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    MOC: An examination of costs and impact to physicians

    The controversy surrounding maintenance of certification triggered policy action from the AMA

     

    It's considered onerous, expensive and its impact on patient outcomes is debatable. The controversy about making maintenance of certification (MOC) mandatory has triggered new policy action from the American Medical Association (AMA) calling to keep MOC voluntary and to investigate the feasibility of a study to examine the impact of MOC and osteopathic continuous certification (OCC) on physician recruitment and retirement.

    The study should also probe the negative impacts of failing certification tests as they relate to health plan participation, access to hospital privileges, and a physician’s reputation in the community.

    While June’s action reignites the debate about the need for such a rigorous re-certification program, the concept of continuous professional development was adopted more than 14 years ago by the 24 boards comprising the American Board of Medical Specialties (ABMS) to focus on six core competencies: medical knowledge, patient care, practice-based learning, systems-based practice, professionalism, interpersonal and communications skills.

    From these roots, a multi-million dollar continuing education infrastructure was born to help physicians keep pace with the accelerating growth of medical knowledge. While proponents of the MOC process believe it improves healthcare delivery, its critics want more proof that it is worth the high costs and time away from their families and practices, and truly benefits patients. The issues surrounding MOC are so contentious that they have sparked a lawsuit and an online petition with 17,000 signatures.

    In the latest round, AMA delegates sided against mandating MOC, and they want to explore the feasibility of conducting an impact study on MOC requirements as they relate to entry into the profession, retirements or recertification lapses, practice costs, outcomes and patient safety.

