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Maintenance of Certification or Maintenance of Cash: A call to check the checkers

Maintenance of Certification, known as MOC, has riled up the entire physician community. More than 15,000 physicians have already signed a petition against it.

Many fear that MOC, with all of its demands and requirements, will put them on a perpetual treadmill that will consume exorbitant amounts of time and money. Many who have gone through MOC realized little value from it and do not plan to do it again.

Missing evidence

In a time of “evidence-based medicine,” where is the evidence to support putting physicians through such an onerous process? Where is the evidence that recertification even matters?

Ironically, the strongest advocate of evidence-based medicine, the American Board of Medical Specialties (ABMS), has none for this MOC scheme that it has forced on physicians. But it does have a disclaimer stating that board certification does not guarantee “performance or positive outcomes.” Conversely, there is no evidence indicating that physicians who are not board certified provide worse care than those who are certified.

Richard O. Dolinar, MD

Richard O. Dolinar

So whom does MOC help? The physician? The patient? Or someone else?

And doesn’t continuing medical education accomplish the goal of keeping physicians current in their medical knowledge? The annual meetings of the American Association of Clinical Endocrinologists have physicians attending not only from all over the United States but also from all over the world. Each year, attendance records are broken. Physicians are so eager to participate in the learning that even the 6 a.m. sessions are packed. Is the competency of physicians so poor that they need to be saddled with another layer of regulatory requirements involving MOC?

Data from Ohio argue otherwise. Lack of competency is an extremely rare problem in licensing actions there. In 2011, it was the cause of action for only one of the 42,000 practicing physicians in the state.

Opposing viewpoints

Meanwhile, what is being done about MOC? Some have decided not to do it and just vote with their feet. Others have become active on websites opposing MOC. The most active website is that of the Association of American Physicians and Surgeons (AAPS), Also, and have been very active.

The American Medical Association House of Delegates wants an impact study of MOC on patient outcomes and voted to oppose MOC as a condition of licensure. Medical societies have initiated dialogues with ABMS and the American Board of Internal Medicine (ABIM). Surveys show that most physicians oppose MOC. But with millions of dollars involved, the leaders of some of these societies may be tempted to find enough common ground with the Boards to get in bed with them and share in some of the revenue generated, despite the objections of their members. Of course, the Boards may not be willing to share.

On the legislative side, the American Legislative Exchange Council has proposed model state legislation that, if passed by the individual states, would prohibit MOC as a condition of medical licensure. It would also prohibit state medical boards and any facilities accepting state funding (such as hospitals) from discriminating against physicians who do not participate in MOC. CME would suffice to demonstrate professional competency.

Legal action underway

It is in the courts where the real action is. On April 23, 2013, AAPS filed a lawsuit claiming ABMS is in violation of Section 1 of the Sherman Antitrust Act and is misrepresenting its proprietary recertification program and thereby reducing patient access to physicians.

AAPS alleges that MOC is “a money making … scheme that reduces the supply of hospital physicians and decreases the time physicians have available for patients.” The lawsuit goes on to accuse ABMS of enriching itself, its executives and coconspirators by “promoting falsehoods that its proprietary product is somehow indicative of the professional skills of a physician, when it is not.”