Doctors Push Back Against MOC Requirements

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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?

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.

Bio:

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.

 

 

Comments

  1. says

    Thank you, Dr. Girgis. Unfortunately, the MOC requirements are simply another layer of bureaucracy added on to the already burdensome system of regulatory hoops physicians must jump through to maintain their ability to practice. The American Board of Medical Specialties continues to tout that the public is demanding this effort, but this is a self serving claim as the ABMS profits mightily from this testing scheme. There is no scientific evidence that this requirment produces safer or better physicians. Doctors are all quite aware that we must keep current in our field of expertise for the benefit of our patients. It is time to end this MOC fiasco, the sooner the better.

    Richard A. Armstrong MD FACS

  2. says

    Dr Girgis states this clearly. Independent patient surveys demonstrate that patients have no idea what board certification is. And they rarely consider board certification when choosing a physician. Board certification and MOC have never been proven to lead to better clinical outcomes. In this age of “what is the evidence?”, there is no evidence that MOC or board certification (despite all my credentials) translates into superior care.

    Clinical endocrinologists have cleared stated their opposition to MOC in the recently released position statement https://www.aace.com/files/views/lifelong-learning-moc.pdf

    which promulgates a more rigorous and relevant certification in lifelong learning that is primarily CME based. Other societies need to follow suit. Currently ABMS holds an unjustified monopoly on certification which is onerous, irrelevant and very costly.

  3. says

    Well said, Dr’s Armstrong and Weiss.

    Physicians have long fallen prey to the thousands looking to take “just a few dollars” for this or for that and we have kindly done it. The massive 400% increase in FDA certifications with a requirement now to often have multiple certificates is one example. But the numbers above belie the true cost of board certification/MOC/MOL. The fact is, by the time you factor in the cost of the test, cost of study materials, time spent studying (away from patients and your life), time spent away from home for potential class, and lastly, time out of practice for the actual test, which for some, can be days, the actual cost of this can run $20,000, or more. Absolutely unacceptable in this day where, especially primary care salaries, will continue to fall. How many people would accept having that amount of money being taken from their salary with no evidence of necessity? None.

    Taking time away from patients and one’s life would be one thing if this was helpful in any way. It is not.

    This is not to even mention people like subspecialists who are required to do MULTIPLE of these or people practicing outside of their original residency. This prevents mobility of physicians, which is a major problem with the whole system. If we develop a cure for cancer, would it not be helpful to be able to move those physicians to another specialty? This is an extreme example, but there are many smaller examples present every day as medicine advances. The mobility of our physician workforce is imperative and the entire boards system inhibits, rather than augments this.

    It is time to get rid of the entire boards system. It has been a money making scam from the beginning, but this new aggressiveness is beyond the pale.

  4. says

    The problem lies with the makeup of the specialty board. Mostly bureaucrats from large institutions that have a stake in the outcome. It becomes a problem of control and economics. The current situation with regards to Internal Medicine is not sustainable. A residency program cannot go on forever no matter how much the autocrats would like to maintain control. Either they change or some other organization will assume their function.

  5. Diane says

    These repeat certification exams are atrocious. They cost a fortune, take time away from a physician’s practice and do not measure the excellence of a physician.

    I know physicians who are certified repeatedly, able to pass these exams and I would never send a patient to them

    The measure of a good physician takes place in the exam room where he/she listens, focuses, is attentive, gets a good history lays hands on the patient and when they do not have the answer, refers to a specialist.

    PHysicians are constantly educating themselves, with self study, courses, conferences, grand rounds, meetings etc.

    Physicians who are not “up” in their field are reviewed by hospital committees of their peers and appropriate actions taken

  6. says

    Thanks for the great comment, everyone. I think another point is that the re-certification/MOC process is not being carried out/developed by practicing physicians. Until those in the field have more role in developing the means of keeping doctors current, it will never be truly meaningful.

