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    Docs sound off, question MOC

    Among the many challenges primary care physicians face in their work, few trigger more anger or frustration than maintaining board certification.


    Related: Maintaining cerfitication—gold standard or is luster tarnished?


    Most physicians understand and agree with the overall goals of the maintenance of certification (MOC) process, which are to ensure that physicians are keeping their knowledge and skills up-to-date. But many also feel that the benefits of MOC, as most specialties apply it, don’t outweigh what it costs physicians in time, money and anxiety. And just as they would with an ill patient, they have ideas on how to cure what they believe ails MOC. 

    While MOC detractors can probably be found among all the 24 certifying boards under the umbrella of the American Board of Medical Specialties, the American Board of Internal Medicine (ABIM) has come under especially harsh criticism. Much of it stems from the ABIM’s 2014 decision to expand MOC requirements to include new practice- and safety-related activities in addition to its existing 10-year recertification exam. Moreover, doctors had to complete a certain number of these activities every two years to maintain their board-certified status.

    Faced with a torrent of criticism, the board backtracked. Early in 2015 it apologized for instituting the changes and said that the new activity requirements were being suspended through 2017. (The suspension was later extended through 2018.)

    The board subsequently announced that beginning in 2018 it will offer a new testing option, consisting of shorter, open-book tests—what it calls “knowledge check-ins”— available more frequently than the once-a-decade written exam it now requires as part of MOC. Doctors can take the shorter tests wherever they choose, rather than having to travel to a secure testing location, and those who score well on these will be allowed to test out of the 10-year exams.

    (The knowledge check-in option will be offered first to doctors recertifying in internal medicine and nephrology, and expanded to the other subspecialties covered by ABIM in 2019 and 2020.) 


    Funny Bone Comics: Is there a MOC for monks?


    These changes have lessened, but by no means ended, physicians’ complaints about the ABIM’s process for maintaining certification. For its part, the board maintains that the tests and other activities it requires can help doctors identify gaps in their medical knowledge and improve how they run their practices.

    At the American College of Physician’s 2017 internal medicine meeting, ABIM President and Chief Executive Officer Richard Baron, MD, MACP, offered another justification for MOC: keeping patients’ trust in their physicians in an era of “fake news.”

    “I don’t think we can assume as individuals or as a profession that deference and trust is a given for doctors,” Baron said during a conference session. “I think we all have to think about how trust is built in the new world.”

    To get a better sense of physicians’ views of MOC, Medical Economics spoke with physicians around the country to find out how they view the costs and benefits of MOC, and what they would do to change the process if the opportunity arose. Here’s what doctors had to say.

    Alan Aboaf, MD

    Type of practice: General internal medicine 

    Practice location: Centennial, Colorado

    Years in practice:  24

    Most recent board certification: 2012

    Recent MOC-related financial costs:
    Purchase of Medical Knowledge Self Assessment Program (MKSAP), $620; attending meeting of Colorado chapter of ACP for MOC points, $765 ($200 for lodging, $565 for meeting costs); annual MOC fees, $194 ($1,940 over 10-year cycle) 

    MOC-related time costs:
    Two days out of office for attending annual meeting of Colorado chapter of ACP for MOC points, one day for taking MOC exam 

    ACP/ABIM affiliation(s): none

    Q: Where are you in the MOC process now? 

    A: I sit for the exam again in 2022. I’ve been doing activities steadily along, just to make sure I don’t have to cram it all in at the end. Mostly those consist of going to [local ACP] meetings.

    Q: Do you think MOC has benefitted you in any way? 

    A: It’s always good to review. Medicine is an area that’s so fluid that if you don’t keep up you can end up practicing medicine that’s 20 years old. So I think there’s a benefit in that. The question is, should you be taking a proctored exam that’s so rigid and doesn’t reflect what you normally do? Also, you can’t get on the medical staff of a hospital without being board-certified, so it kind of hangs over your head as something you need to do.

    Q: How would you design the MOC process if it were up to you? 

    A: I’d just require regular CME in the discipline you practice in. I don’t think taking a proctored exam is something I would require. But if it is required, then the issue is how long do you make physicians do it? I’ve done it three times and am getting ready to do it a fourth time. I think at some point they could say you don’t have to do it anymore. 

    Next: 'There can be significant improvement in the process'


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