The Maintenance of Certification for Psychiatrists or Maybe I Don’t Need Multiple Certifications

So I have been studying the American Board of Psychiatry & Neurology (ABPN) guidelines on their recently revamped web site at The site looks like it’s still under construction in one or two places and navigation is still a little challenging.

Maintenance of Certification (MOC) is a jugular issue these days, mainly because of the Performance in Practice (PIP) Module. My latest post about this is a shortlink

I recently sent an email message to ABPN  asking a couple of questions about the Clinical Module of the PIP as follows regarding the approved PIP tool for the Assessment and Treatment of Adults at Risk for Suicide and Suicide-Related Behaviors, which is in the FOCUS Journal, spring issue [1]:

1. If I just log the tool with checkmarks in the boxes, is that sufficient? How do you know a diplomate has actually selected patients? The tool itself doesn’t have a way to document that.

2. Do you consider a completed PIP module to always contain Stages A, B, and C? What if there’s no deficiency? Can a completed PIP module be Stage A only?

Here was the prompt reply:

The tool has checkboxes for patients 1-5. Obviously one could simply check boxes and not do the exercise. We have no way to actually verify that you are using it as it is intended. We would never ask a physician for patient names or identifying information, so yes, one could cheat.

If there are no deficiencies identified, that’s great. You would do the exercise again in no more than two years anyway and check again.

You will need to submit the tool to APA in order to receive a certificate of completion and CME for the exercises.

And the representative let me know that I could suggest improvements for the tool by contacting APA directly. He also gave me the phone number for the Credentials Department, if I had further questions.

Now to get the PIP tools, you’ll have to either buy a subscription to FOCUS which starts at around $300 for one year or well over $500 for two years or buy the article itself for the suicide risk assessment PIP tool for $15. However, there are other tools available although not for every subspecialty.

I’m not implying that any physician would cheat the system. I wonder how confident the public can be about an honor system like this, though. You wouldn’t necessarily have to cheat the system to get by. All you need do is give yourself high marks every 3 years on five or more patients.

And who solicits the peer and patient feedback forms? If the diplomate does it, there is always the chance for cherry-picking. I’m unsure about how effective the system would be if we simply trust physicians to be objective about who they ask to evaluate them. And I’m not sure how many delirious patients I see who would be capable of completing a patient feedback form. And how about the patients we have to ask for a court order to hospitalize involuntarily? Are they likely to give completely unbiased evaluations?

Maybe I’m asking too many questions.

Now how about the Continuous Pathway to Lifelong Learning Program (CPLLP) and the Physician Folio? The ABPN will charge diplomates $175 to upload and store documents that track progress on collecting the data on CME, Self-Assessment, and PIP modules toward being eligible to apply for the MOC cognitive examination every 10 years.

That’s a nice service because the fee covers the cost of one MOC cognitive examination in a 10 year period. What if you have more than one certification? Well, money doesn’t grow on trees; I said it pays for only one exam, which can cost up to $1500.

Some psychiatrists might consider dropping one or more subspecialties because of the expense and the added work of the PIP modules. However, you can apply your credits, so to speak from psychiatry to another subspecialties so you really don’t have to do double work. There are no approved PIP module tools for Psychosomatic Medicine, though. I’m not sure what that means yet.

The possibility of audit by the ABPN is also a consideration. Having your data already on file through the CPLLP would be a nice way to avoid anxiety about an audit–as long as you stay up to date about uploading your data.

Those are my thoughts. What are yours?

1. Duffy, F. F., E. K. Moscicki, et al. (2011). “Performance in Practice: Physician Practice Assessment Tool for the Assessment and Treatment of Adults at Risk for Suicide and Suicide-Related Behaviors.” Focus 9(2): 171-182.