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    Docs sound off, question MOC


    Q: Where are you now in the MOC process?

    A: I take the internal medicine exam again next year. I got my MKSAP book, which is a great resource, and I’m trying to get through that this year. There are also a lot of paying courses available to help you with the exam but I don’t think I’ll do any of those. For me to go in person just about anywhere takes a lot of time. It’s possible I might do a video course. 


    Editorial: ABIM needs to look in the mirror when discussing lack of trust


    Q: Have you benefitted from the MOC process in any way? 

    A: Definitely. When I did my practice improvement module for diabetes I pulled 25 charts and looked at the results [for blood pressure levels] and remember thinking, ‘that’s much higher than I expected, there must be a mistake in that sample.’ So I pulled 25 more and got the exact same numbers. We were on paper records at the time, so I decided to make a paper registry. It sounds archaic, but it was really helpful. It really mapped out the problem for me. I attribute that to the practice improvement module.

    Q: What do you think about the requirement for doing a certain number of MOC activities every two years?

    A: To me, that’s an attempt to say, ‘let’s not put this off until the last minute.’ If MOC is really about keeping up-to-date then putting it off until the ninth year doesn’t make any sense.

    Q: Are there any changes you would make to the MOC process if it were up to you? 

    A: It seems like they should be able to develop a test that’s open book. After all, medical practice is open book. If a patient is in the exam room with me and I don’t know the answer to something I’m going to start looking at all the available resources.

    I also think if you can get the process to where MOC isn’t a separate thing, but is part of the workflow like CME, then that’s ideal. I think we’re moving in that direction. We’re a lot closer than we were in 1998, I can promise you that.

    Christopher Unrein, DO

    Type of practice: Internal medicine/palliative care

    Practice location: Parker, Colorado

    Years in practice: 26

    Most recent board certifications: 2008 for allopathic internal medicine; 2012 for osteopathic internal medicine; 2013 for osteopathic palliative medicine

    Recent MOC-related financial costs: Week-long review course in Arlington, Virginia (including cost of course, travel and lodging), about $2,300; MKSAP, $690; annual fees for double-boarding, $256 


    Related: ABIM touts certification to restore patient trust


    MOC-related time costs:  Five days away for review course, one day each for allopathic and osteopathic exam 

    ACP/ABIM affiliation(s): none

    Q: Where are you now in the MOC process?

    A: I finished my most recent cycle of certification for internal medicine in 2008, even though I didn’t have to finish until 2012. So I’ll do it again sometime in the 2021-2022 timeframe. Hopefully that will be my last one. In the meantime I’m getting credit for MKSAP and CME.  

    Q: What are the costs of MOC to you?

    A: The ABIM charges $2,560 over the 10-year cycle, $256 per year, to renew both certifications [internal medicine and palliative/hospice care]. I don’t have to travel to take the exam because there’s a test site less than a mile from my home. But MKSAP costs almost $1,000, and the ABIM review courses are usually in distant locations and they can last five or six days. So you’ve got airfare, five or six nights in a hotel, and meals to pay for. And the review courses themselves usually cost somewhere around $700 to $1,000.

    I use the term ‘board-certification industrial complex’ to describe it all. There’s this whole industry of people selling you stuff, because they know we’re all scared to death if we don’t pass this exam we can’t get hospital privileges and we’ll get kicked off insurance panels. 

    Next: 'I don’t think it’s that helpful'


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