    Maintenance of certification costs

    Next: AMA's call to action on MOC

    20 Comments

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    • sgrechter@------.net
      sgrechter@------.netMar 18, 2017 Just passed my MOCk boards in abpn. But guess what! I'm not done... now I'm to pay equivalent of 1 hour wage yearly for next 10 years to police my record for Board approved courses- not the same ones I will use to update my medical license in order to maintain my Certification. 1 hour of hard earned money tending to sick patients, fights over approved medication, and filling out of numerous papers in an era of paperwork reduction! So what do I refer to myself if I chose not to follow these mandates- "board *decertified* or board uncertified after these next 3 years pass? I just got my new business cards from Vista print.
    • IshikaAgarwal
      Policies must be easy to be applied on people. Otherwise, any one would boycott it because it is their rights. People should say a professional to write my coursework UK to get an idea before writitng new policies so it would help them to design a valuable policy.
    • Anonymous
      I've recertified once and must do so again in 2017. I recall my previous recertification was really pointless. It was simply jumping through hoops because we allegedly had to. But I think physicians--if they can collectively work together--can actually boycott this process. Unlike previously, physicians have been kindred spirits and have not worked together on various issues. Hence the dismantling of our profession. If we all chose not to jump through those hoops and thus no-one was "board certified" then what would the powers that be do? In fact, I just received an email asking me to do just that. If I knew my physician colleagues would all do this, I'd also do it in a minute. But unless it's a collective effort, it's a waste of time.
    • Dr. David
      MOC is a burden, no doubt. If other MD's would stand toe-to-toe and agree not not participate, it would put some of these testing institutions out of business. The word on the street is that our Board Pres., J. Stockman, has become a millionaire by running a testing and recert. gorilla. Certainly, a physician like myself with 24 years of fulltime peds experience, and not a single blemish on my career, should have a way to opt-out of this mandate. i would like to spend more of my spare time with family, and patients, than saddled to this demanding recertification process. There must be a better way to weed out the "bad eggs". I preferred the on-line testing we pediatricians had about a decade ago. This resembled real-life practice more than a proctored exam and all of these MOC modules. Access to resources, in order to attain a satisfactory score, was more fair and educational, in my humble opinion.
    • Dr. Bruce Kinzy
      I agree wholeheartedly with the opposition statements of my physician colleagues. Besides being costly, time consuming and not really providing the stated purpose of improving care to our patients, it is apparently a gold mine for the non practicing ABIMS execs who earn 2, 3, 4x's their colleagues who are in the trenches seeing patients. The stated length of the MOC certification is 10 years which is similar to prior re-certifying processes but in reality it is only 3 years or the time of each separate part of the 10 year process. Evidently, the ABIMS believes that doctors forget very rapidly. I'm not aware of a profession that thinks so little of their colleagues to even suggest such a stringent method of insuring quality professionalism, certainly not lawyers, dentist or accountants.
    • Anonymous
      How is it that our predecessors deemed themselves so qualified that they do not have to recertify and grandfathered themselves, yet we younger physicians must? Surely we are as educated as they. I am a sub specialist in Physiatry, and the idea of spending nearly $4000 to: complete a PIP, pay10 years of fees ($150/yr)paid to ABPMR to keep track of my CMEs, pay at least $100/module for 4 mandatory learning modules, re-certification exam and application fee, all to take a re-certification exam on areas of medicine that I no longer practice. I have always felt that this was a money making skeme. There are no other post graduate programs in any other profession that requires this, nor in any other area of healthcare. I am a professional. Allow me to learn what I deem important for my medical practice, and I will continue to care for my patients without this additional financial burden and time spent away from my patients and family to take an exam that is irrelevant. certification examination on topics that that are not part of my daily practice
    • EDWARDJVOLPINTESTA
      The boards were never meant to be mandatory. They started out as voluntary exams. Physicians would never have supported them if they had known that eventually they would attain the de facto mandatory status that they now have. The punitive nature of the exams is counter-productive to learning whatever the board may be because the pass/fail approach forces examinees to cram and engorge themselves with information a large part of which they do not need. This is taxing and actually it is dishonest. Because of their punitive nature, a large industry of board preparation courses has grown to take advantage of the fears of those examinees who are not good test takers or who just shun the thought of not getting a passing grade. I have seen some board preparation courses actually guarantee a passing grade. Besides the cost and the time expended it seems the prep course also raise an ethical question. For example it seems reasonable to assume that those doctors who have not taken board preps are disadvantaged compared to those who have. Besides, being expensive and time-consuming, the board preps cannot accurately assess the totality of a doctor’s talents and capabilities. For example, like many other family physicians and internists, I have customized my practice over the years. Once I did office surgery, gynecology, and treated patients in the ICU and on the hospital floors. I also did pediatrics and took care of patients in the nursing home. Now, however, I now use hospitalists for my in-patients and delegate the care of my nursing home patients as well. I no longer do gynecology or pediatrics. I rarely do suturing. The great majority of my patients are the same ones that I started out with in my practice because I have practiced in the same town and office. When I last took my Family Medicine boards at least 30% of the questions were unrelated to my practice. Besides, the test which was formerly a multiple choice and completed with a no. 2 pencil was now computer-based which unnerved me a bit. The point is that whether one is an internist or a family practitioner the burden and the defects of the boards are a source of distress and distraction to both. Continuing education cannot be punitive. That should have stopped in medical school. For doctors who have already been certified, education should adopt more of a self-assessment type approach. I know of at least one psychometrician who was at odds with the current modus operandi of the boards. Finally, MOC cannot measure personal qualities like honesty, the ability to connect with patients in a personal and humane way, working well with one’s consultants, serving on hospital committees and participating in medical affairs in one’s state and county medical association. These are just a few of the issues that the leadership of the American Board Of Medical Specialties must address. Sincerely, Edward Volpintesta MD
    • EDWARDJVOLPINTESTA
      July 25, 2014 Medical Economics Re “MOC: An onerous mandate or a safeguard to public health?” Digital edition, July 25, 2015. There is no preponderance of evidence to support the proponents of MOC. I suspect that the driving force behind MOC is the Institute of Medicine’s 2000 report “To Err is Human” (National Academy Press, 2000) wherein it reported that 44,000 to 98,000 hospital deaths occurred yearly because of medical errors each year. That study only looked at statistics from New York, Utah, and Colorado. Clearly, even one preventable death is a tragedy, but rather than concentrate on making hospital care safer, MOC was and is applied to all specialties, many of which do not even treat patients in the hospital. There is lots of CME available to physicians. Most self-direct their education. Many hospitals offer CME to their staffs and many good self-study programs exist. MOC detracts from the ability of those programs to survive. Ultimately, MOC will fail. Its mandatory status, its pass/fail approach and its lack of practicality will appeal only to those in teaching positions in academia who are desirous of adding another accolade to their resumes. Add to this the rumors that surround its profit-making success and it is clear that MOC will not succeed. Edward Volpintesta Bethel, CT 06801
