Focus Group Weighs in on MOC

Psssst, I think the American Board of Medical Specialties (ABMS) thinks we want them to keep lying to us about how essential Maintenance of Certification (MOC) is to doctors who practice real medicine. I just noticed an article about MOC on Medscape which seemed to acknowledge both support of the principle of lifelong learning and opposition to MOC. It’s based on an article in JAMA Internal Medicine:

The comments are growing and they all share the same tone and message. We want the boards to stop beating up on us. We work hard enough already. The last time I looked, only Dr. Paul Kempen, MD, PhD, caught the disconnect between the actual intent of the study, (which is to sell it to doctors) and the ironic twist of the focus group finding–which is that most doctors aren’t buying it except under duress.

I would think that most leaders would give up trying to push this boulder up hill, but my guess is that board executives are likely laughing all the way to the bank.

I left my comment but just in case you can’t access it, I’ve copied it below:

I’m an academic consulting psychiatrist and I write the blog The Practical Psychosomaticist at, a substantial portion of which is devoted to my support of the principle of lifelong learning and opposition to MOC and the threatened add-on, Maintenance of Licensure (MOL). Just because MOC and MOL are promulgated by some executive academics doesn’t mean that every academician supports them.

Most of us are opposed to MOC and MOL because we don’t believe they embody the principle of lifelong learning.

I agree with Dr. Paul Kempen’s remarks about the article and the study itself. Even though there is obvious bias, the fear and loathing of the MOC process bleed through.

Everywhere I look there is intense opposition to MOC. I’ve worked with my state medical society to oppose MOC and MOL and I’ve managed to get two resolutions adopted that oppose MOL (last year) and oppose MOC for licensure , hospital privileges and reimbursement from third party payers (this year in September).

My state medical board and I have been in touch about MOL and it looks like they don’t plan to implement it for now, even though Iowa was one of the 11 states which originally agreed to pursue the so-called MOL Implementation Projects, which included the MOL Physician Acceptability Survey, inaptly named as the results showed that MOL is unacceptable to Iowa physicians.

I think direct actions like these are one of the few ways individual doctors can have an impact in this controversy. Although broad-based initiatives like the petition against ABIM’s new changes to MOC and the pledge to be non-compliant with MOC as well as the AAPS lawsuit against MOC and the ALEC model legislation opposing MOL are all measures of our frustration about these burdensome and wasteful activities, I don’t think they’ll stop them.

That doesn’t mean I think we should abandon those efforts. I wish I had better ideas. The President and CEO of the American Board of Psychiatry & Neurology, Dr. Larry Faulkner said “MOC is not going away…” at the October meeting of the American Association of Psychiatry and the Law. It has permeated the ACA law in the form of the byzantine PQRS MOC so-called CMS financial “incentive” (soon to become a penalty for not complying with MOC). Despite my resolutions opposing MOC and MOL, I cannot unilaterally refuse to participate in MOC. I’ll lose hospital privileges if I do. I marvel at the irony of my position.

But I can refuse to renew my membership in the organizations claiming to represent my interests but which have done little to acknowledge the opposition of their constituents, rank-and-file doctors, to MOC: the American Psychiatric Association and the American Medical Association.

And I can retire and let the misguided leaders of the MOC debacle regard the consequences to the physician workforce shortage.


Cook, D. A., et al. (2014). “Getting maintenance of certification to work: A grounded theory study of physicians’ perceptions.” JAMA Internal Medicine.
Importance  Despite general support for the goals of maintenance of certification (MOC), concerns have been raised about its effectiveness, relevance, and value.Objective  To identify barriers and enabling features associated with MOC and how MOC can be changed to better accomplish its intended purposes.Design, Setting, and Participants  Grounded theory focus group study of 50 board-certified primary care and subspecialist internal medicine and family medicine physicians in an academic medical center and outlying community sites.Exposures  Eleven focus groups.Main Outcomes and Measures  Constant comparative method to analyze transcripts and identify themes related to MOC perceptions and purposes and to construct a model to guide improvement.Results  Participants identified misalignments between the espoused purposes of MOC (eg, to promote high-quality care, commitment to the profession, lifelong learning, and the science of quality improvement) and MOC as currently implemented. At present, MOC is perceived by physicians as an inefficient and logistically difficult activity for learning or assessment, often irrelevant to practice, and of little benefit to physicians, patients, or society. To resolve these misalignments, we propose a model that invites increased support from organizations, effectiveness and relevance of learning activities, value to physicians, integration with clinical practice, and coherence across MOC tasks.Conclusions and Relevance  Physicians view MOC as an unnecessarily complex process that is misaligned with its purposes. Acknowledging and correcting these misalignments will help MOC meet physicians’ needs and improve patient care.



  1. This is another one of my comments on this Focus Group study of MOC. Please see the other comments, especially those from psychiatrists.

    What would be the most skillful response to formulate from all this and who would have the authority to present it to the ABMS?


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