January 07, 2019
2 min read

Majority of rheumatologists see minor value in maintenance of certification programs

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As many as 74.8% of rheumatologists reported they see no significant value in maintenance of certification programs beyond what is already gained from continuing medical education, according to survey data published in Arthritis Care & Research.

“Board certification which started as a voluntary achievement, and remains so in theory, has become involuntary in practice making participation in [maintenance of certification (MOC)] programs mandatory for many if not most physicians in order to maintain employment, clinical privileges, or reimbursement,” Amr H. Sawalha, MD, and Patrick Coit, MPH, both of the University of Michigan, wrote. “Rheumatologists have been following the controversy regarding MOC and board recertification very closely. Indeed, the American College of Rheumatology has questioned the value of [American Board of Internal Medicine (ABIM)] MOC program, and issued a statement raising concerns regarding cost of MOC, lack of evidence to support beneficial impact of MOC on clinical care, and concerns about the financial stewardship of the ABIM.”

To analyze the impact, value and purpose of maintenance of certification programs in rheumatology, Sawalha and Coit designed a 20-question survey sent via email to 3,107 rheumatologists in the United States. The survey, created using SurveyMonkey, included 19 closed-ended questions and one open-ended question designed to address rheumatologists’ perceived value and impact of maintenance of certification programs. Ten rheumatologists at the University of Michigan, who are board certified by the ABIM and participate in MOC, provided input on the survey questions.

As many as 74.8% of rheumatologists reported they see no significant value in maintenance of certification programs beyond what is already gained from continuing medical education, according to survey data.
Source: Shutterstock

The researchers sent the survey via email on March 6, 2018, with responses collected until March 26, 2018. Overall, 515 rheumatologists completed and returned the survey; Sawalha and Coit analyzed the results in the computing environment.

According to the researchers, 74.8% of respondents reported that there is no significant value in MOC programs beyond what is achieved from CME. Further, 63.5% said they did not believe such programs were valuable in improving patient care. Most respondents questioned the primary reason for creating MOC programs, with 43.4% believing it was to further the financial wellbeing of board certifying organizations, and 30% reporting it was to satisfy administrative requirements in health systems.

Despite these views, 65.6% of rheumatologists said staying current with new knowledge was a positive impact of MOC programs. However, 74.6% of respondents also perceived these programs to result in time away from patient care, with 74% reporting they take time away from family. When asked about anticipated effects of requiring maintenance of certification, 77.7% of respondents said, “physician burnout,” with 67.4% reporting “early physician retirement,” while 63.9% stated it will reduce the overall number of practicing rheumatologists.


“The medical community in general, and the rheumatology community in particular, needs to address the gradual transformation of board certification and maintenance of certification from a voluntary activity to practically a requirement for many physicians to be able to practice medicine and get reimbursed for services provided,” Sawalha and Coit wrote.

They added, “It is important to caution against lobbying activities driven by financial interests in setting health care policies, especially in mandating expensive programs such as MOC, in the absence of convincing data to demonstrate improved patient care, which could result in serious consequences in a field threatened by a large shortage in the workforce such as in rheumatology.” – by Jason Laday

Disclosure: Sawalha reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.