The AACE Lifelong Learning Certification: A Brave Little Boat on the Ocean

I recently got the message by email from Psychiatric News about the American Board of Psychiatry and Neurology (ABPN) changes to their Maintenance of Certification (MOC) feedback requirement rules:

The gist of it is that I probably don’t have to use patient feedback because other choices are available. It’s hardly a great wave in the scheme of things as envisioned by the schemers at the American Board of Medical Specialties (ABMS). It’s barely a drop in the ocean.

IMG_1405However, I’ve been waiting for the major announcement by the American Association of Clinical Endocrinologists (AACE) about their response to the ABMS notion of lifelong learning. I just got word of their launching a little boat which many of us hope will not only stay afloat, but will lead an armada if only other specialty boards will also weigh anchors.

The AACE is making a courageous move and the document reads almost like a manifesto in some places (see italicized excerpts, boldface mine):

About 25% of actively licensed physicians in the United States do not carry ABMS board certification. And ABMS board certification by no means guarantees “performance or positive outcomes,” as stated in an ABMS disclaimer. There is no evidence to indicate that physicians who are not board certified provide inferior clinical outcomes to those who are ABMS board certified.

Independent surveys indicate that most patients do not understand the concept of an independent certifying organization outside of state medical licensure. Patients largely choose their doctors based upon recommendations from others including other doctors.

Recently in the United States, ABMS has created a product called Maintenance of Certification (MOC). In endocrinology, diabetes and metabolism MOC includes MOC approved self-assessment modules, so called “practice
improvement modules,” and the passing of a secure closed-book exam.

Physicians who have gone through MOC have found it to be of little value. Given the choice, most would not elect to repeat MOC. Over 13 years ago, AACE expressed serious reservations about this ABIM product (AACE White Paper 2001).

While MOC is promoted as “voluntary,” more and more commercial insurance plans and hospital credentialing committees require MOC. Equally concerning are efforts to couple MOC with maintenance of medical licensure (MOL) and participation in federal and state insurance programs. These efforts by ABMS may amount to restraint of trade and have recently lead [sic] to legal challenges.

AACE believes that ABIM MOC requirements place an undue burden of time and energy on the practicing physician, taking the physician away from patient care, in pursuit of an activity with no proven benefit to physician or patient. AACE strongly discourages connecting ABIM MOC with hospital privileges, maintenance of licensure or insurance credentialing.

Going forward, AACE will advocate for a creating a process of certification for the clinical endocrinologist that is the most rigorous, relevant and real world available. This certification is called Lifelong Learning Certification. Lifelong Learning Certification will be awarded on a three-year cycle.

AACE also urges other specialty and sub-specialty medical societies to advocate for creating certifications that are equally rigorous and relevant for their physician members.

This position statement is available for AACE members to provide to insurance companies and hospitals.

It’s a small boat on the ocean–with a brave crew. I hope the ABPN is looking over the bow and following in her wake.



  1. George, I agree completely. Nothing would make me happier than if this created a domino effect among specialty boards.


  2. My thought is that this is an outstanding initiative by the AACE and one that all specialists should get behind. It is the basic truth about the politics behind the MOC initiative and I find it quite exciting that a specialty organization is finally articulating it.

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