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    ABIM does about-face on changes to MOC program

    In a surprising development, the American Board of Internal Medicine (ABIM) is changing or suspending several of the recent revisions made to its maintenance of certification (MOC) program—and has apologized for making those revisions.

    “A year ago, ABIM changed its once-every-10-years MOC program to a more continuous one,” ABIM’s president and chief executive officer Richard Baron, MD, MACP, said in a written statement. “This change generated legitimate criticism among internists and medical specialty societies. We got it wrong, and sincerely apologize.”

    Read: MOC needs revision before physicians will recognize value

                The changes ABIM is making include:

    • immediate suspension of the practice assessment, patient voice, and patient safety requirements of the MOC process for at least two years. “This means that no internist will have his or her certification status changed for not having completed these activities in these areas for at least the next two years,” according to the ABIM statement;
    • changing, in the next six months, the language on the ABIM website used to report a diplomate’s MOC status from “meeting MOC requirements” to “participating in MOC”;
    • updating the internal medicine exam to make it more reflective of what practicing physicians are doing;
    • keeping MOC enrollment fees at or below 2014 levels through at least 2017, and
    • assuring “new and more flexible ways for internists to demonstrate self-assessment of medical knowledge by recognizing most forms of  ACCME-[Accreditation Council for Continuing Medical Education] approved Continuing Medical Education.”

    "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,” Baron said.

    In addition, Baron pledged that ABIM “will work with medical societies and directly with diplomates to seek input regarding the MOC program through meetings, webinars, forums, online communications channels, surveys and more.”

    The ABIM is the largest of the 24 boards comprising the American Board of Medical Specialties.

    Prior to 2014 physicians who boarded after 1990—and who did not therefore have lifetime certification—had been required to recertify every 10 years. Last year, however, ABIM announced it would require physicians to complete various MOC requirements on three- and five-year cycles. It also said that physicians who certified in 1989 or earlier, and who had not subsequently recertified, would be listed as “certified, not meeting MOC requirements.”

    Next page: How significant are the announced changes?



    The 2014 changes provoked heated opposition among individual physicians and medical societies, who said that MOC is expensive, time-consuming and unnecessary. In a June, 2014 article in the journal Anesthesia & Analgesia Paul Kempen, MD, an outspoken MOC critic, called MOC “untested, unnecessary, ethically questionable, and lucrative to academic-based physicians, board corporations and national medical specialty societies.”

    Ron Benbassat, MD, a board-certified internist and a founder of the anti-MOC organization Change Board Recertification called today’s announcement “just a small first step.”

    “Physicians are no longer afraid to speak their minds about MOC. We are on the right side of the truth here and will not rest until the MOC scam is fully revealed and abolished,” he said.

    Steven Weinberger, MD, FACP, chief executive officer and executive vice president of the American College of Physicians, was more conciliatory. “I would say we were very pleased,” he said. “We’d been focusing for a long time on providing to ABIM the concerns and complaints we heard from our members and ABIM’s diplomates. This announcement today is a real game-changer and we’re delighted to see it.”

    Weinberger added that Baron and ABIM’s leadership deserve credit “for being able to come out and admit that ABIM has to take some responsibility for the way the MOC program was and the problems that resulted. It’s to their credit that they have taken this responsibility and are willing to make changes.”

    The American Medical Association (AMA), in a written statement, said “The AMA is delighted that ABIM is listening to physicians’ concerns and recognizes the need to better align the requirements of its MOC program with physician learning and practice improvement needs. Today’s announcement aligns with the AMA’s MOC principles as we have strongly advocated for a process that is evidence-based and evaluated regularly to ensure physician needs are being met and activities are relevant to clinical practice."


