What’s Up, MOC?

what's up docSo I sent a message to the Iowa Board of Medicine (IBM) inquiring about the results of the Iowa Physician Acceptability Survey on Maintenance of Licensure (MOL). The IBM was supposed to have received the aggregate results in June. What’s up, Doc?

I’ve been waiting for the results of the Iowa Physician Acceptability Survey on Maintenance of Licensure (MOL) to be announced. I believe the aggregate results were to be presented to the Iowa Board of Medicine in June of 2014.

Are you at liberty to tell me about them?

I also wanted to let you know that the first Policy Forum of the Iowa Medical Society accepted my Policy Request Statement (PRS 14-02) opposing mandatory Maintenance of Certification (MOC) on September 25, 2014:

“The Iowa Medical Society opposes mandatory Maintenance of Certification (MOC) for licensure, hospital privileges, and reimbursement from third party payers. IMS supports continuing medical education and the principle of lifelong learning by physicians.”

The following two events are closely related: the Iowa Physician Acceptability Survey and the recent decision to accept my proposal to oppose what that survey was really designed for–to assess Iowa physicians’ opinion about MOL as well as what we now do to embody the principle of lifelong learning. The Iowa Medical Society (IMS) Policy Forum decision to accept PRS 14-02 is a confirmation of Iowa doctors’ support of the principle of lifelong learning while opposing MOL which was initially and unanimously supported in the adoption of my resolution to specifically oppose MOL last April at the IMS House of Delegates meeting in Iowa City.

The Federation of State Medical Boards (FSMB) has been driving the MOL and has partnered with the American Board of Medical Specialties (ABMS) and other regulatory agencies to force the MOC into the structure of our health care educational and delivery systems. They have shoehorned these processes into the structure of our payer systems with the Affordable Care Act (ACA).

Watch out for the Physician Quality Reporting System (PQRS) of the Centers for Medicare and Medicaid Services (the notice from IMS to Iowa physicians is below), which will start penalizing physicians, including psychiatrists if they’re not participating in MOC programs.

IMS Message on PQRS

However, what the corporate boards have not yet done is to shoehorn MOC and MOL into the broad culture of medicine. Widespread opposition to them has resulted in a Federal lawsuit, resolutions to oppose them in several states, model legislation proposed to make it illegal to impose MOL on physicians, a petition calling for changes to the burdensome structure and costs and even a petition pledging noncompliance.

Amid claims that American patients demand these controversial regulatory burdens on physicians, has anyone thought about actually asking patients what they know and what they think about them? The boards claim patients want them while the physicians opposed to them claim most patients hardly know what certification is.

Moderates, despite acknowledging the many flaws in them, encourage putting up with MOC and MOL in the hopes that these processes will somehow be improved and eventually be relevant to what real doctors have to do in real life.

Hardliners in the ABMS say with clenched teeth that MOC is not going away, as though they are defending a principle rather than an ugly patchwork representation of it. Hardliners opposed to MOC attack essays and editorials supporting it (which are, frankly, advertisements) wherever they crop up as though they could pull every weed in the country.

And all the while we’re preoccupied with skirmishes like these, how are we achieving excellence in medical knowledge and patient care, systems-based knowledge, practice-based improvement, professionalism, communication and interpersonal skills? Can we find time for creativity, innovation, and self-care?

No, because we’re too busy fighting each other. I think we all need to let go and find a more skillful response to the challenge of encouraging doctors to pursue lifelong learning as a habit. Maybe we need to admit that the drive to engage in it probably has to come from the inside–not imposed on them from the outside.

What’s up, MOC?

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