Update on Linkedin APA Discussion on MOC and MOL

Dr. Jim Amos, MDBelow is one of my comments (edited to preserve anonymity of some others who participated) in a recent LinkedIn discussion about Maintenance of Certification (MOC) and Maintenance of Licensure (MOL) as an issue for American Psychiatric Association (APA) candidates in the upcoming 2014 elections.

“I want to reiterate my support of the principle of lifelong learning. I think one comment, “I will never stop reading and learning,” echoes what many of us feel.

Another physician’s observation that political rhetoric may be distracting all of us from the goal of developing a better vision for what lifelong learning should entail in a theoretical and practical sense also is an inspirational note.

I wonder how many APA candidates are actually participating in the MOC and whether they hold time-limited or time-unlimited certificates. Very few physicians with time-unlimited certificates participate according to the article which was recently under discussion on our new online journal club, Psychiatry Online Lifelong Learning (POLL), the link to which is the lead-in to this discussion.

Are the leaders of APA asking themselves why that is so? If you view the number of state medical societies who’ve passed resolutions opposing MOC and MOL at (right click following links to open in new tab) http://www.changeboardrecert.com/mol.html  and https://thepracticalpsychosomaticist.com/2013/05/07/roll-call-for-mol/ you have to wonder why candidates would support these processes at all.

It’s ironic that many of the states which were supposed to be “early adopters” of the MOL implementation pilot projects actually passed resolutions opposing MOL.

I participate in MOC. I have personally solicited patient and peer feedback and I find it both distasteful and ineffective for motivating me to change my practice. Most of my colleagues and I really don’t know how to provide meaningful feedback. I don’t think a social worker is my peer, yet the ABPN thinks that should be the case. Most of my patients are delirious or angry that they’ve been detained by court order because I’ve persuaded a magistrate that they pose a threat to themselves or others. The ABPN doesn’t want the actual feedback forms because of confidentiality concerns; they just want you to click a button on your Folio web page to indicate you’ve collected it.

I wonder how it would feel to be audited at board exam time. Dr. Renne Binder (one of the current candidates for APA President-Elect) shared that it was anxiety-provoking and I suspect this was probably an understatement. How would the ABPN audit patient feedback? Many physicians have endured the high-stakes board exam process and some have vowed never to endure it again.

Just because the MOC is mentioned in ACA law in the context of payment incentive from CMS doesn’t make it right or practical. A colleague in Ohio was able to collect data via the Freedom of Information Act about actual participation rates in the PQRI incentive—and it was low. Do the candidates think CMS penalties for psychiatrists who choose not to participate in MOC starting in 2014 is fair?

I’m a clinician teacher in an academic medical center. Our department is now struggling to integrate the new Psychiatry ACGME Milestone Project into our resident evaluation system. I’m sure those who’ve looked at it can see that it bears the unmistakable stamp of the MOC. That’s partly because one of the members of the advisory committee is the CEO of the ABPN.

As a consulting psychiatrist, I’m invisible to my hospital’s Ongoing Professional Practice Evaluation (OPPE), which is yet another regulatory layer from the Joint Commission critical for maintaining hospital privileges. I’m invisible simply because the metrics chosen to assess physicians don’t apply to me—but my participation in MOC might be an acceptable alternative.

How ironic is that?”

Medal of Irony

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