In a case of either bad timing, tone deafness, or perhaps both, in 2014 the American Board of Internal Medicine (ABIM) chose to add several requirements to its maintenance of certification (MOC) program.
In effect since the year 2000, the MOC recertification exam was already unpopular with many physicians because studying for a high-stakes test every 10 years was seen as time-consuming and costly, and they believed many of the elements were not relevant to their practice. (Some also noted that there was little or no research yet showing the MOC program had any impact on health outcomes for patients). The changes introduced in 2014 also required them to earn accreditation points on a continual basis over the 10 years between exams in areas related to practice assessment, patient voice, and patient safety. The amount of effort involved led to howls of protest and petitions denouncing the changes.
In a February 2015 attempt to quell the uproar, Richard Baron, a physician and ABIM's president and CEO, suspended the new requirements and wrote a public letter of apology to the internal medicine community: "While ABIM's Board believes that a more continuous certification helps all of us keep up with the rapidly changing nature of modern medical practice, it is clear that parts of the new program are not meeting the needs of physicians like yourself. We got it wrong and sincerely apologize. We are sorry."
So how could a certifying body like ABIM have so badly misread the needs of the physicians it serves? "To some degree ABIM simply was not keeping track of the burden of its requirements on practicing physicians," says Todd Sagin, a physician and attorney who works as a consultant to hospital boards, medical staffs, and physician organizations. "Some of that pushback with regard to burden is a reflection of the increased requirements that ABIM was putting in place, but also it was happening at a time when physicians were generally feeling burdened by other new demands being placed on practicing physicians. So in that sense it was bad timing to be pushing a more aggressive MOC agenda."
Also, ABIM was looking to increase the rigor of the MOC requirements at a time when a growing number of physicians are nearing retirement. "There is a growing cohort of physicians for whom the benefits of MOC are going to be short-lived because they will be out of practice in a relatively short number of years," Sagin adds. "About 40 percent of physicians practicing today are within a decade of retirement, so it was an unfortunate time to suddenly burden these doctors with a new set of requirements to stay in practice."
What's Happening Now?
Fast forward to 2016: What has ABIM done in the year and a half since then to become more responsive to physicians in regard to MOC? Well for one, they've assessed the scope of the problem.
In a recent survey conducted by ABIM, 69.6 percent of physicians expressed dissatisfaction with the current MOC program. However, 86 percent responded positively to the idea of taking an assessment at home or in their office rather than in a testing center, and were comfortable with tasks potentially necessary to facilitate and secure remote assessment. Additionally, 79 percent responded positively to the idea of taking shorter knowledge assessments that would allow them to skip the full-length MOC exam.