Should a doctor rest on their residency laurels, never to learn another thing as they sink deeper into their careers and patient care? Of course not. For years, our state medical boards have required us to complete a certain number of CME’s to keep our state licenses active. Lately, our specialty boards have added a layer called MOC (maintenance of certification). An additional educational hurdle that allows us to keep our board certifications. In previous years, we just had to meet CME requirements, usually acquired as part of our state licensing, and be tested on a periodic basis.
Recent MOC requirements require training above and beyond our state board with a heavy investment in time and fees. Doctors are increasingly vocal against the changes. In fact, there was a recent petition started by internal medicine doctors (now over 10,000 signatures) protesting the publication of those doctors who did not comply with MOC requirements. Many of these doctors refused to comply because they were opposed to the changes. Some associations who administer the MOCs say they are voluntary, but that’s not the reality. Without board certification, a doctor cannot have hospital privileges or be contracted with insurance companies. In fact, according to a recent poll on Sermo, only 3% of doctors think the MOC process works well currently.
Why are doctors so opposed to MOC?
- It is expensive. The cost just to the board is tens of thousands of dollars over the course of a doctor’s career. This excludes study material and conferences that a doctor needs to purchase or attend in order to prepare and complete the modules and tests. One anesthesiologist on twitter stated he is required to purchase modules for review which costs several thousand dollars.
- It is too time consuming. An emergency medicine doctor commented on twitter the time involved in complying hurts patients care by taking doctors away from the patients’ bedside. Others commented on the redundancy of study for physicians who must meet state CME and board requirements. Some doctors feel that CME’s and personal education are an adequate lifelong learning process that we are already required to take.
- Many doctors feel the MOC has little relevance on our daily practice of medicine, specifically the recertification exam which tests “obscure and irrelevant information that has little or no translational value to patients.” Even according to the ABMS[what is the ABMS?], there is no certification that guarantees performance or outcomes.
- Many doctors fear the MOC will be converted into MOL (maintenance of license). While doctors are opposed to the MOC process for reasons above, they also fear they will eventually lose their licenses if they don’t participate. A few doctors have gone so far as to call this extortion.
- The tide of popular opinion among physicians has clearly turned against the current MOC process. Many doctors are refusing to comply and encouraging others to follow suit. Petitions are circulating and political organizations gearing up for the sole purpose of stopping MOC.
Many doctors have spoken up that CME’s and practical patient centered exams every 10 years is sufficient to stay current with current medical advances. But, amidst the rising antagonism to MOC, we must ask, what is the best way to detect “clearly outmoded MDs/DOs?”
A simple solution is to let CME state licensure requirements combine with specialty board requirements. This mainstreams the process and ensures physicians are up-to-date with the latest research, diagnostic protocols, and tools.
Additionally, CME could be required in certain topics. At present, physicians are required to achieve a certain number of prescribed credits. The whole CME requirement system could be overhauled to allow physicians the option to pursue self-study while making sure they are maintaining their competencies. Regular testing would ensure quality standards are maintained.
Finally, let’s make sure doctors are studying practical information that they can apply immediately to their patients. Practicing doctors should help craft content, tests requirements and give input for CME goals.
Our current system feels punitive and predatory to physicians. The majority of us feel torn from our patients and burdened with needless study that doesn’t improve patient care. The time has come to make the MOC process meaningful.
Dr. Linda Girgis MD, FAAFP is a family physician that treats patients in South River, New Jersey and its surrounding communities. She holds board certification from the American Board of Family Medicine and is affiliated with both St. Peter’s University Hospital and Raritan Bay Hospital. Dr. Girgis also collaborates closely with Rutgers University, University of Medicine and Dentistry of New Jersey (UMDNJ), and other universities and medical schools where she teaches medical students and residents.