The man behind MOC defends the program against critics
Efforts to ease requirements for maintaining board certification have not quelled internists’ complaints about the time and costs the maintenance process demands. Still, the president of the American Board of Internal Medicine—the body that oversees certification for internists and many other subspecialties—remains convinced that maintaining certification is important for physicians, and that the board’s path for doing so is the best one.
“Putting out a credential that speaks to whether doctors are staying current in knowledge and practice, I think overwhelming numbers of doctors want to have a way to reassure themselves that they’re doing that,” says ABIM president Richard Baron, MD, MACP. “And they want a way to communicate to their patients and colleagues and institutions that they’re doing it.”
Related: MOC is crazy and unfair
Even so, the ABIM has been trimming many of the changes it made to the maintenance of certification (MOC) process in 2014 and that led to the outcry among physicians. Last year, for example, the board invited practicing internists to review the outline—or “blueprint”—of the assessment exam and rate the topics it covers for their relative frequency and importance to everyday practice.
Then earlier this year the board announced plans to introduce a shorter assessment test in 2018, one that doctors can take on their own computers rather than in a central testing location. Doctors who do well on these assessments can “test out” of the current assessment, which is required every 10 years.
Baron’s comments were part of a wide-ranging interview with Medical Economics regarding MOC and other issues facing the ABIM that took place during the American College of Physicians scientific meeting in May. The full transcript follows:
Medical Economics: One of the complaints we hear about MOC is that the process has very little relation to the kinds of problems most practices face on a day-to day basis. Do you anticipate that the changes you outline in the announcement are going to address that complaint?
Richard Baron, MD: I would say that a number of changes we’ve already made have taken important steps to address that. We’ve been engaged in what we call a blueprint review process where we invited practicing doctors, all board-certified doctors in a discipline, to give us feedback on what’s called the blueprint, which is the design specification for putting together the exam. We did it in IM in the MOC exam in the fall of 2015 and had very positive reviews from doctors that it was more relevant and moving in the right direction.
So crowd-sourcing in how to put the exam together has helped a fair amount in the relevance area and we’re rolling that out across all our disciplines. So I think we’ve taken a number of important steps there and will continue to.
The changes we made with ACCME [the Accrediting Council for Continuing Medical Education], creating a way for more CME programs that met ABIM standards to seamlessly generate MOC recognition is something we also think was in the direction of saying this is a program that gives people credit for the work they are doing that is sustentative, valuable educational work.
ME: Can you point to any specific changes in the blueprint that you feel are making it more relevant to everyday practice?
RB: I’d have to say it’s too numerous to count. In other words, the blueprint review is pretty technical. It not only gets into different diseases but it gets into is it important to be able to diagnose this, to treat this? Is it important to understand the disease mechanisms? Those are all things that exam questions might test. So some of the things we’re asking doctors is, how important is this?