Support AMA Resolution 316 Moratorium on Maintenance of Certification

Dr. Jim Amos Red Pants Today

Recall my post July 30, 2013 in which I wrote, “If such a resolution even gets on their agenda for discussion, I’ll consider wearing my red pants to work. If it’s adopted, I will.”

“Res 316 Moratorium on Maintenance of Certification

posted at 5/5/2014 12:09 PM CDT
RESOLVED, That our American Medical Association work with the American Board of Medical Specialties (ABMS) and individual specialty boards to put a moratorium on maintenance of certification (MOC) until all of the following occur:
1. Pilot studies have shown the efficacy of MOC in physician care and patient outcomes;
2. An assessment of the cost of time and money on the profession per year is completed; and
3. An assessment of the impact of MOC on worsening physician shortages by the adverse effect of tying the MOC program to state licenses (i.e., estimation of physicians that would leave or be removed from the physician pool of practicing doctors) is completed. (Directive to Take Action)”
I just became aware of AMA Resolution 316 Moratorium on Maintenance of Certification on May 12, 2014 and I support it. More information supporting this resolution can be found on http://www.changeboardrecert.com/ and my blog site, https://thepracticalpsychosomaticist.com/

This post contains my comment on the AMA Member Forum. Even though I’ve heard that currently only 20% of American physicians are AMA members, I think we should use any means available to reverse the tide of ill-timed and ill-advised, and poorly researched mandatory MOC processes being foisted on hard-working physicians. The site has low traffic, and I’m urging AMA members to make a noise there.

I sponsored a resolution to the Iowa Medical Society House of Delegates to support the principle of lifelong learning but to oppose Maintenance of Licensure (MOL) in April 2013. It was co-sponsored by the Iowa Psychiatric Society and adopted unanimously.

Since then the Iowa Medical Society (IMS) has moved from the House of Delegates format to a new process to set policy which engages all IMS members. I’ve introduced a new resolution (which, under the new model, will be called a Policy Request Statement). It has been officially submitted by IMS and in early August of this year, IMS will send out the Policy Request Statement to the entire membership.

My Policy Request Statement will be an adaptation of the resolution opposing MOC recently adopted by the South Carolina Medical Association. This resolution specifically opposes mandatory maintenance of certification for licensure, hospital privileges and reimbursement from third party payers.

Leaders accepted my draft and discussion about it will begin prior to the next scheduled Policy Forum meeting in September this year.

The Policy Request Statement will then be returned to the entire membership for feedback prior to the meeting.

The IMS staff will conduct additional research which might include review of existing AMA as well as IMS policy, regulations in other states, and other data.

All comments and research will be forwarded to the Policy Forum Staff about a week prior to the meeting. Any of the IMS members, including the author of the Policy Request Statement, is eligible to testify about the issue. Other experts could also be asked to participate.

Following discussion the Policy Request Statement could be approved, rejected, or tabled pending review by a specially appointed committee. That decision could be as soon as September 18, 2014.

Resolutions opposing MOC and/or MOL have been adopted in Iowa, Ohio, California, Florida, Alabama, Texas, Oklahoma, New York, Michigan, Wisconsin, and North Carolina. The number of signatures is nearly 15,000 as of this moment on a petition to the American Board of Internal Medicine to recall recent changes to MOC making participation even more frequent and more costly than it already is.

I urge AMA to adopt Resolution 316 Moratorium on Maintenance of Certification. This will further encourage the movement toward rational fulfillment of the principle of lifelong learning, a large part of which is that it be voluntary and self-directed.

The kind of self-reflection that boards are trying to enforce on doctors must come from the inside out.

We need more visibility and a lot more noise on the AMA site on Res 316 Moratorium on MOC.

 

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Comments

  1. I just had a look at a few other resolution drafts in the AMA HOD schedule. New York Ref Committee F is proposing Res 610 proposing “Alternative MOC”; New Jersey Ref Committee C also for an alternative to MOC; and New York Ref Committee C with Res 319 opposing MOL.

    Those are drafts in addition to the other two resolutions firm on the schedule, Res 316 opposing Moratorium on MOC and Res 313 opposing MOL.

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  2. There’s a new AMA resolution on the AMA Member Forum: “Res 320 Mandatory Board Re-Certification”:

    RESOLVED, that our American Medical Association urge the mandatory recertification to be replaced with a specialty-specific continuing medical education alternative.”

    This was just posted today.

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  3. And this is the other part of my response to the con-Res 316 commenter (see my 2nd comment below):

    “However, I’m a consulting psychiatrist at an academic medical center and I have found few MOC Performance in Practice (PIP) products on the American Board of Psychiatry and Neurology (ABPN) web site that are relevant to my practice. It’s true that the ABPN Folio helps me track my MOC CME, Self-Assessment, PIP Activity/Patient & Peer Review credits. It helped qualify me to sit for what I hope will be my last recertification exam in Psychosomatic Medicine before I retire, which I took recently–and which cost $1,500.

