My Comments on Affirming Lifelong Learning and Opposing MOC in Iowa

cropped-dr-jim-amos-md.jpgThe Iowa Medical Society (IMS) new Policy Forum will meet on September 25, 2014 to discuss a half-dozen pivotal issues including my Policy Request Statement (PRS) 14-02: Support of Lifelong Learning and Opposition to Mandatory Maintenance of Certification (MOC). Below are my comments on the IMS LinkedIn site. I’ve already submitted written comments required by rule, and they’re very similar.

What makes this issue very important to me was brought home by an article on MOC in the most recent issue of the Academy of Psychosomatic Medicine Newsletter. I’m a member of the APM and justly proud of how this growing organization (now over a 1,000 members strong) has met the challenge of helping its members meet the demanding MOC requirements.

The author of the article “Changes in the Recertification Process,” Bob Boland, MD, FAPM, notes the recent flexibility in the MOC process according to the American Board of Psychiatry and Neurology (ABPN). However, you have to love his sense of humor in his answer to the question, “Why do I have to do this?”–“Because the ABPN said so.”

Obviously the tongue-in-cheek reply starts with this remark because most physicians feel burdened, sometimes mystified, and irked by this new regulatory layer which is especially ironic to APM because of the struggle to gain approval of Psychosomatic Medicine as a subspecialty. It took many years, and the  first try met with failure, partly because of resistance from the American Board of Medical Specialties (ABMS) which objected on the grounds that approving yet another subspecialty would contribute to the balkanization of medicine. I was among the first diplomates taking the exam for the first time ever in 2005.

Now APM has to put up with the MOC process–because the American Board of Medical Specialties (ABMS) says so.

It’s hard to disagree with Dr. Boland’s point that doctors do, in fact, need to have some formal, systematic way to continously assess and improve their medical knowledge and clinical skills. I agree completely. I just don’t think MOC adequately embodies the lifelong learning principle.

Yet, the APM leadership would definitely have political difficulties publicly opposing the MOC process, given all the trouble they went to in order to get Psychosomatic Medicine through the rigorous and complicated subspecialty approval protocol. It’s to their credit they soldier on because of the critical importance of Psychosomatic Medicine, especially now in this evolving health care delivery environment in which the drive to integrate medical and psychiatric care figures so prominently.

At any rate, below are my comments on why I treasure the path of lifelong learning and why I think MOC impedes our progress on it and may even be a blind alley.

“I submitted PRS 14-02 and I have no conflicts of interest or anything to gain personally by doing so. I’ve submitted written comments to the Policy Forum for the discussion at The University of Iowa on September 25th, although I’ll probably be unable to attend in person because of my clinical duties.

I was also the sponsor for the resolution (adopted) to support the principle of lifelong learning and oppose Maintenance of Licensure (MOL) last spring at the IMS House of Delegates prior to the switch to the Policy Forum format.

There are several reasons why I think PRS 14-02 is necessary in addition to the opposition to MOL policy.

 

  • I think MOC as it stands would create a strong disincentive for physicians to relocate to or stay in Iowa to practice (a physician shortage area), because most doctors believe:
  • MOC is time-consuming, expensive, often not relevant to our practices, and not supported by high-level research to improve patient outcomes
  • Despite the American Board of Medical Specialties (ABMS) assertion that MOC is voluntary, it has becoming essentially mandatory in order to obtain hospital privileges, third party reimbursement, and most recently it’s being promoted by the Federation of State Medical Boards (FSMB) to be used as a condition for state medical licensure

 

Although I’ve not yet seen the results of the Iowa Physician Acceptability Survey results regarding MOL (administered by the Iowa Board of Medicine [IBM]), which was completed in April this year, I’m confident that many doctors answered Question 31 (asking for free-text comments about it) indicating their opposition to MOL. Indeed, most of the states supposedly collaborating on MOL implementation projects have adopted resolutions opposing it.

I’m not advancing PRS 14-02 just because so many other states are doing or planning to do likewise.  I’m doing this because, in my opinion, MOC and MOL do not adequately embody the principle of lifelong learning. In fact, I think they foster mediocrity because they are being foisted on doctors, most of whom favor pursuing excellence and who naturally bridle at being forced to do otherwise.

When I was interviewed in June this year by Becky Watt Knight, Senior Vice President of the public relations firm, Get Your Message Right, as part of the IBM implementation project for MOL (an important piece of which was the Iowa Physician Acceptability Survey), she asked me if I thought a systematic process for helping physicians achieve competency in lifelong learning is needed. I told her I agreed wholeheartedly that something like it is sorely needed.

However, I believe we should let individual physicians decide voluntarily how to embody the principle of lifelong learning in their practices. I agree that diplomates’ knowledge and skill base erode over time and 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 American Board of Psychiatry & Neurology (ABPN) MOC program (I just recently passed 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.

I think we should give physicians an incentive to engage their own personally crafted lifelong learning practices. One way to do that might be for state medical boards and societies to formally and publicly recognize their efforts.”

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