    • Lanie Soaedy says

      Dr Linda
      We all strive for better more efficient ways to stay current in our field. If practicing doctors wrote the material and made it useful for learning we could at least see some value in participating . How did we let this get away from us? Must be those who ‘grandfathered ‘ themselves out of the requirement.

  7. howard c. mandel M.D., facog says

    I am a strong believer in the Oath of Maimonides. It reads: “Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend indefinitely to enrich itself daily with new requirements. Today he can discover his errors of yesterday and tomorrow he can obtain a new light on what he thinks himself sure of today…”
    I also embrace the parallel concept of satyagraha, loosely translated as “insistence on truth” (satya ‘truth'; agraha ‘insistence’) coined and developed by Mahatma Gandhi.1,2,3,4
    Among others, I have previously published that MOC has never been proven to improve the quality of medical practice. To the contrary, it has been associated with the decreased collegiality of our profession as well as decreased involvement in local as well as national medical societies.5,6,7,8,9,10,11,12,13,14,15,16 Most practicing physicians find MOC to be clinically irrelevant 6,7,16 , and polling of physicians in clinical practice showed that only 1.6% wished to maintain the current system – whereas 4.7% supported reform and 93.7% voted to abolish requirements altogether.9
    The American Board of Medical Specialties has published that the quality of research on MOC does not meet commonly accepted research standards17 and that certification does not “guarantee performance or positive outcomes”.18
    As respected professionals, physicians believe in our own continued education and quality improvement. Accordingly, if MOC has not been empirically proven to improve our practices, or be clinically relevant for most of us, than why is it being forced down upon us?
    Veritas vos liberabit – Shouldn’t we insist on truth? If MOC is inadvertently decreasing attendance at scholarly and collegial meetings, shouldn’t we consider that detrimental to the medical profession? With 50% of the counties in America lacking an obstetrician to deliver babies, won’t the early retirements of OBs that MOC could provoke worsen the health access crisis?
    The AMA House of Delegates study on the impact of MOC on physicians concluded, in a resounding consensus at their June 2013 meeting, that these programs were “burdensome, costly, and have little known positive impact on patient outcomes”11. Resolutions against MOC have recently been enacted by the American Medical Association and the state medical societies of New Jersey, Michigan, Ohio, Oklahoma, New York and North Carolina.
    The ABMS is involved in civil litigation with the Association of Physicians and Surgeons (US District Court No. 3:13-cv-2609-PGS-LHG) – in “an unlawful conspiracy in restraint of trade in violation of Section 1 of the Sherman Act”. Of interest, previous US Courts have favored antitrust provisions against other monopolistic professional certification processes19. Unfortunately, the ABMS and the coalition of boards that make it up are in a tyrannical campaign that is being forced upon the physicians of America. They have conspired to manipulate the public, our governments as well as organized medical societies with an agenda that increases their revenue without any scientifically sound evidence that MOC is beneficial to the care and treatment of patients. Their media campaigns including “Choosing Wisely” have specific political goals that are not necessarily in every patient’s best interests.
    The Oaths that physicians take upon earning their degrees speak of dedication to the individual. MOC has been used to further the interests and propagandize articles, consensus opinions and other specific goals of the boards that those leading those boards believe is in the best interests of society, yet that is in direct contradiction to the ethical obligations of physicians.
    In the words of Thomas Paine,
    “He that in defense of reason rebels against tyranny has a better title to Defender of the Faith.”
    Howard C. Mandel M.D., FACOG
    1) McKay, John P.; Hill, Bennett D.; Buckler, John; Ebrey, Patricia Buckley; Beck, Roger B.; Crowston, Clare Haru; Wiesner-Hanks, Merry E. A History of World Societies: From 1775 to Present . Eighth edition. Volume C – From 1775 to the Present. (2009). Bedford/St. Martin’s: Boston/New York. ISBN 978-0-312-68298-9. ISBN 0-312-68298-0. Page 859
    2) Uma Majmudar (2005). Gandhi’s pilgrimage of faith: from darkness to light. SUNY Press. p. 138. ISBN 9780791464052.
    3) M.K. Gandhi, Satyagraha in South Africa, Navajivan, Ahmedabad, 1111, pp. 109–10.
    4) Mohandas K. Gandhi, letter to P. Kodanda Rao, 10 September 1935; in Collected Works of Mahatma Gandhi, electronic edition, vol. 67, p. 400. http://www.Ghandiserve.org
    5) Not Until Proven to Improve Health Care Practice, Mandel HC. N Engl J Med 2013:368 1261-1263
    6) Dubravic M. Board certification/recertification/maintenance of certification—a malignant growth. J Am Phys Surg 2011;16:52-53
    7) Orient JM. AAPS survey: physicians skeptical of recertification. Evaluating the quality of care provided by graduates of international medical schools. J Am Phys Surg 2009;14:17-18
    8) Norcini JJ, Boulet JR, Dauphinee WD, et al. Evaluating the quality of care provided by graduates of international medical schools. Health Affairs 2010;29(8):1461-1468
    9) Change Board Recertification. Website poll. Available at http://www.changeboardrecert.com/vote.html. Accessed December 30, 2012
    10) MOC doesn’t create better physicians, Mandel HC. Med Econ Sep 25, 2013
    11) AMA House Disses Recertification Programs, Pittman D http://www.medpagetoday.com/meeting coverage/AMA/39949 June 18, 2013
    12) Recertification and Maintenance of Certification. Mandel HC; J Am Phys Surg:16;3,65 Fall 2011
    13) Why don’t lawyers have to be recertified? Mandel HC, Med Econ Feb 10, 2012
    14) Recertification and Maintenance of Certification. Sharon, GE; J Am Phys Surg:16:3,66 Fall 2011
    15) Recertification and Maintenance of Certification. Mackel JV; J Am Phys Surg:16:3,66 Fall 2011
    16) Kempen PM: Maintenance of Certificiation—important and to whom? Journal of Community Hospital Internal Medicine Perspectives,Issue 1, 2013 Pages 1-4
    17) Sharp LK, Bashook PG et al. Acad. Med. 2002;77:534–542
    18)www.abms.org/maintenance_of_certification/pdfs/ABMS­_MOCMythsFacts_3-20-13.pdf
    19) Havighurst CC, King NM. Private credentialing of health care personnel: an antirust perspective. Part Two. Amer J Law Medicine 1983; 9:263-334

