In our recurring blog "Inbox" we share comments from physicians and practice administrators telling us what keeps them awake at night.
Editor's note: We work hard to write about issues that will help physicians run their practices in a manner that is both prosperous and efficient, while still delivering quality patient care. And we are delighted when our readers let us know what they are thinking. This month we are excerpting two articles written by contributing author David Raths and anesthesiologist David J. Norris on the vagaries of the ABIM's maintenance of certification (MOC) program. The articles have been edited for space and is followed by comments made by readers at PhysiciansPractice.com.
Will Doctors Ever Accept Maintenance of Certification?
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.
Gary says: I used to be proud to be board certified. I distinguished myself, I had a feather in my cap. But now that it is required, it no longer has that merit. It's like the children who live in Lake Woebegone and are all above average. Furthermore, there is not a shred of evidence that board certification or MOC improves patient care. Aren't we supposed to be practicing evidence-based medicine? [This] is a sham treatment, don't do it. After 33 years I have let my certification expire, I will enroll with NBPAS.
Jose writes: I was supposed to do this MOC torture this year for the second time. I am an [infectious disease] specialist in Florida. None of my patients care about my board certification. I am mature enough to pick my CME areas of interest. I personally know board certified colleagues that I wouldn't trust my cat. And vice versa, non-certified colleagues that I trust and respect professionally.
I've made the decision to go with NBPAS and ignore ABIM subtly threatening emails reminding me of the consequences of my decision. It's a matter of principles and dignity. I hope more of my colleagues will arrive to the same conclusion.
Susan comments: "Sagin says that critics who focus on ABIM's finances are picking on issues that trigger emotions rather than rational considerations." Multiple illegal activities have occurred with the ABIM that are more than just "triggering emotions." It is illegal to perform research on physicians and their practices without a protocol or informed consent. It is illegal to purchase a $2.3 million condo complete with chauffeur-driven Mercedes S-Class town car as a non-profit and include depreciation in "program service expenses." It is illegal as a 510(c)(3) to lobby Congress and fail to document this on your tax forms. It violates physician civil liberties to use a two-time convicted felon as your "Director of Investigations" to coordinate a sting operation where secret audiotaping occurs and results in the raid of Dr. Arora's residence in 2009. This isn't just about finances, it's about tax fraud, violations of HHS statutes on research, and likely anti-trust monopoly creation.
Floyd writes: … I agree with most of the comments. It is the old way of doing things. Make a board, grandfather in the old doctors, and then charge the new guys coming up for the privilege of being board certified. Now let's look what the board has done for its' members recently and in particularly the state of Pennsylvania. Soon all kinds of professionals including nurse practitioners will be able to practice independently in Pennsylvania. While the board is busy robbing us, we are losing market share and the profession in general. Second, [we have] complete loss of control. Doctors no longer are in charge of their profession. They are told what to do by the boards, administration, nurses, and insurance companies, and the second the doctor disagrees, he is labeled as a troublemaker. …Thousands of years of physicians did well without board certification. It really was a marketing ploy boarding on collusion. It's almost certain death for a doctor to not be board certified, but what does that really get you. … I can go on for hours, but I have to do a peer-to-peer review to try to get my patient a CT scan for neck mass that the insurance company says is not needed. Next, I have to spend my time writing a [history and physical examination] for an upcoming surgery. Mind you all this I can't bill for, but try getting any free work out of any other profession. Maybe the board can help me with this?
Robert says: MOC is a sham to enrich various organizations (e.g. ABIM) and "Ivory Tower" educators at the expense of overworked and over-stressed physicians. Paranoid about being somehow "shut out," doctors succumb to the implied (and possibly real) threats of exclusion. If only physicians could agree on anything, they should unite and end this before it joins death and taxes!