    • Dr. Khera
      It is good to know that some thing is being done to get rid of this MOC requirements. This is the most ridiculous thing in the history of the medical field. I have been writing on this topic since 2011 and I now see the momentum in the right direction. This is nothing more than money making trap and harassing physicians to do their normal activities. Physicians are already working extra extra hard to take care of their patients. MOC not only takes away the time from their family but also money for the fun time. Let the state board do their jobs for the requirements as they have been doing for many years.
    • PAULMKEMPEN
      The true costs of REcertification are far beyond the test payments, include travel, payments for expensive MOC "products" (yes that is what the ABMS calls them!) yearly fees, CME and MOC point acquesition. THis all comes to at a mimimum over $2,000 a year just to stay in the game and now includes political impositions: see:Revocation of Board Certification for Legally Permitted Activities. Mayo Clin Proc. n July 2014;89(7):869-872 n http://dx.doi.org/10.1016/j.mayocp.2014.04.017 There is no limit to the things the ABMS can continue to FORCE on physicians if we do not stop them NOW. State Medical Boards have been regulating for decades-we do not need private police (i.e. another Mall Cop with a badge!)
    • Dr. Paul W. Johnson, DO
      What about the idea of boycotting the ABIM altogether and getting certification through the American Board of Physician Specialties (ABPS). I know they don't comprise a large # of the total physician force, but "voting with your feet" by making the switch would send a message.
    • Dr. Marc Frager
      There is no reason to believe the ABIM/ABMS can improve my practice that they know nothing about. Collective education/testing of physicians who have established their niche over some time has to be a questionable proposition. Perhaps the reason no high quality data exists to show any efficacy of MOC is that the whole proposition is wrong.CME can be individualized to meet my needs. If insurance companies/hospitals are looking for a credential that means something, they should seek a different alternative. MOC is a burden on physicians and a boon to ABIM/ABMS administrators.
    • Dr. Matt Raines
      Like I have stated on a previous article: Until the medical profession as a whole stands together against this nonsense then we will continue to be bent over farther and farther. Enough is enough.
    • Dr. Eran Duzman
      Having gone through this process several years ago in Ophthalmology, I think much of it is un-necessary . The only portion that I found useful was the open book exam where you can sit with two computers and review some material you may not use on a daily basis. I think the closed book exam is ridiculous. We have all proven in our training that we can take an exam, and that doing so does not make us a better doctor. What really angers me is that the folks at the Ophthalmology board grandfathered themselves so that they do not have to take the exam. As in the article, they quote that the public wants to know that doctors are keeping up. First, there are many ways to accomplish this task and second, the folks sitting on the committee are much further away from their training than us newer grads. Doesn't the public want to know that they are keeping up as well. Total double standard. I think its a money scheme and I can tell you for sure that it does disrupt life at home, and in your practice. Its a system that requires a significant overhaul. No Lawyer, engineer or architect have to go through this scrutiny. Imagine if you asked all the lawyers to retake the bar every ten years. The MOC is a total waste of time. It is not clinically significant and aims for people to learn all the insignificant minutia that is not required for day to day practice. I think that the AMA and physicians should demand that the process be changed!
    • Dr. Jonathan Weiss
      Anonymous and Rosemary are spot on; MOC = SCAM
    • RosemaryEMcHugh
      Please correct my name in the comment heading. My name should read: Rosemary McHugh, M.D., M.B.A. Thankyou.
    • RosemaryEMcHugh
      As an American physician who has also received medical training in England and Ireland, I am truly saddened by the lack of professionalism of Dr Nora and others who are making their colleagues jump hoops to prove their worthiness to continue practicing medicine. I never experienced that type of belittlement by professional colleagues in Ireland nor in England. I had no idea that Dr Nora's salary is $800,000. No wonder those making big bucks by intimidating their colleagues do not want to see an end to MOC. The only reason people outside of the profession are asking for re-certification is because the leaders of medicine are not standing up for their colleagues by making it clear that one time certification and continuing CME do prove that a physician is highly qualified. I applaud the AMA for putting a moratorium on MOC. I hope and pray that the AMA has the wisdom to end MOC all together and show their medical colleagues the respect due to them for the years that have been given in training to be the best that we can be for our patients. It is up to the AMA to make it clear to hospitals that physicians who have achieved Board Certification are highly qualified physicians, who are continually updating themselves by annual Continuing Medical Education (CME). This outrageous treatment of doctors by the promoters of MOC is crippling to the medical workforce at a time when nurses and physician assistants are being given duties beyond their competencies, putting patients at risk, as well qualified doctors leave the profession because of disgust at their expertise being so belittled by MOC promoters. Sincerely, Dr Rosemary Eileen McHugh, M.D., M.B.A., Chicago
    • Anonymous
      I can give the AMA the info for their study right now. 1. Yes, it is expensive. 2. It takes time that could otherwise be better spent, either continuing our education or having personal time. 3. There is no proof that it is clinically relevant to outcomes. 4. I suggest that Dr Nora's salary be cut to $150,000 per year instead of $800,000, and require her to do the MOC modules annually, and we'll see how much of an advocate she becomes then. It is easy to be an advocate when your earn a huge salary for what you advocate for.
    • Anonymous
      Amin. MOC is moc-king the profession. All should stand against. I am 60 year old, in private practice. I am grandfathered in general pediatrics, and Have to do MOC for subspecialty. If I was certified in my subspecialty a year earlier, I would have been grandfathered too for my subspecialty. There is no difference between me being grandfathered or not. I am the physician who was trained to do what I trained to do, kept my continuing education regardless. What a waste of time, and humiliation to take a day of my practice, to show at a testing center, being inspected and asked to empty all belongings of my pockets and check them out. Being looked at by a kid (who turned out to be my patient) looking over me to see if I am going to cheat at my Exam. .. Disgusting. By the way my first two recertifying exams were open book exams and I have two months to finish and I have to get 80% of the answers which was time consuming but not as humiliating. Going to Getting my Points..(Part II and Part IV) what a joke is that... 40 points of part two took me 20 min to do... I take it that I was good doctor !!! the 40 points of part four ...were jokes.. one was a hand washing module and the other was medical litarecy module. took a lot of my time, but no one could tell me I became a better Dr. I have many colleagues who decided to let the certification go because of this crab, and they are Dam good doctors I would take my family members to them at any time. I guess that should be enough .. O no and I never made Half of what Dr. Nora make.. may be I should apply to take her Job.
    • Anonymous
      A “brain dump” is a term commonly used for a site or material where real exam questions and answers are provided (in most cases, for a fee). The promise to a user is that by memorizing the answers, one can pass the exam. Brain dumps are not legitimate training or test prep resources for two reasons. you can pass ur 70-41- exam by the help of exams4sure

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