    • says

      Note ACP note to members on MOC, Ann Internal Med 2014. My response: Thank you, Drs Weinberger, Centor, and Fleming, for looking into the issue seriously. Major problems and onerous, costly challenges to the physician workforce have been discussed ad nauseam for > 5 years in our specialties and among those in the Council on Education for the AMA. What happened? Nothing. A collaborative discussion has not been fruitful for the last five years. In fact, the MOC program (in Boston Red Sox terms, a Green Monster) has grown and metastasized with absurd requirements and ever increasing fees to pay for nonmedical psychometrics and educator employees judging our medical careers and practices. Hundreds of fine physicians have lost their hospital privileges wrongfully solely due to the failure of participation in these peculiar MOC programs. Patients lament the loss of their doctors and are collecting prescriptions from nurse practitioners, PAs, noctors, pharmacists, and others not trained as physicians and not neutralized by MOC.
      ACP and AMA please note, as discussed at many of our state medical societies: US physicians and surgeons need an immediate moratorium on MOC while we begin to discuss viable future options to measure competence and lifelong learning. Based on constitutional anti trust commercial law, no group should carry a monopoly on the guilding or certification of any profession. Based on past experience, negotiations with the high revenue ABIM and ABMS testing industry will go nowhere until these unconstitutional MOC requirements and breaches of our original Board certification contracts are stopped dead. No exceptions. MOC managers need to desist and stop operations especially exhibits, journal promotionals, and false advertising of exclusive credentials for professional competency. Thank you. I remain yours committed to clinical science, medical integrity, and lifelong learning, research, and education independent of the ABMS, and also committed to the primary doctor-patient relationship. — K Murray Leisure, MD, Infectious diseases, Massachusetts.