    However, what I do every day to stay current as a general hospital psychiatric consultant has nothing to do with MOC and is more practical and useful to me than almost any of the currently available MOC products available from the ABPN, with the exception of the Focus Journal for Lifelong Learning for Psychiatry–which is costly and which, incredibly, is not covered by the very high price of my membership in the American Psychiatric Association (APA). I hope that new APA President-Elect, Dr. Renee Binder, MD, will be able to rectify that during her term. Her proposal to include the cost of subscriptions to Focus in the APA membership fee is just part of her well developed position opposing both MOC and MOL.

    And I find it interesting and ironic that the AMA is now opposing MOC and MOL (the latter with Resolution 313 Opposition to FSMB MOL Program, detailed elsewhere) when it figured importantly in getting doctors into this complicated process in the first place, in part helping to ensure that it got into the Affordable Care Act in the form of the MOC:PQRS incentive (now replaced by penalties from the Centers for Medicare and Medicaid Services), see post for details about this extraordinarily complicated regulatory hoop which adds to the cost of this misguided effort by the American Board of Medical Specialties (ABMS), https://thepracticalpsychosomaticist.com/2014/01/13/mass-noncompliance-with-moc-already-there-with-mocpqrs/

    As of this moment, over 15,000 signatures are on the petition opposing the American Board of Internal Medicine (ABIM) proposed changes to the MOC process–which will make it even more complicated. You can see this steadily growing opposition by rank-and-file doctors at link http://www.petitionbuzz.com/petitions/recallmoc

    Most of the comments on the petition criticize MOC on several grounds, including its lack of relevance to physicians’ practices. The majority don’t believe it’s worthwhile to try to save the baby. The ABIM has so far declined to change its proposal in response to the outcry from doctors across many specialties.

    In my opinion, the ABIM and other specialty boards should take their cue from the AMA resolutions opposing MOC and MOL, both of which I hope will be adopted.

    Personal opinion – James Amos”

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  4. Here’s my reply to the so-far lone dissenter to Res 316, based on the view that it would be throwing out the baby with the bathwater since, despite the expense of MOC, there hadn’t been so far any complaints about the effectiveness of the learning gained from MOC. There was also a puzzling opinion from the same doctor about maybe the MOL being better than the MOC in some way that was not clear to me from the description:

    “I think the discussion here could do with some clarification about the view that the public is “demanding” MOC and MOL and about the distinction between MOC and MOL.

    I fully support the need for physicians to provide safe and competent care (more desirable would be excellent care). I believe that high profile malpractice cases like the Bristol Heart Baby Scandal in the United Kingdom may be the source of the belief that the public is making a broad demand for programs like MOC. That kind of egregious behavior by doctors is what malpractice law and state medical board sanctions are intended to address. See my post at https://thepracticalpsychosomaticist.com/2013/02/11/bristol-heart-of-the-moc/for details about the Bristol Inquiry. The scandal led to the controversial proposal for Revalidation in the UK, and it’s very similar to the MOL program in the US. I don’t believe MOC/MOL or Revalidation will prevent the kind of dangerous behavior by surgeons which led to the deaths of many infants with cardiac disease.

    Dr. Paul Kempen is a Ohio physician who led the opposition to MOL in that state, where it was defeated. One of his arguments against the competence issue assumed to be driving the push for MOC and MOL is that competence was only very rarely a reason for actions against physicians by the state board. See his video for details at link https://www.youtube.com/watch?v=WRS15Dmsk7E

    MOL would tie medical licensure to programs essentially similar to MOC. It’s driven by the Federation of State Medical Boards (FSMB). Resolutions opposed to MOC and/or MOL have been adopted in Iowa, Ohio, California, Florida, Alabama, Texas, Oklahoma, New York, Michigan, Wisconsin, South Carolina, and North Carolina. The resolution opposing MOC and MOL adopted this month by the South Carolina Medical Association specifically opposes mandatory MOC processes being tied to state licensure (affirming the principle of lifelong learning by opposing MOL, in effect), hospital privileges and reimbursement from third party payers. I have already mentioned my adaptation of this resolution, formally submitted as a Policy Request Statement to the Iowa Medical Society, which adopted my resolution opposing MOL last year. Moreover, the AMA itself has its own Resolution 313 Opposition to FSMB MOL Programs.

    I think most of us strive for excellence in our practice. I don’t think MOC does that for me. I run an inpatient psychiatry consultation service at my hospital and an important piece is the Clinical Problems in Consultation Psychiatry (CPCP), a Practice-Based Learning and Improvement activity which involves a search of the evidence base for guidance on how we can continuously improve our service to patients and colleagues. Who puts these together? Residents and medical students take the lead on creating and presenting CPCPs and they are a great source of pride to me as a teacher. I post them on my blog site, https://thepracticalpsychosomaticist.com/tag/cpcp/

    A New York Times op-ed from 2004 identified the “Bell Curve” phenomenon in the provision of quality care by doctors,http://www.newyorker.com/archive/2004/12/06/041206fa_fact?currentPage=all?mbid=social_retweet

    My take-home point from that article is that MOC programs tend to emphasize competency to the point of celebrating mediocrity, driving physicians to the middle of the bell curve. Our patients deserve better than that.

    Personal opinion – James Amos”

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