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    • Anonymous
      You should trust the ABIM just as much as you should trust the Iranians not to develop a nuclear weapon.
      February 4, 2015 Medical Economics For “about face” to have meaningful use that will help doctors and will heal the bitter feelings that for too long have festered will]require extensive changes =in the philosophy of MOC and the modus operandi of the leadership of the American Board of Medical Specialties: “ABIM does about-face on changes to MOC” (Medical Economics, February 3, 2015). To begin with, after passing their initial board exams doctors should never lose their certification and become “decertified”. That this has happened is clear evidence of how even the very organizations that are supposed to help doctors can lose their focus and be harmful. The implications and uncertainty over MOC have undermined physicians’ peace of mind for too long and have done so with impunity. Being exploited and treated with indifference has made many doctors lose faith in the ABIM to treat them fairly. It will take years and positive action to restore the faith that has been lost. Without it future success and acceptance are impossible. To show their commitment to rapprochement with the medical community, the primary care boards (internal medicine, family medicine and pediatrics) would do well to allow anyone who has failed their last recertification to retake them once more gratis. Whatever future shape and direction the ABIM and MOC (and the other primary care specialties) take on, doctors must include rigid safeguards to protect their professionalism. Lacking them, the risk is great that after a grace period the ABIM will resume its aristocratic airs and promote its influence with the public, state medical boards, the Federation of State Medical Boards, hospitals, and medical societies to control doctors. The primary care specialties (internal medicine, family medicine and pediatrics) require special attention because many primary care doctors after finishing training and passing their initial boards tailor their practices to the demographics of their communities and the availability of specialist care. As a result no one knows better than they which areas of they need to update their knowledge in. They should be allowed to choose their own updating. It will be interesting to see how the future of MOC will look like. Right now it is still an ugly duckling\. Edward Volpintesta MD
    • Dr. Jonathan Weiss
      The recent announcement by the ABIM is undoubtedly meant to be little more than a diversion to help quell the recent outcry over the outrageousness of MOC. Their hope, I'm sure, is that front-line docs will consider this the "victory" they were looking for, and in a mere 2 years, when we have presumably gone back to our old complacent selves, focusing on patient care, they will strike anew. But the ABIM will find that this time, they have gone too far with the scam that is MOC, and that this apology and slight roll-back of MOC requirements will not suffice. Whether they understand it or not, they have a battle on their hands, and we are united and prepared to fight this until the end. MOC either has to go completely, or be radically revamped, with the permanent jettisoning of the secure exam, PIM, patient questionnaires, etc, as well as ending time-limited certificates, and a substantial roll-back of fees. Fight the power!
    • RosemaryEMcHugh
      As a family physician who went to medical school at Trinity College Dublin in Ireland, and did further medical training at the Queen Elizabeth Medical Center in England, I am outraged by the unprofessional way that physicians are being treated in my own home country, the USA, by our own colleagues. MOC has to stop. I am grateful for the new board NBPAS which has a common sense certification that shows respect for fellow physicians in fulfilling our state requirements for continuing medical education at a very reasonable price. The NBPAS recognizes that we are worthy and respects our time, so that we can focus on patient care, and not focus on proving ourselves worthy to share our very hard earned and God-given skills for the benefit of patients who need them. Sincerely, Dr Rosemary Eileen McHugh, M.D.
    • Dr. David L. Keller
      One of the "changes" listed in Dr. Baron's letter is vaguely-worded, open-ended and worrisome: "Updating the internal medicine exam to make it more reflective of what practicing physicians are doing." This could be a good thing if it means eliminating esoteric questions covering knowledge which is not required in general medicine, or allowing test-takers to use online references, as we do in actual practice. However, it could be a bad thing if the questions and their answers will be biased too heavily toward "choosing wisely", "less is more", and the other campaigns to influence internists to reduce their screening, testing and therapeutic measures to the bare minimum required by existing evidence. Such minimization of care is not in the interest of patients, given the uncertainties of the real world, where a little extra care or a slightly redundant test can provide a margin of safety.
      My full quote was this: "This is just a small first step. The ABIM and ABMS have been publicly shamed by all the financial records and articles that have recently come out. They are backpedaling now and trying to save face. Physicians are no longer afraid to speak their minds about MOC. We are on the right side of the truth here and will not rest until the MOC scam is fully revealed and abolished." It's very clear the boards are feeling the collective heat of physician outrage, new alterative boards being created ( http://nomoc.org/about-2/ ), the AAPS lawsuit and of course the public shame of their financial records being revealed. And they should be. Opposition to MOC continues to gain momentum, second only to Ebola as one of the top medical news stories of 2014, and now it leads the news. www.changeboardrecert.com has been updated with articles and physician commentary, videos and financial info about our "nonprofit" Boards, all showing MOC’s evolution into a discriminatory, costly burden to physicians and patient care, a profiteering scam without proof of efficacy or patient protection, with compliance rapidly being tied to practicing medicine. Please review the site, forward this to all your colleagues. Together we are making a difference. MASS MOC NONCOMPLIANCE is the only rational solution to forces taking over our profession. Note the recent additions here: http://changeboardrecert.com/anti-moc.html
    • Anonymous
      As I prepare to take my board recertification next Monday to fulfill the requirements of the ABPMR, I have reviewed material that I haven't touched since completing my residency in 2005. I am a sub specialist in pain management and have at least 800 hours of AMA category 1A CMEs that have enhanced my clinical care. These were programs that I am interested in and applicable to my practice, yet I am required to take an additional 150 CMEs (300 CMEs of which 150 have to be in PMR and the Board decides if they are relevant to PMR) in areas that I have no interest in, nor will they be utilized in my practice. The MOC is making money for those who run it and placing a major economic burden on those who have to fulfill it, otherwise we are seen as less qualified physicians. It proves NOTHING. I have no problem with taking a board certification after completion of your residency and 20 CMEs/year in your area of interest/clinical practice. Fulfilling the MOC over a 10 year period including the recertification exam easily costs $20,000 -$30,000 not including loss of income away from our practices to fulfill these requirements. Give physicians some credit to decide what is best for our practices and not mandate testing over irrelevant material. The exam only demonstrates whether you are a good test taker, not a good physician. NO other profession in healthcare or otherwise has this type of recertification requirement. KM
    • Dr. David W. Allison
      This is a positive beginning of what will be the total demise of MOC. A bright light is being shined on the ugly truth. What truth is that, you ask? The fact that MOC helps NO ONE except the people that administer and force it upon unwilling physicians. I like how the ABIM's letter talks about "meeting the needs of physicians". Attention ABIM, your job is not to "meet my needs"! The only thing I and my colleagues need you to do is leave us alone and let us do our job!
      The battle is NOT over! Until these boards return to lifelong certification they will continue to rely on regulatory capture (Street term=Extortion). MOC is not certification but a whole new and very unproven "product" that no one wanted and will not survive in a competitive environment alongside traditional CME as the index of life long learning! The whole ABMS certification industry is archaic and passe' in modern medicine where government, insurance and about 15 other oversight agencies are controlling practice and collecting data. see: www.youtube.com/watch?v=WykrUZW31WA How much waste will we tolerate-ABMS boards costing over $400 million each YEAR already. Paul Kempen, MD, PhD
    • Anonymous
      Although these admissions seem to be a positive development (better than continued stonewalling or rigidly towing the ABMS party line), there is no doubt that such conciliations are motivated at least in part by a desire to undermine arguments in the ongoing antitrust litigation by AAPS against ABMS. http://www.aapsonline.org/AAPSvABMScomplaint.pdf We should expect other ABMS boards to follow suit.

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