  8. Dennis Petrocelli says

    I commend Dr Girgis and her peers for taking a thoughtful stand against a process that ostensibly protects the public but in practice probably does the opposite. Continuing medical education – in the form of CMEs – AND, more importantly, peer-to-peer consultation/review/discussion has historically been the basis for maintaining sound practice and cannot be replaced by pencil-and-paper tests of book knowledge twice removed from any clinical situation. #STOPMOC @drpetrocelli on twitter

  9. says

    MOC is a scam, plain and simple; should be fought any way possible; mass noncompliance being the easiest and cheapest, if docs would just unite and act together.

  10. says

    Let’s be clear: the current MOC process is only the tip of the Utopian iceberg for the ABIM. Ladies and gentlemen, I bring you Dr. Benson of the ABIM and his vision for ABIM’s new push: Assessment 2020.

    Unbelievable.

    But if this “2020” initiative is the path the ABMS/ABIM is heading in, they will likely self destruct as more reasoned clinical care doctors flee from their stranglehold.

    But who will take over in their void? I suspect hospital systems who stand to make 2% more from CMS for assuring a marketing facade of “quality” to the public when really they’re soon to be about access and low cost.

    Clinical doctors must offer the public and regulators who hold the monetary keys an alternative choice from the expensive and bureaucratic status quo. Otherwise, we can look for others to do it for us.

  11. says

    Thank you so much for commenting here, Dr. Fisher. I know that you personally have done much in the battle against this unfair and burdensome MOC process. I think it is equally bad across all specialties. The ABFM is not so different than the ABIM, who I feel sets the standard for other specialty boards.
    But, that is absolutely the most correct statement. It must be practicing doctors who set the standard of what clinical practice means. No one else should be testing us on that.
    And it should not be such a money making ordeal. The Boards should have some obligation to help doctors stay current, not profit from it.
    And though they claim MOC is voluntary, I can’t have hospital privileges without being board certified. And without hospital privileges, I cannot contract with insurance plans. Being in private practice, that would be the death of my ability to practice medicine.
    And I hope this raises awareness to all doctors. If only a few of us speak up, nothing will change. We will be forever at the mercy of bureaucrats who decide what we need to do.

  12. says

    You only need MOC IF you depend on insurance contracts or government programs for your income. I opted out 12+ years ago. I was first certified by the American Board of Surgery in 1980 and re-certified in 1990 and 2000, each time on my first attempt. However, I could find absolutely no reason to re-certify again in 2010. I refuse to submit to this system the ivory tower elites continue to treat me as though I were still a resident. JUST SAY NO!

  13. Paul Kempen, MD, PhD says

    Dr Sewell has the right idea. Recognizing EXACTLY that certification and particularly MOC are extortion scams, designated as “voluntary” by the ABMS, it is time to take them at their word and make the whole “product” IRRELEVANT by no longer participating or acknowledging this nonsense. Just like all those “Top Doctor” ads in every airline magazine, make them meaningless! Do not comply and sue anyone who tries to restrict your trade and involve the FTC! The FTC is “protecting” the rights of NP and PA practice of medicine-it is time they protect NON-certified licensed PHYSICIANS!
    SEE: https://app.sermo.com/posts/posts/187568

  14. Joe says

    For an old guy like me who always gloated over being “grandfathered” in, I am gravely concerned about attempts to even make that obsolete. The net effect will be to push those of us near retirement into retirement, thus exacerbating the physician shortage. I think that is part of the plan to try to diminish private practice and drive medicine back to the large academic hospitals.
    In many ways, this may be how we reduce healthcare costs, we simply reduce access. If my specialty radiation oncology tries to brow beat me into doing a MOC, then I will either quit, or do locums, where that probably won’t be an issue.

