Last week in medscape, there was an article about doctors protesting the new rules of the ABIM MOC requirement process. Many doctors feel that the MOC process is an added expense without doing what it has claimed to do: maintaining the competency of doctors. Every specialty has their own MOC requirements based on the medical board of their specialty. In family medicine, we are required to do yearly modules to test our knowledge on certain subjects and modules on patient simulation cases. If we keep up with our modules, it puts us on the 10 year path where we are required to take the recertification exam every 10 years.
Two days ago, I took my recertification exam and found the process to be highly distressful. We were required to be subjected to a complete body search every time we re-entered the exam room, even if we went out for a quick bathroom break. The test was 8 hours long and the questions mostly academic and many esoteric. Few tested anything we encounter in everyday life in our practice of medicine.
Why do doctors think the MOC requirements are unfair?
1. As stated above, we do not feel like we are being tested on what is relevant to clinical medicine. We should be tested on things that are needed to be known to competently perform our medical duties.
2. We are required to pay thousands of dollars to be in the MOC process. There are some doctors who claim this is nothing more than a money-making idea for the boards.
3. We are already required to do a certain number of CME hours to maintain our medical licenses. In order to meet the number of hours required, doctors read educational materials and attend conferences. These keep us informed on the latest updates in medicine. Often, the tests are asking questions on out-dated guidelines.
4. Many states require physicians to do CME hours in certain areas. For example, in NJ, we are required to complete CME hours in cultural competency. We have many immigrants in our state. This is a great way to ensure we are keeping up on a needed area of focus. Other states have required CME hours in HIV, domestic violence, etc.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
5. The MOC modules are very time-consuming. They are not something that can be completed during a work day. We need to take several hours of personal time to complete these. And most of us feel these modules add little value in terms of practical knowledge. In essence, we are being forced to pay for educational activities that most of us feel are worthless.
6. Board certification is required to be on staff at most hospitals as well as to be contracted with most insurance plans. Some may claim that MOC/board certification is voluntary. However, we are excluded from participating in insurance plans and being able to have hospital privileges if we do not comply. Thus, we are forced to follow the MOC requirements to maintain our practice of medicine and be able to get paid for our services.
7. Many of the people who are developing the requirements are not practicing physicians. Thus, they are not qualified to assess the skill of those practicing clinically. Yet, much of the MOC process has been devised by those not practicing medicine or are even doctors.
Doctors should be evaluated on a regular basis to determine they are competent to safely treat physicians. However, most physicians feel that the MOC requirements are not the way to do it and are more a forced activity that adds to our costs with little useful benefit to us. Perhaps, CME could be better reported to serve our needs and ensure our skills. Or perhaps, physicians can be asked to devise a way their colleagues’ level of competency be determined. They are, after all, the only ones who truly know what needs to be known and done to treat patients once they step inside that exam room.
