AMA on MOC and MOL and More Letters of the Alphabet

So far, my letter requesting that the American Medical Association uphold the importance of lifelong learning and oppose Maintenance of Certification (MOC) and Maintenance of Licensure (MOL) to the AMA House of Delegates (AMA HOD) had been forwarded to in the AMA Council on Medical Education because that office deals with the issues I’m raising. My guess was that I’d be referred to Report 4 the AMA 2013 Annual Meeting update on MOC, Osteopathic Continuous Certification (OCC) and MOL,

I had already sent an email message to the contact in the AMA Council on Medical Education, informing her that I’ve read Report 4 and of what I’ve learned so far about the Federation of State Medical Boards (see post “Update on the Senate Investigation of the FSMB” published August 7, 2013). By the way, if you’re planning to send the form letter asking the AMA to oppose MOC and MOL, you need to send it to

The American Psychiatric Association has not replied yet.

In fact, I’m pleased to report that Sue replied to my message very quickly, assuring me that the AMA has been monitoring the MOC and MOL issues and reporting annually to the AMA HOD. The AMA Medical Council also meets regularly with the American Board of Medical Specialties (ABMS) and the FSMB to discuss how important it is to make sure there is an evidence base to support MOC and MOL. Unfortunately my comments won’t be shared with the AMA HOD until the next annual meeting in 2014–evidently not at the interim meeting in November 2013 in Maryland.

Sue also clarified that the Council on Medical Education provides only policy making support to the HOD–it doesn’t submit resolutions, which have to be submitted by delegates.

So why was I shifted from the HOD to the Council on Medical Education? Oh well. Sue said she’d get back to me.

Anyway, let’s have a look at Report 4. The report is long, but I invite you to at least scan most of the sections. It may help us realize that the AMA is at least examining the concepts of MOC and MOL. Report 4 seems to say that the AMA supports the ideas of ensuring that the MOC and MOL processes don’t unduly burden physicians or threaten to reduce the physician workforce (I’ve removed line numbers and some other non-essential words to make for easier reading):

CME Rep. 4-A-13 — page 9 of 35



The Council on Medical Education recommends that the following recommendations be adopted in lieu of Resolution 917-I-12, and that the remainder of the report be filed.

1. That our American Medical Association (AMA) Reaffirm Policy H-275.923, Maintenance of Certification/Maintenance of Licensure, to reinforce that our AMA encourages rigorous evaluation of the impact on physicians of future proposed changes to the MOC and MOL 8 processes including cost, staffing, and time. (Reaffirm HOD Policy)

2. That our AMA Reaffirm Policy H-275.924, Maintenance of Certification, to reinforce that any changes in the MOC process should not result in significantly increased cost or burden to physician participants (such as systems that mandate continuous documentation or require annual milestones). (Reaffirm HOD Policy)

3. That our AMA Rescind Policy D-275.960 (2), An Update on Maintenance of Certification, Osteopathic Continuous Certification, and Maintenance of Licensure, since that has been accomplished through this report. (Rescind HOD Policy)

4. That our AMA will continue to monitor the evolution of Maintenance of Certification (MOC), Osteopathic Continuous Certification (OCC), and Maintenance of Licensure (MOL), continue its active engagement in the discussions regarding their implementation, and report back to the House of Delegates on these issues.

5. That our AMA will 1) work with the American Board of Medical Specialties (ABMS) and ABMS specialty boards to continue to examine the evidence supporting the value of specialty board certification and MOC and to determine the continued need for the mandatory high- stakes examination; and 2) work with the ABMS to explore alternatives to the mandatory high- stakes examination.

6. That our AMA encourage the ABMS to ensure that all ABMS specialty boards provide full transparency related to the costs of preparing, administering, scoring, and reporting MOC and certifying/recertifying examinations and ensure that MOC and certifying/recertifying examinations do not result in significant financial gain to the ABMS specialty boards.

7. That our AMA work with the ABMS to lessen the burden of MOC on physicians with multiple board certifications, in particular to ensure that MOC is specifically relevant to the physician’s current practice.

8. That our AMA solicit an independent entity to commission and pay for a study to evaluate the impact that MOL and MOC requirements have on physicians’ practices, including but not limited to: physician workforce, physicians’ practice costs, patient outcomes, patient safety and patient access. Such study will look at the examination processes of the ABMS, the American Osteopathic Association, and the Federation of State Medical Boards. Such study is to be presented to the AMA HOD, for deliberation and consideration before any entity, agency, board or governmental body requires physicians to sit for MOL licensure examinations. Progress report is to be presented at Annual 2014; complete report by Annual 2015.

That our AMA 1) support ongoing ABMS specialty board efforts to allow other physician educational and quality improvement activities to count for MOC; 2) support specialty board activities in facilitating the use of MOC quality improvement activities to count for other accountability requirements or programs such as pay for quality/performance or PQRS reimbursement; 3) encourage the ABMS specialty boards to enhance the consistency of such programs across all boards; and 4) work with specialty societies and specialty boards to develop tools and services that facilitate the physician’s ability to meet MOC requirements. 

Of course, the report stops short of resolving that the AMA support a national effort to oppose MOC and MOL. In some places, it also seems to indicate that, either the AMA is not aware of the lack of interest in the MOL pilot projects in several states, or that our state medical boards are not being “above board” with us about them:

Pilot Projects

The FSMB is currently engaged in a series of pilot projects, in collaboration with the ABMS and NBME, to advance understanding of the process, structure and resources necessary to develop an effective and comprehensive MOL system. Nine state medical boards are participating in pilot projects: Osteopathic Medical Board of California, Colorado Medical Board, Delaware Board of Medical Practice, Iowa Board of Medicine, Massachusetts Board of Registration in Medicine, Mississippi State Board of Medical Licensure, Oregon Medical Board, Virginia Board of Medicine, and Wisconsin Medical Examining Board.

The first pilot project, a State Readiness Inventory survey, was distributed to participating pilot state medical boards in October 2012. The pilot consisted of an electronic survey designed to facilitate discussion of implementation of MOL and to identify issues state boards need to consider and possibly resolve to ensure successful implementation of MOL. The survey results are currently being collated and analyzed. The second pilot to be implemented will be a Physician Acceptability Survey to collect opinions from licensed physicians about the potential features of a comprehensive MOL system. Additional pilots will be undertaken throughout 2013.

I have searched the on-line board meeting minutes and the web pages of the state medical societies and found rampant apathy about the pilot projects, or at least that’s what they want us to think:

I Know What You Don’t Want – The Practical Psychosomaticist

Roll Call for MOL? – The Practical Psychosomaticist

Wisconsin Not On Board with Federation of State Medical Boards MOL? – The Practical Psychosomaticist

All of this makes me wonder why my Iowa Board of Medicine (IBM) representatives are working so hard to schedule and reschedule telephone conferences with me to discuss my opposition to MOL in my state.  The IBM has been posting its involvement with the Federation of State Medical Boards (FSMB) for quite some time now about MOL, .

By the way, the board and I rescheduled for August 30, 2013. How likely is it that the IBM is really going to listen to one geezer psychiatrist about his support of the principle for lifelong learning and opposition to MOC and MOL? I guess that makes me sound suspicious; but I’ve got to hand it to them, they’ve been persistent about giving me a chance for a fair hearing.

The likelihood that the AMA HOD will support a resolution opposing MOC and MOL at the November 2013 interim meeting in Maryland is probably nil and probably low in 2014.

But I’m a geezer and I’m not giving up.  I’ll keep my red pants pressed, just in case. What if thousands registered opposition to MOC and MOL instead of just one or two?

There’s a form letter available at a link on my home page. It has the old-fashioned stamped envelope icon. Or if you prefer, use the shortlink

You know, I recently got my copy the july/August 2013 issue of Iowa Medicine, Journal of the Iowa Medical Society.  The President of the Iowa Medical Society, Dr. Victoria Sharp, MD, wrote an article entitled “Advice to Medical Students: Believe in Yourself”. In it she announced that this issue is the first to be distributed to all medical students in the state of Iowa. Dr. Sharp asked physicians from different specialties and backgrounds to give one piece of advice to the graduating class of 2013. Her own advice–“Believe in yourself.”A few of the others are also pertinent in our life and times:

“Commit to lifelong learning.”

“Lead change; don’t resist it.”

“Always be involved in the profession of medicine. Don’t let others make the rules that affect you and your patients. Make your voice heard.”

“Don’t lose sight of your purpose: to relieve the suffering of those for whom you care.”

“Place yourself in your patient’s shoes so you can understand his/her perspective.”

I think we have the right to ask our non-profit boards and large organizations which represent us to walk a mile in our shoes as well.

Related post to explain the red pants bit: AMA HOD Resolution to Oppose MOC and MOL for the Red Pants Revolution? – The Practical Psychosomaticist.

“…And we must build a culture of humanistic clinical excellence.”—Jamos the Elder
“…And we must build a culture of humanistic clinical excellence.”—Jamos the Elder