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Maintenance of certification under fire by endocrinologists

On Jan. 1, 2014, the American Board of Internal Medicine, along with other subspecialties within the American Board of Medical Specialties, instituted increased requirements under the maintenance of certification process and those requirements have been met with contention from endocrinologists and other physicians.

Richard J. Baron, MD, MACP, president and chief executive officer of the American Board of Internal Medicine (ABIM) told Endocrine Today that these changes are just another step in the evolution of maintenance of certification (MOC), which serves as “a professionally created framework for keeping up.”

“Things change pretty rapidly in medicine, and knowing that you’re maintaining your knowledge base in a way that is professionally appropriate can be challenging,” Baron said. “An endocrinologist who is actively participating in the MOC program knows that they are acquiring skills and knowledge that makes them a better endocrinologist and that they are keeping up with the new knowledge and expectations and discipline.”

Yet experts in the field, including R. Mack Harrell, MD, FACP, FACE, ECNU, president of the American Association of Clinical Endocrinologists, believe the new requirements, which include regular completion of practice improvement modules and taking a closed-book test every 10 years, are onerous.

“Endocrinologists, and indeed all medical subspecialists, totally understand the need for lifelong learning. We’re not opposed to lifelong learning. That’s part of our DNA,” Harrell said in an interview. “What we are concerned about is the increasingly difficult, one-size-fits-all pathway that’s been created by the American Board of Internal Medicine to exclusively establish maintenance of certification as the only way of demonstrating lifelong learning.”

Richard O. Dolinar, MD, Endocrine Today columnist, agreed with Harrell and said endocrinologists are tested on a daily basis by patients and other outside forces.

Richard O. Dolinar, MD, an Endocrine Today columnist, explains why he feels the new MOC requirements are financially burdensome and take away from patient care.

Photo courtesy of Richard O. Dolinar, MD.

 

“Every day, in our office, every patient we see is a test. You don’t know what the next question is. ... Every day is a test of our clinical acumen, clinical abilities and medical judgment,” Dolinar said.

Purpose of MOC

Baron, who first took the ABIM recertification exam in 1998 and most recently in May, said he did so to ensure his knowledge was at its peak.

He said there is literature showing that many physicians overestimate their performance and would benefit from the practice improvement modules that MOC offers.

“In small practices, it’s not reliably being done that people are looking at their practice as a population, that they know how to do that and there are skills that it takes to do that,” he said. “It’s important to demonstrate that you have those skills because not everybody does.”

He said physicians, especially endocrinologists, should take pride in having board certification and maintaining it, proving to their patients that they are the best.

But Dolinar said the business of medicine does that on a daily basis.

“You have to bring a good product to the marketplace so the customers will buy it. You’re constantly looking at your practice. You’re constantly trying to improve it,” Dolinar said. “If my patients walk out of our office satisfied, with good results, that’s how you show them you are keeping up and you care.”

“I know where the weaknesses are in my practice and my office is working to correct them,” he said. “If we don’t, we are going to fall behind and other doctors are going to be taking your patients. It’s the discipline of the marketplace.”

The Endocrine Society hosted two sessions regarding MOC during their annual meeting and, after meeting with ABIM in July, issued a call for a suspension of the new MOC requirements until the impact and unintended consequences of the changes can be independently examined.