Letter to Fellow Psychiatrists about MOC and MOL

I am as frustrated as you are about MOC and MOL. I wonder if mass noncompliance will be the way younger physicians go in the future. And I wonder if that’s what it will take to make the boards pay attention.

I have been a staunch supporter of the principle of lifelong learning and opposed to Maintenance of Certification (MOC) and Maintenance of Licensure (MOL) for a number of years. You can check my views on my blog site, https://thepracticalpsychosomaticist.com/

The recent ABIM petition opposing MOC shows that nearly 10,000 have signed it. The number of signatures on my petition opposing MOL in Iowa creeps along, but shows a fundamentally similar objection to non-evidence-based processes which burden doctors.

Few physicians will give up their certification. I’m in academia and don’t have the option of simply quitting MOC. I just took the recertification exam for Psychosomatic Medicine only days ago. In a few short years, I’ll apply for the general Psychiatry recertification exam. After that, I’ll probably retire. But until then, I plan to oppose MOC and MOL because I care about the burden it will oppose on newly minted doctors.  And I care about the risk of exacerbating the shortage of physicians they’ll incur by deterring undergraduates from even considering medicine as a career.

I wonder what effect petitions and letter-writing campaigns will have on the boards. Because there is no higher court above the American Board of Medical Specialties (ABMS), it’s doubtful that appealing to them to rescind all current MOC and MOL processes will lead to a reduction in their drive to promulgate activities that are neither relevant to our practices nor proven to change outcomes.

I supported the campaign of Dr. Renee Binder for President-Elect of the American Psychiatric Association (APA) and, as you may know, she won. It remains to be seen whether she’ll have an impact on APA policies and culture which tends to support MOC and MOL.

I have led the opposition to MOL in Iowa, which resulted in the adoption of a resolution opposing MOL by the Iowa Medical Society House of Delegates in April 2013. I continue to oppose MOL by indicating on the ironically named Iowa Physician Acceptability Survey that MOL is not right for Iowans because it will likely lead to greater difficulty in recruiting physicians to this already underserved area.

I’ve also volunteered to take part in a telephone interview with the Federation of State Medical Boards (FSMB) committee promoting MOL in order to express my opposition to it. It’s unlikely that opponents will be selected.

I have contacted my state congressmen urging them to consider legislation to oppose MOL in Iowa.

I have preferred direct action whenever I can to promote the principle of lifelong learning and to demonstrate that physicians need to change from the inside out rather than tolerate empty, wasteful busywork foisted upon them by boards which are little more than corporations selling tests.

In my opinion, opposing MOL is a hill physicians could take because it is the prerogative of state medical boards to implement MOL. This cannot be forced on them by the FSMB. Ohio physician leaders soundly defeated MOL, demonstrating victories can be attained at the state level. As far as I can tell, Colorado is the only state amongst the 11 claimed by the FSMB to support MOL implementation.

MOC has threaded its way into the lives of rank-and-file doctors by way of the Affordable Care Act in the form of the Centers for Medicare and Medicaid Services (CMS) incentives and penalties (read “carrot and stick”) reimbursement policies in the form of the MOC:Physician Quality Reporting System or MOC:PQRS. It has been adopted as a selection criterion by hospital accreditation committees, third party payor insurance panels, and the Joint Commission.

I nearly didn’t renew my membership in the American Medical Association (AMA) and the APA last year because they don’t seem to represent physicians on the MOC and MOL issues. I was persuaded to renew the APA membership by the President of the Iowa Psychiatric Society, Dr. Dan Gillette, MD, who signed my petition to support lifelong learning and oppose MOL in Iowa. I’m undecided on whether I’ll renew again next year.

I wonder what would be the best way for physicians to demonstrate our integrity in the struggle against MOC and MOL. I’m reminded of the sideshow in the news about the Los Angeles Clippers basketball team owner’s alleged racist statements and the suggestion that players boycott the upcoming game in order to show their integrity to the principle that racial bigotry not be tolerated. The NAACP has been called upon to show integrity by not giving the owner a lifetime achievement award, which incredibly, they apparently planned to do.

Is there an analogy about our own integrity in the debate about MOC and MOL? Can we boycott these processes, as many have suggested, and maintain both our integrity to the principle of evidence-based practice and to the Hippocratic Oath as well? And are the boards relying on our internal conflict to stifle our resistance? What would be the best way for our representative national organizations to demonstrate their integrity to the principles in question?

I wish I were in a position to do more than raise rhetorical questions. Presently, all I know is that it would feel wrong to me to stop resisting MOC and MOL, which I believe are not ultimately going to improve patient outcomes. A recent study seemed to show how difficult it is to show that MOC can do that (Galliher, J. M., B. K. Manning, et al. 2014. “Do Professional Development Programs for Maintenance of Certification MOC Affect Quality of Patient Care?” The Journal of the American Board of Family Medicine 271: 19-25. See link http://www.jabfm.org/content/27/1/19.long ).

Let me know if you have any other ideas about how to preserve the integrity of our profession.





  1. Donna Lohmann says:

    Totally agree. My MOC runs out in 2020 and I will not recert (I do at least 50 CMEs per year of category 1 and will not stop doing that). I will be close to retirement by then and since I am now in private practice I am not mandated to be board certified. The hoops seem pointless (which of my patients will honestly rate me? At my old non-profit HMO I always had high scores and I will continue to strive to do my best work). I’ll do all the PIP, lifelong learning etc but not the rest. Sigh.

    Liked by 1 person

%d bloggers like this: