If you’re looking to start a contentious discussion among pediatricians or internal medicine practitioners, bring up Maintenance of Certification (MOC) – one of the most divisive issues facing specialists today.
To bring you up to speed, the nature of specialist physician certification changed just over a year ago: Whereas passing their certification boards was once an optional “feather in the cap” stamp, it has now become more of an expensive, time-consuming requirement for many doctors employed in large hospitals and health systems.
Why? Because some health plans are implementing programs that recognize and reward physicians who are actively participating in Maintenance of Certification activities, and the windows on how long the certifications keep shortening (from ten years, to 7, to 5 in some specialties). Because earning MOC credentials requires taking closed-book exams – often on topics unrelated to their speciality, such as the “hand washing module” – they require a lot of burdensome prep in exchange for little value in return.
Reforms are underway: Oklahoma recently became the first state to remove maintenance of certification requirements for physicians, and other states and physician groups are actively advocating against MOC, because there are more reasons the program is problematic than just the inconvenience involved. Here are a few.
Where’s the Evidence? Programs like PQRS and the expansion of the accountable care model are helping shift the American healthcare system to a more value- and outcome-driven landscape. But MOC is unconnected to any larger results-focused or data-backed initiatives, making its correlation to “quality” ambiguous at best.
Where’s the Money Going? Studying for and taking certification exams costs physicians and hospitals money and takes doctors’ time away from patients (to the tune of 20-40 hours each year). Meanwhile, the certification boards are not-for-profit, but many physicians feel that MOC’s advocates are only in it for the revenue the boards collect.
What about CME? The specialty-specific boards are an additional requirement on top of other continuing medical education (CME) requirements. Given that the CME mechanism has been in place for much longer, and is more broadly respected across the healthcare space, MOC is considered redundant by many.
Why so Complicated? Closed-book exams aren’t the only thing required: Some boards make physicians also attend an association conference and complete other tasks in order to pass. Not only does mandatory travel add costs and lower physicians’ income, many doctors don’t even know what they need to do in order to complete all MOC criteria.
Why at All? The idea of placing heavy recertification burdens on specialists (who are highly trained to begin with) is at odds with other forces across the medical field – like the expansion of scope of what nurses and nonphysician practitioners (who are less trained) are able to practice. With some docs so fumed that they’re publicly pulling out of practice to protest MOC, the ABMS clearly has a lot of reforming to do if they want to keep the program alive.
What are your thoughts on MOC?
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