For the past many months, doctors cried out against the Maintenance of Certification (or MOC) process. Under the MOC program, required courses and modules need to be completed in order for a physician to remain “board-certified” by their specialty board.
These requirements differ for each specialty. In general, doctors find the whole MOC process to be expensive, time-consuming with no added value and no proven benefit, either to the life-long learning of physicians or for improved patient clinical outcomes.
Perhaps, the whole MOC concept is a at time when it should be ended.
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Life-long learning is very important for physicians and I doubt anyone would argue with that. Medicine constantly evolves and new technologies and innovations roll out at amazing speeds. As doctors, we are the first to admit that it is hard to keep up with these rapid-fire medical changes and we need to be constantly studying.
However, the point at which the vast majority of physicians differ from the ABMS (American Board of Medical Specialties) is how this task is carried out.
Not only do we disagree with the whole flawed process itself, we are offended by the corruption of the leaders of these boards who enforce the process on us, their colleagues, for their own profit. While for the most part, individual physicians and small groups led the charge on the anti-MOC front.
Medical associations are now adding their voices to the growing criticisms.
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The American Association of Clinical Endocrinologists issued a position paper regarding life-long learning. They are clearly in favor of life-long learning and CME (continuing medical education). They support initial board certification after the completion of an endocrinology training program.
The AACE goes so far as to say they believe the MOC process is damaging: “……… believes that ABIM MOC requirements place an undue burden of time and energy on the practicing physician, taking the physician away from patient care, in pursuit of an activity with no proven benefit to physician or patient. AACE strongly discourages connecting ABIM MOC with hospital privileges, maintenance of licensure or insurance credentialing.” 1
On August 25, 2015, the American College of Rheumatology joined the ranks of those opposing MOC by issuing their position statement. This statement was formulated with the feedback of approximately 1,100 rheumatologists. The statement holds 7 key positions:
1. As it stands, MOC does not meet the educational needs of rheumatologists.
2. The ABIM should eliminate certain parts of the MOC process because they are redundant with other program requirements.
3. The closed book exam should also be eliminated.
4. The ABIM should fund an external, independent review to evaluate all aspects of their program and commit to revising this program if it fails to demonstrate patient benefit.
5. It emphasizes the redundancy of being required to complete both MOC and CME credits.
6. It calls on the need to reduce the costs of the MOC program.
7. It asks the ABIM to provide evidence that it improves the education of physicians. 2
These key points echo the problems that many of us voiced over the past year. Unfortunately, our calls to reason fell on deaf ears and the ABMS and its leaders continue to profit off the exploitation of doctors forced to comply in order to keep our profession.
Without board-certification, we are disallowed from holding privileges at many hospitals and being contracted with many insurance companies. If we want to practice medicine, we pretty much must obey anything the ABMS tells us to do and pay any money they ask.
They have monopolized our careers for their own financial gains.
They failed to provide evidence that MOC offers value to either patients or doctors.
We have called them out and they ignored us, chastized us, blocked us from asking questions on their social media pages, and tried to silence us.
But, our associations are now listening. We have reached the summit. And the MOC mountain is now crumbling. Isn’t it time that doctors on the front-lines be asked to define what we need for life-long education and how we can give evidence-based quality medical care to our patients?
1- https://www.aace.com/files/position-statements/lifelong-learning-moc.pdf
2- http://www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/673/American-College-of-Rheumatology-Issues-Physician-Driven-Position-Statement-on-ABIMs-Maintenance-of-Certification-Requirements
