Board of Internal Medicine (ABIM) charges physicians to take the test. A recent study in JAMA found that initial exams averaged $1,846 in cost for the written version and $1,694 for the oral component; MOC fees were, on average, $257 per year, or $2,570 for a 10-year period. The researchers also found that fees collected from certification exams accounted for 88 percent of revenue coming into those boards in 2013.
"It's clear the entire ABIM structure is colluding under this financial benefit they get from recertifying physicians," says Fisher, who is an active voice in the anti-MOC movement and has been tracking various state-level efforts on his blog.
In Michigan, Edison is also active in anti-MOC circles, as her open letter to the American Board of Pediatrics (part of ABMS) went viral last year. The letter, she said, made her realize she was in a position to tackle the issue head on. Last year, she worked on proposed legislation in her own state of Michigan that targeted MOC requirements in hospitals, on insurance panels, and through the state licensing boards. It hit a common roadblock.
"[The bill] went to a hearing and then it didn't go anywhere. There was a lot of pushback from insurance companies and hospitals," Edison says. "Those are very strong lobbies." This year, Edison, working with the Michigan State Medical Society, is reintroducing the bill and focusing on removing MOC requirements for insurance panels. She says this is because hospitals will be hesitant to change their bylaws if they aren't paid by insurance companies. Thus, physicians have to focus on changing insurance company bylaws first to eventually change hospital bylaws, she says. Otherwise hospitals will be pressured by insurance companies to keep MOC requirements intact.
Michigan's Legislature is currently in summer recess, Edison says, but when they return, there will be a hearing on the updated bill. She foresees this becoming a vital issue of physician recruitment as more states address MOC requirements. "This is exploding across the country….we need to get on board if we want to be a competitive state and attract physicians," she says.
One area of the country where this movement has made inroads, in particular, is in the southwest. In 2016, Oklahoma passed Senate Bill 1148, which said physicians were not required to recertify through a MOC program as a "condition of licensure, reimbursement, employment or admitting privileges at a hospital."
When the legislation passed into law after facing little resistance, many anti-MOC observers celebrated it as a major milestone. But Jack Beller, MD, Oklahoma Medical Society past president and an orthopedic surgeon in Oklahoma City, said the bill has yet to make a huge difference. "We found out later the reason [we faced no] resistance from hospitals and insurance companies is that they felt it exempted them, even though they were specifically [named in the bill]," Beller says.