  15. DA Rydland MD FACOG says

    As the above posters have stated, this is another expensive and time consuming process that really has no relevance to physicians in clinical practice. We have many other requirements to maintain our clinical skills. State requirements and board requirements are expensive and time consuming enough. Older physicians with a lifetime of experience are retiring early rather than go through this process. We are losing our consultants and teachers.

  16. Iker Leycegui MD says

    I have yet to read a post by a physician in favor of MOC that is not a member of the board or that has a private practice. Gathering all the data without medical students/residents regarding your practice is unbelievably time consuming. I am in primary care and can barely make it with a couple medical assistants; most of them work for the sole purpose of checking insurance information, preauthorization, HEDIS, etc. Now do I need to hire someone else to able to comply with MOC? I am currently certified and satisfying MOC. We still have to deal with PQRS, EHR, etc. Where are we going with all this? Are the bureaucrats going to medical school and delivering health care or are WE!
    I am here for my patients. I studied medicine to help the patient.Not to help a bureaucracy nor third party payers, corporations, etc.
    We want to practice evidence based medicine; please show me the evidence regarding MOC,EHR,PQRS,etc. providing improved healthcare and I will comply 110% with it!
    For now, what we can do is support the organizations that actually represent us practicing physicians: AAPS.

  17. David Sacco, MD says

    The biggest problem is that the boards are answerable to no one. To quote from Dr. Baron’s recent piece in Annals, “[ABIM] is insulated from the pressures of dues-paying members by being an independent organization with a self-perpetuating governance that relies on experts to set standards.” No other profession that I can think of has a similar set of powers given to an unelected, “self-perpetuating” group. Also what should be publicized are the enormous budgets and salaries of executives in the boards. It is insane that we pay salaries to administrators that are several times higher than those of actual practicing physicians.

    The discussion of overall cost should include more than just the fees associated with taking the test itself. Personally, the biggest cost was the number of hours I had to study and complete the practice improvement modules. I spent roughly 150 hours on these activities, not counting the day I had to take off of work so I could take the exam. These hours have to come from somewhere. For perspective, at a usual 15 minutes for a follow-up visit, 600 patients could’ve been seen instead during that time. But even more importantly (and paradoxically), where many of those hours came from was my usual daily review of the literature, looking up conditions I’d seen recently to make sure I was practicing with the latest recommendations, etc. Thus, instead of learning about conditions which would actually make me a better doctor, I instead learned about conditions that I will very likely never see. Thus, I have no doubt that recertification not only didn’t make me a better doctor, it actually hampered my ability to improve my practice.

    Perhaps more important than the presence of esoterica on the exam was the converse – there was very little on the exam relating to material internists actually SHOULD know. The gag order on discussing test content makes giving concrete examples difficult, but I don’t think it violates any confidentiality to note that the word “insulin” was not used once on my exam. The fact that one of the most important drugs in the armamentarium against one of the most important diseases in medicine was excluded from an exam that purports to determine a physician’s competence is scandalous.

    Unfortunately, simply refusing to participate is not a serious option, unless we could get everyone to agree to do so together. Insurance companies are now requiring board certification as a prerequisite for billing for care, and many hospitals require it to be on staff. If one reviews the IRS form 990 for ABIM, one of the lines that stands out in expenses are the millions of dollars spent on lobbying and legal fees. That is what we are up against. The only way to change it is to make payers and patients realize that they are ultimately the ones who wind up paying for this nonsense.

