Maintenance of Licensure and Certification for Physicians and the PIP Requirement

I received an email recently about the failure of the recent American Psychiatric Association (APA) election referendum to pass which was critical of the American Board of Psychiatry’s Maintenance of Certification Performance in Practice requirements (ABPN MOC PIP) currently required by the American Board of Psychiatry and Neurology (ABPN) specialty board. 80% of the voters supported the statement but because only 25% of the members voted rather than the 40% needed, the referendum failed to pass. The referendum garnered a higher percentage of votes than any of the candidates running for office. The author of the referendum is not done yet and will request support for formation of a Member Caucus on Certification and MOC issues.

I blogged about this issue in January,
see link

Many APA members are concerned about the MOC requirements, especially the PIP requirement as well as the high cost ($3,000) of the knowledge assessment examination. They are viewed as burdensome. An excerpt from my blog describes part of the process:

“The sticking point is the last one, Performance in Practice
(PIP). In the Chart Review module, the diplomate must collect data from at
least 5 patient cases in a specific category (for example, diagnosis, type of
treatment, treatment setting) from his or her personal practice over a 3-year
period. Then the data must be compared with published best practices or
peer-based standards (such as hospital quality improvement programs) leading to
the development of a plan to improve effectiveness or efficiency. Then within
24 months, the diplomate must collect the same data again from at least 5
clinical cases, either the same clinical cases previously assessed or new ones.
Obviously this has to be done 3 times over the course of 10 years.

The Feedback module of the PIP requires the diplomate to solicit
personal performance feedback from at least 5 patients and at least 5 peers
(which can include psychologists, social workers, physicians, counselors, and
nurses) regarding the diplomate‘s clinical performance over the previous 3
years. Then the diplomate must develop a self-improvement action plan to
correct inefficiencies and improve effectiveness. Again, within 24 months, the
diplomate must obtain feedback from another 5 patients and peers to see if
performance has improved. The patients and peers could be the same ones
originally solicited. Again, this has to be done 3 times over a 10 year period.”

We’ve been completing physician feedback forms for years but I’ve never
seen any feedback from my colleagues. Implementing the PIP is easier said than

The issue will become more complicated as states work toward
implementing the maintenance of state medical licensure. This relicensure
process will also require an examination, a reflective self-assessment
involving completion of a certain number of continuing medical education (CME)
courses, and—Performance in Practice (PIP) measures. It sounds like doubling
the work of physicians to maintain both their state medical and specialty license
and certifications although the president of the American Board of Medical
Specialties assures us that will not be the case. See the original article in
Clinical Psychiatry News, link

These changes will take about 10 years to implement. What this means for health care consumers is that their physicians are actively working on increasing the quality of health care.

What this means for physicians is that we’ll need to craft a more practical way to both provide high quality health care for our patients and stay on top of the latest research providing the evidence base allowing us to do that while finding a relatively painless way of showing licensing and certification boards we’re doing so.

Until we can do both, there will be challenges from physicians about the practicality and meaning of PIP measures to maintain licensure. Or the 10 year countdown for relicensure requirements could become another kind of countdown—to retirement.

2 thoughts on “Maintenance of Licensure and Certification for Physicians and the PIP Requirement

  1. I realize that the cost for the multiple-choice questionnaire of the MOC at about 2000$ was impossible to justify. Now throw in the PIP and perhaps a cherry wood framed certificate and we should understand why are asked to pay 3000$…….
    We are the ones that have to jump through the hoops of getting all this paperwork together that will then be reviewed and stamped by a secretary, who makes 10$ per hour.
    Besides, these additional steps do nothing to prove our extent of knowledge in the field of Psychiatry but rather show how popular we are with our collegues and patients. Chances are, my coworkers would want me to write the assessments (which they then will sign), so that they don’t have to bother.


    1. Hi Karin,

      I hear you. You know, I wonder if you’re able to attend the APA annual meeting in Hawaii next month. I posted a blog April 21, 2011 about 3 free sessions they’re holding about the MOC and PIP. I can’t go myself, but I’d sure be interested in what happens at these workshops!

      Best wishes,

      Jim Amos, MD


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