"[Other state medical associations] should encourage their members, physicians on the ground to get involved with the legislative process. Let their legislators know [MOC programs] are onerous. And encourage their specialty board to make this a better process," says Monday.
Like many others that have been active voices against board re-certification, she notes she is not opposed to the idea of continuing medical education, but doesn't see this as being helpful to her specialty. "I don't think anyone would care about [MOC tests] if it was relevant, cheap and didn't take us away from our patients," she notes. For her part, Monday says she will still take her MOC test in November, as she doesn't want to risk exclusion from an insurance panel if something with the law changes
Leaders in Michigan, Texas, and Oklahoma say the efforts to thwart mandatory MOC regulations began when a groundswell of physicians presented these problems to the state medical associations. As the resistance to these requirements started to grow, many physician leaders such as Beller in Oklahoma, said its medical association was prompted to take action. Cardenas in Texas said the anti-MOC law began as a grassroots movement when members of the organization continued to bring it up as a problem.
Experts say this is the way to enact change, by bringing these issues forth to state medical associations. "Right now that's our most effective action," says Fisher. On the national level, Fisher has doubts about the American Medical Association's dedication to the cause, even after the AMA's House of Delegates passed two resolutions, one of which called for the end of mandatory MOC exams and the other that had the AMA create model state legislation to deal with this issue.
Edison too implores physicians to go to their state medical associations to get the ball rolling. She says these associations are the voice of the physician. Once the state medical society has an official policy on board re-certification, they are instrumental in getting bills introduced, she says. Another tip she offers is to get to know legislators who are also physicians.
"In almost every state that's done this, it's been physician lawmakers. It is finding your physician lawmakers, contacting your state medical society and [asking them], 'what can we do in our state to protect physicians and patients?' That's the absolute first step and stay on it. Don't stop calling after one try. Keep calling," she says.