Ruth comments: The last time I took a five to six hour test sitting all day was nine years ago when I re-certified in Critical Care. I found it torturous then and find it extremely off base with how I practice medicine today. Plus I couldn't drink or eat during that time. I even fell asleep for part of the exam - the only time I would sit so long in front of a computer is to take this ridiculous test. In real practice, IF I do not know something, I look it up, or discuss with colleagues. Not everything in medicine is a simple yes or no. Plus my knowledge is strong in the cases I see every day, but I am not in a transplant hospital, etc., so don't know all the nitty gritty about transplants - nor do I need to. I have no outpatient practice. Lastly, I go to conferences for CME credits and updates. Do I really need to take a test so out of touch with the reality of practicing?
Tamzin writes: What this MOC stuff really represents is physician-politicians who have learned from the low-down criminal bozos in the government. They set themselves up as authorities to "make sure" everyone else toes the line, as if we are a bunch of delinquent 4th graders. I deeply resent that. They also get paid royally for harassing us. When Richard Baron says "ABIM's Board believes that a more continuous certification helps 'all of us' keep up." Who does he mean, "All of us"? There are people grandfathered in - so I guess they are first-class physicians, and everyone else is 2nd class. What a sweet deal. Get old, make money for doing nothing, and exempt yourself from the stuff you foist on everyone else. And so what if ABIM's Board believes that? This is the real world, and we perform miracles in it every day; under very taxing circumstances, I might add. He talks about if we want to self-regulate, blah, blah. Hasn't he noticed that we have jackboots of government thugs on our necks all day, every day, "regulating" us? Bullying us. Is it too late to go to veterinary medical school? No "Veticare," no "Veticaid," no MOC, no [pay for performance], no forced EHR, no coding, no [CMS], no APM, no "insurance" contracts, no MIPS, no MACRA.
Have you thrown out MOC with the bath water? Tell us what you think; join the conversation at bit.ly/no-to-moc.
Physicians Desire Focused Communication Over MOC
I've been intrigued as I've watched what seems to be constant changes in the various requirements for my physician maintenance of certification (MOC). I know for my specialty board the requirements have changed at least three times during the 10 years I have worked on my second round of certification. I thought I would share a few lessons I've taken away from this experience.
1. Be focused in your message. I'm not real certain what message the boards are trying to send to their members. At no time when I received communication from my board did I hear "We are doing this for you and your patients." Instead I got a constant thread of changing requirements which seemed to come with a new and higher fee. I was told that it's important for me to comply and participate in this voluntary process. My participation will ensure that I work to keep healthcare costs down and provide quality patient care because they are forcing me to keep up to date with the latest treatments. I consider myself a life-long learner, and I enjoy keeping abreast of the most recent findings. It's the reason I go to meetings and read journals. The message physicians hear from the board seems to be very different from its stated mission and purpose.
Sajid writes: I guess this issue has been going on for long time, I wonder if ABIM understands how and what physician are saying and thinking. The only way to get rid of the rod in their neck is all physicians should get certification from "National Board of Physicians and Surgeons," which is 100 percent CME based on your specialty. Also get it approved by your hospital bylaws as an alternative to ABIM; as so many hospitals are trying to adopt NBPAS as equivalent to ABIM board. Once this is achieved this topic will be dead, and all physicians will be in more peace with their patients and families.
Susan says: MOC was created because the ABIM could not support their handsome salaries and benefits on just initial certification fees alone. That's the only reason. No other profession requires "re-certification" - not the law, not airlines, no one. Yet here we are in medicine having to "re-prove" ourselves every 10 years because some people decided in 1990 to suck their colleagues dry for cash, while failing to acknowledge the value experience provides for us as we strive to care for patients over all those years without getting sued. Time for the ABIM to learn "accountability" and about the rule of law. No more strongman tactics in the name of "public good."
Is there anything to be salvaged from MOC? Tell us what you think; join the conversation at bit.ly/moc-lessons.
* We are interested to know what our readers really think about the future of MOC. Help us out by taking our short poll here: "Can MOC Be Salvaged or is it Forever Hopeless?"