June 09, 2014
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ACP president shares concerns about ABIM's MOC requirements

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In light of a recent editorial published in the Annals of Internal Medicine criticizing the American Board of Internal Medicine’s new Maintenance of Certification requirements, Cardiology Today spoke with the president of the American College of Physicians, David Fleming, MD, MA, FACP, to better understand the concerns of ACP members.

What are some of the specific complaints you are hearing from your members?

We are hearing universal dissatisfaction with the ABIM MOC process. Our members and other physicians are telling us that MOC is unduly labor-intensive, burdensome and expensive. Those with time-unlimited certificates feel they are being significantly pressured to participate in a program that is supposed to be voluntary. There is also general concern that these requirements are being forced on diplomates without solid evidence that they actually make for better physicians [and] safer practices or ensure professional development. Given the diversity of professional activities and practices of internal medicine specialists and subspecialists, many physicians feel that they are being tested on material that has little relevance to their practice, yet not being tested on the information they really need to know. Others find that, given the size and/or nature of their practice, it is impossible to fulfill some of the requirements. Finally, internists report that MOC as currently structured is not a learning experience, nor does it lead to better patient care.

What steps does ACP hope ABIM will take, and what alternate strategies does ACP support?

First, the ABIM needs to recognize that there is a problem with the way the MOC process is being deployed. Unless significant changes are made, we fear that the pushback from the physician community undermines the process and potentially even threatens the attractiveness of internal medicine as a profession. There is widespread acceptance and recognition that physician competence needs to be maintained and that certification does have value. It's good for our profession and good for our patients. However, the mechanism to do that needs to be revamped and made relevant to what we actually do in our practices.

At this point, we believe it is critical for ABIM, ACP and the internal medicine subspecialty societies to work together to: a) examine the models for MOC that are used by other American Board of Medical Specialties (ABMS) to look for “best practices”; and b) explore a variety of alternatives that have been proposed by ACP and others about all current components of the MOC process, particularly the secure examination and the assessment of practice performance.

What are your other concerns?

Many internists who would otherwise not yet be planning to retire have stated that they may be driven away from practice because of the time commitment, the burdensome process, the economic impact and fear of the secure recertification exam. The fact that the pass rate on the secure examination for first-time takers has dropped from 92% to 78% over the past 5 years only adds to the concern and the likelihood of early retirement.

All specialty organizations and boards are dealing with the challenges of MOC in one fashion or another, and the level of dissatisfaction across most medical specialties is unprecedented. The House of Medicine now appears to be responding with a unified voice, and the concerns are starting to be heard by the ABMS and its 24-member boards. There is hope that a true collaborative effort between the societies and the boards will be successful in revamping MOC, and that both our profession and our patients will be better for it. I believe it is critical for all of us.

For more information:

Centor RM. Ann Intern Med. 2014; doi:10.7326/M14-1014.

Disclosure: Fleming reports no relevant financial disclosures.