MOC is Easy?

I have some opinions (surprise!) about the “grandfathering” issue as it applies to Maintenance of Certification (MOC). I doubt I’m the only one who suspects that the exception to the requirement to participate in MOC was established, in part, to prevent a substantial number of older doctors from retiring, thereby exacerbating the physician shortage.

This highlights an interesting item regarding the upcoming American Board of Psychiatry and Neurology (ABPN) presentation on MOC at the American Psychiatric Association (APA) annual meeting in New York tomorrow from 9:00 Am to Noon on Tuesday at the Jacob K. Javits Center. The title of the presentation is “Maintenance of Certification: Why, What, and How.” I’m not going to the APA meeting, but I get ABPN mailings because I’m a diplomate and that’s how I learned about this session. This particular message carried an extra remark indicating that it was being sent to “…even those with ‘lifetime’ certificates, in case they are interested in the MOC Program.”

It’s a free session for ABPN to answer questions about the ABPN MOC requirements. If anyone is interested in going, it’s being held in Room 1E15 on Level 1 of the Jacob K. Javits Center.

The Chair of the program is Dr. Mark H. Rapaport, MD from Emory University School of Medicine in Atlanta, Georgia.  He and another presenter, Dr. Deborah Hales, MD of APA Arlington, Virginia are both on the Editorial Board of The Focus Journal of Lifelong Learning in Psychiatry, a disclosure not listed in the email notice. The reason that might be important is that Focus is a major source of MOC credit for ABPN diplomates. Focus also advertised in the Fall 2013 issue a “Call for Papers” for a new section that will feature the following areas related to lifelong learning:

  • MOC and Maintenance of Licensure (MOL)
  • Self-Assessment, Practice and Performance Evaluation
  • Quality Improvement research and projects
  • Patient and Family Centered Outcomes research

Submissions can be sent to Kristen Moeller ( I’ve encouraged anyone who has skin in the  MOC game to submit articles which could foster a more even-handed discussion of MOC and MOL regarding its flaws as well as its advantages. However, it remains to be seen whether that will actually happen.

Understand I’m not criticizing the importance of understanding what diplomates need to know about MOC and how they should meet the requirements. I’m just pointing out that the “Why” portion of the goals of this session might have content which is slanted away from encouraging debate about the scientific merits of MOC in terms of the evidence base for showing whether or not it actually improves patient outcomes.

There are currently about 13,000 signatures (a moving target because the number seems to grow by the hour) on the petition to oppose recent changes to the American Board of Internal Medicine (ABIM) MOC with plenty of comments casting doubt on the scientific merits of MOC. As most of you know by now, the ABIM leadership found it easy to say “No” to the petition signatories.

Just because my petition supporting lifelong learning and opposing MOL has what I’ll openly admit is a very low response rate, I don’t think this means necessarily that psychiatrists are enthusiastic about participating in MOC.

Let’s also remember that my resolution to oppose MOL in Iowa was unanimously adopted at the April 2013 Iowa Medical Society House of Delegates meeting and that one of the signatures on my petition to oppose MOL is that of the President of the Iowa Psychiatric Society. I was recently informed that the South Carolina Medical Association just passed a resolution to oppose MOC (see link; it starts on page 179 of pdf). These are just a couple of examples of the several states which have adopted similar resolutions.

Note that I’m not doubting that diplomates’ knowledge and skill base erode over time and I agree that doctors need to engage in some form of lifelong learning. While I am openly opposing MOC and MOL, I’m also compliant with the ABPN MOC program (I just took the Psychosomatic Medicine recertification exam). However, the MOC products available to me are often not relevant to my practice, take significant time to complete, and are far from inexpensive.

Another interesting item is that Dr. Philip Muskin, MA, MD of New York will be delivering one of the presentations, provocatively titled “I Did It and It Ain’t Rocket Science.” I have to hand it to the organizers for their panache.

Although I’m not certain about this, I think Dr. Muskin might be a lifetime certificate holder. He’s a highly respected leader in psychiatry, and one of his specialty areas is Psychosomatic Medicine. He’s a winner of the Alan Stoudemire Award for Innovation and Excellence in Psychosomatic Medicine Education. His credentials are unimpeachable and I have nothing but respect for him as an educator.

The strategic inclusion of Dr. Muskin’s talk may be intended to counter the widespread criticism of the complexity of the MOC process itself and the arbitrary exclusion of certain physicians who were certified before a specific time frame. I’m only guessing but the message could be that MOC is easy and that those who are grandfathered can and should participate. Indeed, another presentation is entitled “How the APA Can Help Make MOC Easy for You,” to be delivered by Dr. Deborah Hales, MD. Dr. Hales who, as I mentioned already, is on the editorial board of The Focus Journal for Lifelong Learning in Psychiatry, which is not free to APA members but should be in my opinion and in the opinion of recently elected APA President-Elect, Dr. Renee Binder, MD.

Dr. Muskin is a highly-esteemed leader within the Academy of Psychosomatic Medicine (APM) as well. The legacy of the rocky road to subspecialty approval for Psychosomatic Medicine by the American Board of Medical Specialties (ABMS) is well known to APM members and there may be more than a little trepidation that the MOC mandate may lead some doctors to question just how many certifications they want to hold, given the cost and time commitment keeping up with multiple certifications entails.

If my impression is wrong about the strategy of including Dr. Muskin on the panel of speakers and his presentation is not as I imagine it will be, please just let me know and I will stand corrected. I’m hoping that at least one of the attendees will notify me on how the session went.

Other speakers are Dr. Lois Nora, JD, MBA, MD on the ABMS and Dr. Larry Faulkner, MD, the CEO of the ABPN.

If anyone gets a chance to attend this session, and if questions are allowed, could you please ask:

If MOC is so easy and it’s such a great deal, why do thousands of physicians oppose it?

Maybe MOC is promulgated because it’s easy money and it’s easy to be hard on doctors because we’re like fish in a barrel–which some think has to change.shooting-fish-in-a-barrel