    Dave

  18. kmpnpm says

    Joe: Don’t kid yourself. Most locums firms will require Board Certification-just to appease the hospital bean counters who will always want “everything”. You are only allowed to retire or stand up against the boards with all your colleagues. This is an interesting proposal-go with one of the “new boards” now arising to provide your “certification needs”. See this article about the “top doctors” http://abcnews.go.com/Health/top-doctor-awards-deserved-abc-news-investigation/story?id=16771628
    Just how does that differ from ABMS certifications-this is just another group of “experts” voting to give you something to advertise! Remember when doctors and lawyers were not allowed to advertise??? That has changed the Certification game!

    • Joe says

      The locums firms will work out terms, trust me. They will be under different rules, somewhat like nighthawk groups for radiology are. The restrictions burden will apply more on private practices, who don’t have the manpower to allow people to take a day off to study.

  19. says

    I agree that a large burden is falling on the doctors in private practices and small groups. Large groups can afford to lose insurance contracts. Private small groups cannot. It would put me out of business and I practice in an area that was designated a PCP distressed shortage area by the AAFP. Who will treat these pts?
    I would love to be able to just say no. But, unless my colleagues step up as well, I am cutting off my head.
    This truly needs a group effort.

    • Dennis Petrocelli says

      I agree it needs to be a group effort. Ultimately the certifying boards are being very well paid to repeatedly stick their necks out and crow (by way of implication, not demonstrable ) that their diplomates are safe. This is something that licensing boards really just do once upon conferring a license (before the newly-licensed really had a chance to screw up) and essentially say, at the time of re-licensure “we haven’t heard different yet.” Thus what the certifying boards pretend to offer is appealing. An alternative could be peer consultation and discussion: annually each licensee presents cases to three peers and everyone learns from one another – not a graded oral exam, but a peer-to-peer discussion: much more persuasive than an exam. Everyone has to participate both ways. That plus CMEs and I think the public would be kept plenty safe. Some years ago Mass.Medicaid was spending a fortune on questionable psych med combos. It assembled a team of local peers who were nationally know and they visited the docs who were outliers. No one was forced to change, or take a test :) They just discussed cases and literature. Huge change in prescribing habits. So education and public safety and cost containment can all be brought out without mindless compulsory exams.

  20. tom riney md says

    the quest for knowledge comes from within, not from government enabled nannies who are profit driven for their own ends.

  21. Monticello says

    When we were residents and worried about passing the board. We reassured ourselves by remembering a couple of mediocre docs who had passed board. I think MOC only proves that you can pass a test on things that you never do or see, cost a lot and especially with tight budgets take money and time away that might be better spent on CME pertinent to your particular practice. With the advent of webinars low cost or no cost with no time out of office CME is available. Often experts who rarely are available in US will speak as they have no travel time or often no time out of office. Much better investment of time than asking me questions about peds and other things I rarely see in a geriatric practice.

  22. says

    Just when I thought it couldn’t get worse-my own specialty organization (American Association of Clinical Endocrinologists) is following in the footsteps of MOC and forcing endocrinologists to get this special “Endocrine Certification in Neck Ultrasound” which includes an exam, MANDATORY attendance at one of their ultrasound courses (out of town), and submission of sono reports to their “experts” for review. AACE has even sent a letter to CIGNA encouraging reimbursement only for those who get ECNU certification. Of course, all this will cost > $1000. I’m totally disgusted.

  23. says

    Now imagine a plumber, or a police officer, or a railroad engineer, or an electrician – all careers that require specified knowledge that is on-going and that is constantly in evolution as new things are discovered, implemented, pertinent. And imagine those people are now asked to spend 5% of their income, and even a greater percentage of their time to study and test on arcane pieces of knowledge that don’t necessarily pertain to the day to day job. During their periods of study and testing they will not be available to take care of their job and the people that depend on them. If they fail to correctly answer enough of these abstruse bits of detail – they lose their certification. It doesn’t matter that the plumber has worked for 10 years and that everyone recommends him, or that the police officer has arrested hundreds of criminals. It doesn’t matter that the engineer has never had any of his crew injured or had any violations of safety rules, nor the electrician ever have a problem with any building he’s ever wired. Only the esoteric details that escaped them during their respective tests caused them to fail.

    Now I know some people will say that being a doctor is so much different than being a plumber, a police officer, an engineer, or an electrician – but the truth is, beyond the specified knowledge, any career is just the same. In the day to day trench of what you do, you have to learn and apply the new knowledge. The level of intellectual investment is similar. You have to know your business or you will get behind, trashed, sued, investigated, or fired.

    CME mandates require that doctors continue their education. They have to learn new and pertinent ideas. Allowing people to pick the CME that they do will generally lead to people going to conferences or performing learning tasks that they embrace, and therefore ingest the knowledge.

    MOC on the other hand, mandates that everyone sip from the same cup of specious factoids, much of which DOESN’T guarantee anything other than the person who passes is good at memorizing gratuitous details. We all knew someone in residency who could score a 99% on the ITE yet who couldn’t successfully care for a patient under any circumstance. MOC will facilitate those people. Those people will score wonderful scores and recertify with impunity. But that doctor who has clinical instincts, knows his business, yet works 85 hours a week and hasn’t really the time to sweat over MOC – that doctor may not pass, may not recertify.

    So I propose that residencies look to pass those who can always grasp both the relevant knowledge and have the desire to continue to learn and to not pass those they know will never be lifelong learners. Having spent half my career in academia, I can tell you – we know who those people are. Doctors need to do CME because the medical world is always changing. But they don’t need to recertify – because we know how to learn, we know how to get that new relevant knowledge, and we know that if we get behind, we will be found out.

  24. says

    Ndcendo: And that is one of the main points. All these things cost so much money. Clearly someone is profiting from all of this. And doctors do not have much choice or we will lose our board certified status and hospital privileges and insurance contracts. We have to pay these big bucks to someone….and it is money we spend we don’t agree with and we don’t see any positive outcomes being derived from it.
    There is no one overseeing the medical boards. They pretty much have free reign to do whatever they want. Perhaps, the boards are the ones that should be undergoing the scrutiny.

  25. lisasermo says

    A remarkable discussion that shows the variety of issues for MOCs, I’m sure most lay people don’t realize that MOCs are different that state credentials … thank you for contributing this post Dr. Linda.

  26. says

    Thank you Lisa!
    And thank you sermo for being the place that gets doctors’ voices heard. For too long, doctors have been isolated and struggling with these kinds of issues on are own. But, thanks to sermo, we no longer have to do that!

  27. Diane says

    I have refused to recertify. Period.
    Those tests have little bearing on the quality of a physician.
    I read, attend conferences, pursue continuing medical education, learn from colleagues…and simply try to be a good doctor.

    Feh! on recertification

    • says

      Diane: I have the same approach. Many physicians as employees conclude that they have no choice and are mandated to recertify by their employer. I assume you are independent. I am.

  28. says

    The amount of time I waste studying and taking this utterly useless exam angers and offends me. There is absolutely no evidence that this improves anything about patient care. I already have very little time to devote to family life and this robs me of even more. MOC does nothing to improve quality of care and it ironically will most assuredly impair my ability to properly care for patients b/c of the added burden of paperwork and time away to study and take the exam. MOC is all about Money and the acquisition of power by a bunch of bureaucrats who have clearly forgotten that they represent us but instead choose to side with the testing and test prep companies. I see this as nothing more that a giant bureaucracy (ABIM) trying to justify it’s existence.

    It is time for some civil disobedience. Physicians simply need to Say NO to intrusive testing, and an abusive bureaucracy

  29. says

    Has anyone looked into the American Board of Physician Specialties (ABPS) as an alternative, seemingly much less toxic/onerous, more physician friendly board certifying organization ? I understand they don’t have the numbers or the clout of the ABMS or the AOA, but if we get the #’s to shift toward the ABPS maybe we could make an impact on all of this madness.

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