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    Maintenance of Certification must go: One physician's viewpoint


    The Maintenance of Certification (MOC) program’s expense and time commitments continue to grow, producing greater complexity and more headaches for the nation’s physicians.

    The American Board of Medical Specialties (ABMS) lobbied Congress to pass legislation linking Board Certification to Medicare and Medicaid reimbursement payment. The Physician Quality Reporting System (PQRS) led the American Board of Anesthesiology (ABA) to become a “provider” in 2013, even though in 2011 the ABA publicly stated that “The ABA does not believe that the additional requirements for the MOC bonus will have a sufficient impact on patient care, nor will the reimbursement bonus justify the additional time and resource burden on its diplomates. Accordingly, the ABA does not intend to submit an application for CMS [Centers for Medicare and Medicaid Services] approval of an ABA MOC-PQRS program in 2011.” 

    Just weeks ago the ABA gave notice that it will become a new PQRS-MOC provider, under multiple pressures including the impending requirement for providers to register by the end of 2013 so that diplomates can avoid the 1.5% and 2% penalties looming in 2014 and 2015, respectively.

    maintenance of certification

    As a concerned physician, I have followed the multiple requirements for this MOC program and clearly noted that leaders of the ABMS certification industrial complex themselves have been reluctant to subscribe to the corporate policy of certification they propose, except under duress.

    Simulation training has been dictated as a core and primary MOC requirement in my specialty. All anesthesiology certifications have become “limited” to 10-year intervals since 2000, mandating absolution of simulation for the 1,500 anesthesiology resident graduates each year since 2010.

    The leadership in anesthesiology recently disclosed in the ASA newsletter that although these 4,500 “new millennium” graduates are all due to recertify and must have completed simulation by 2010, in the first two years of the MOC-Anesthesiology (MOCA)  simulation requirement, only 583 ABA diplomates completed courses at 27 ASA centers. By the end of  2013, only 1,600 had done so.

    With over 50,000 ASA members, and 35,000 practicing anesthesiologist in the United States, the fact that only 583 physicians submitted to MOCA simulation in the first two “mandatory years”, reaching only 1,600 after the years (0.1% participation,) is hardly a resounding vote of approval for MOCA.

    Recently, four of my colleagues underwent this simulation training. None indicated there was reasonable value regarding the six CME credits at a discounted cost of $1,200 (the typical cost is $2,000) to our department’s membership. They were required to respond in the exit survey indicating three things they had learned, and would only receive these MOCA® credits after an interval to affirm that the chosen “practice improvements” had been instituted.

    The “survey process” itself appears geared to reaffirm the “value” of this simulation as just one more coercive technique.

    Maintenance of certification




















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    • Anonymous
      While I enjoyed reading some of the comments, I'd like to know opinions on physicians that practice without being board certified. Should the reimbursement to them be the same as to those who have been certified? I recently learned that a buddy of mine, a heart transplant surgeon, is not board certified in anything. Sure, he's done some incredible residency programs, but he is not board certified. So, to those of you that have "jumped" through all the hoops, done your 4 years undergraduate programs, 4 years of medical school, residency's, and become board certified - what are your thoughts? I think it's total bs. Where does the liability fall? On the individual, on the sponsoring physician? On the program? To those of you complaining about renewing MOC, really? Is $2k too much? If you'll quibble over that, then you're probably not putting the patient first.
    • Anonymous
      There is NO EVIDENCE-BAESD BENEFITS, from MOC, BC, and they should not be part of the required hurdles to become a medical staff member, in any hospital across the country. They are waste of precious time, and money. Lets all concentrate in providing quality care to our patients, and demand removing MOC and BC from the hospitals Bylaws, all across the the country.
    • Dr. RLS
      it is so obvious the whole MOC item is a conspiracy to move monies into the hands of the certification agencies with the physicians captive in the process via shameless economics of punitive reimbursements by entitlements for the same work of no demonstrable qualitative difference ...why ??
    • Anonymous
      I have recently recertified in internal medicine ABIM. No more.
    • Anonymous
      I am a Family Medicine physician, who has just re-certified on the 10 year Maintenance of Certification program, I do not feel that I received any substantial benefit from the process. The annual tests are open book and a person has multiple attempts to pass - this means that any diligent person could pass. So, if I just send my money each year, and take the open book, multiple attempt to pass module, I continue to be board certified. Board certification should mean that I am a competent physician in my field = not that I paid money to take a test that a non-physician could pass, given enough attempts. And then I have to go through the time-consuming process of doing a PI project - even though I already know how to do it - just to prove to them that I know how - and pay them money for them to acknowledge what I already know. What a sham. My time would better be spent on my family, my patients, reading journals - a whole host of things other than doing the mandatory MOC.
    • Anonymous
      I started keeping up with MOC in my specialty, but it was just becoming more and more cumbersome and a waste of my time. They claimed that it was a good deal since I'd get CME for doing it, but I already get more than enough CME. So, I just abandoned my certification. Didn't see the point. They just make up more rules to justify their existence.
    • Anonymous
      MOC is just an annuity for its board members. Let the government keep their money. They are bankrupt. They need it more than I do.
    • Dr. Optimage
      "The board certification process has never been validated as improving healthcare by outcome-based studies, serving instead more as an exclusive guild, yielding benefits to only those already enrolled." says it all. Discrimination and selection bias is rampant with the checklist examiners in the anesthesiology Oral exams, where 20% are going to "fail" every year, regardless. We must infer that this apparent systemic failure in ACGME training programs, with no improvement year-after-year, not only cheats the resident but also the taxpayer, who subsidizes this training. Or better, let's admit to the self-appointed scam that is certification, where the speed-dating opinion of four Oral examiners of dubious pedigree somehow trump the reality of an applicant's safe anesthesia practice in thousands of cases. We clinicians should not parse out MOC while leaving BC untouched; they are the Siamese twins of putting lipstick on the ABMS pig. Both must go; and let's find their adherents some meaningful work.
    • Anonymous
      MOC is another example of administrative medicine having "a good idea" gone horribly wrong. Supposedly, as physicians, we're supposed to use evidence-based medicine. Where is the evidence regarding MOC? Simulations...attestations...mandates...and money but where is the evidence of WHO this exactly benefits (other than the MOC-Industrial complex)? The requirements are taxing both financially and with time (the more precious commodity). I concur with the predatory "exit surveys." The physician Boards know there is no evidence... so they're manufacturing it with "Look, all these other physicians have told us how useful and important all these 'hoops' are to their practice. Why aren't you following the herd?" Of course the fact that the 'herd' is actively corralled and cattle prodded behind email campaigns and licensure threats is never mentioned.
    • Dr. Margaret Vajdos
      Whole-heartedly agree with Dr Kempen. I've always felt the ABIM was just a money making venture. I'm nearing the end of my career. I can't take it any more. As a result I doubt I'll ever rectify.
    • Dr. David L. Keller
      I agree with Dr. Kempen, especially his observation that, in order to obtain credit for completing MOC modules which are required to continue practicing, the physician must attest to the benefits of the modules. The specialty board then collects this "data" which was obtained under coercive conditions, and publicizes it as evidence that most physicians believe these MOC requirements are valuable. If a doctor gives his truthful assessment that the MOC module did not improve his practice in any way, he may fear that he will be required to complete one module after another until he is worn down into confessing that he found it helpful.

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