Keep Those Cards and Letters Coming on MOC and MOL

The messages which are forwarded to me from psychiatrists who are critical of the Maintenance of Certification (MOC) and Maintenance of Licensure (MOL) processes seem to be increasing in number, albeit very slowly. For reasons that are unclear to me, psychiatrists appear to be more likely to turn the other cheek when it comes to the MOC and MOL and are getting to the resistance phase a bit late compared to internists, who have seen this problem coming for years and have been actively opposing it.

I usually write a letter in response to the few psychiatrists who question MOC and MOL and who always applaud the efforts of those who support the principle of lifelong learning by opposing MOC and MOL and highlighting what we already do. I just posted such a letter, and now find myself compelled to post another on its heels.

One psychiatrist asked what the positions of the American Medical Association (AMA) and the American Psychiatric Association (APA) are.

Regarding the questions raised about the position of the AMA), the best answer is an on-line article posted in June 2013, Physicians at AMA meeting rip call for maintenance of certification

The AMA is not representing my position on MOC and MOL, and I don’t plan to renew my membership in that organization next year.

In July 2013, the AMA claimed that it would investigate the burden of MOC on physicians, which was reported in the on-line American Medical News article, AMA meeting: Study to gauge impact of recertification on doctors

A progress report is supposed to be presented at the annual meeting this year. I believe that’s scheduled for June 7-11 at the Hyatt Regency in Chicago. I scanned the list of resolutions and reports which the AMA House of Delegates plan to address, which is subject to change. As of April 28, 2014, whether or not cheerleading is a sport made the cut, but the MOC study did not.

There is also a question about whether the APA represents psychiatrists on the issue of MOC and MOL. All I can say is that the new APA President-Elect, Dr. Renee Binder, MD, is the only candidate for that office who seemed to have a well-developed position on the matter.

Recall the failed referendum on the Performance in Practice (PIP) module of the MOC in the 2011 APA elections. It was critical of the American Board of Psychiatry and Neurology (ABPN) Performance in Practice (PIP) requirements currently required. 80% of the voters supported the statement.

But because only 25% of the members voted rather than the 40% needed, the referendum failed to pass. The referendum garnered a higher percentage of votes than for any of the candidates running for office.

But hang on; will Dr. Binder have an impact on an organization which, historically, has not represented the rank and file of psychiatrists on the MOC and MOL issues? The other candidate who ran for the office of APA President-Elect is on the Editorial Board of the Focus Journal of Lifelong Learning in Psychiatry. The Focus Journal is probably the best resource for CME and Self-Assessment as well as PIP credits, but it’s expensive even for APA members and there’s a plan to advertise for MOC and MOL on the horizon.

In the Fall 2013 issue, below the table of contents there is a “Call for Papers” announcement “…requesting papers for a new section of the journal that will feature original research and reviews in the following areas related to lifelong learning and quality improvement”:

Maintenance of Certification

Maintenance of Licensure


Practice and Performance Evaluation (audit and feedback)

Quality Improvement research and projects

Patient and Family Centered Outcomes research

The announcement goes on to say that the submissions for this new section should be “evidence-based, drawing upon data and outcome measures or practice guidelines.” They welcome “comprehensive reviews and case reports of successful programs.”

The submissions will be peer-reviewed and should be sent to Kristen Moeller at email address Authors should indicate in the cover letter for which topic the submission is intended. Please look at the Focus Journal guidelines for authors and reviewers if you plan to make a submission. Although I suspect the journal will slant the new MOC and MOL section towards promotion of these processes, I’m urging everyone who has skin in this game to attempt to submit articles presenting opposing views. I strongly suggest they be well-researched, data-driven, and balanced.

Good luck, Dr. Binder.

I don’t think the APA represents my views either, and I don’t plan to renew my APA membership next year.

One group of physicians who are taking a stand against MOC and MOL are promoting a survey for patients on their website, which I’m tweeting below:

Furthermore, how can more than 10,000 people be ignored in the recently launched petition to the American Board of Internal Medicine (ABIM) opposing changes to MOC? But ignoring physicians about their views on this topic is the order of the day, as we can clearly see in this recent article below,

I would not bet against over 10,000 petition signers, who are increasingly less inclined to turn the other cheek. So keep those cards and letters coming–but I suggest we starting routing them to those who can make a meaningful difference. We could start by flooding the offices of our state and federal congressmen with those letters, calling for legislative action against MOC and MOL.





  1. K Murray Leisure MD says:

    Excellent. On target. The large petitions asking to STOP MOC might help get legislative relief perhaps for the thousands of doctors sinking or retiring early. Perhaps legislators and alternative certifying and CME institutions might join us and eventually convince the AMA Council on Medical Education to listen to the cries of its members. Meanwhile the only recourse to justice and relief from the high revenue nonprofit, tax exempt ABMS recert (MOC) testing monopoly might be the anti trust division of the US Dept of Justice. Let the honorable practices of competent, scholarly physicians and surgeons dedicated to high quality patient care, research, and independent lifelong learning not be subject to green monster guilding constraints and increasing, onerous requirements of the MOC industry. MOC requirements and their peculiar secure tests of questionable relevance and scientific accuracy are nothing but hazing shake downs which should be challenged in the courts rather than protected by intellectual property “rights”. Fortunately, the Assocn of American Physicians and Surgeons, AAPS, has listened to its members and has sued ABMS in New Jersey. Would other national medical societies join AAPS with an amicus curiae? We need the AMA to listen to its members, too, and support federal litigation. Otherwise, the billion dollar testing industry run by an unelected group of physicians and medical executives dependent upon bashing the competence of all other medical and surgical professionals will continue to grow and metastasize like a bad cancer. I fear that the unholy alliance of ABMS, CMS, health care regulators, and the American Hospital Association will destroy and kill US medicine and surgery. Under the legal disguise of patient safety and quality,they are already replacing doctors with lapsed certificates with noctors (physician assistants,nurse practitioners), pharmacists, and other less costly health care providers. MOC or Make Others Cash in gentle term could also be called Most Obnoxious Castration in more personal terms. MOC is an unjustified assault on the careers and livelihoods of mostly young and mid career doctors, academics, and medical investigators. As MOC grows, it is now affecting even old timers formerly grand fathered out of this mess. Europeans and internationals scratch their heads and ask, How did you American doctors let this MOC mess flourish in the USA, once the land of the free and home of the brave? Follow the money.


  2. Maybe we’re going about this the wrong way. Maybe letters to government organizations or professional organizations miss the point. Maybe the correct letter to write is to the NYTimes, especially significant next week, when the APA meeting will be in town. Maybe it’s time for the public to be informed in a more meaningful way.

    Liked by 1 person

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