Another Letter to Another Psychiatrist About the MOC

Dear Doctor,

I write a blog, The Practical Psychosomaticist, which devotes a lot of space to my support of lifelong learning and opposition to Maintenance of Certification (MOC) and Maintenance of Licensure (MOL). Two colleagues and I have just launched an online journal club called Psychiatry Online Lifelong Learning (POLL) on LinkedIn, in case you’re interested.

I’m also in touch with the Iowa Board of Medicine of Medicine (IBM) regarding MOL. Many members of the IBM oppose MOL, yet they are still pursuing MOL implementation projects. The Director of IBM hinted that, now that there is a new Federation of State Medical Boards (FSMB) chair, the momentum for MOL might diminish. I’ll believe it when I see it.

I proposed a resolution to support lifelong learning and oppose Maintenance of Licensure (MOL, a move to tie medical licensure to participation in MOC, essentially) this spring at the Iowa Medical Society (IMS) House of Delegates meeting, and it was adopted. It was co-sponsored by the Iowa Psychiatric Society (IPS).

The IMS Executive Vice President sent me a message recently saying “We respect and applaud your advocacy…” The IMS assures me that they are watching the MOL issue closely and will encourage the membership to complete the licensee survey on MOL, a critical step in the implementation pilot projects Iowa has chosen to undertake in partnership with the FSMB. We hope the survey will include questions about whether or not licensees favor MOL in Iowa.

Further, at my urging, IPS just yesterday delivered a mass email message to the membership regarding my concerns about MOL. The President of IPS has told me that he and IPS leadership support my advocacy on this issue.

Academic psychiatrists are in a politically sensitive position. I think program directors would rather present a neutral stance on MOC to ACGME accreditation review committees rather than engage in an open discussion about the relative merits (?) and flaws of MOC. MOC continues to spread with the promulgation of the Milestone Project, a checkbox documentation scheme closely resembling MOC, probably because one of the key members of the Milestone Project Advisory Committee is the CEO of the American Board of Psychiatry and Neurology (ABPN).

This is a politically complex environment in which to challenge MOC and MOL, and I’m sure it’s equally difficult in your practice setting.

Even more frustrating is the tendency for major physician organizations like the AMA to ignore the views of thousands of physicians about this. Only lately has the AMA agreed to study the impact of the MOC on doctors. However, one of the lead attorneys fighting the federal lawsuit filed by the AAPS against the ABMS about MOC has represented the AMA.

The APA has been silent, as I’m sure you know.

What is so ironic for me as a consulting psychiatrist is my recent discovery that the Joint Commission-driven Ongoing Profession Practice Evaluation (OPPE), another regulatory layer, is not applicable to me because the metrics for assessing physicians are geared toward those who staff inpatient units or outpatient clinics. General hospital psychiatric consultants, who are between the devil and the deep blue sea, seemingly are left with few alternatives for demonstrating their eligibility to retain hospital privileges—other than the MOC. This was the answer to my question about this at a meeting just a week ago.

Like many other physicians who are like-minded in their questioning of the validity of MOC processes, I think we need to present a unified voice. I think part of the reason we’re in this mess is because we tend to suffer in silence and simply believe what we’re told about the public demanding all of these extra regulatory burdens.

I’m doing what I can in Iowa. The IMS President’s message in a recent issue of Iowa Medicine passed along quotes from IMS members which were in the form of advice to medical students.

One of them was an exhortation to embrace lifelong learning. Another was “Lead change; don’t resist it.”

I think if individual psychiatrists work through their branch medical and psychiatric societies, we may be able to lead change. I’m not so sure we can do that without resisting as well. The APA, the AMA, and our patients need to hear from us.

If we don’t speak, how can they listen?

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