Can We Do Without K-Cups and the MOC?

So I originally got a tweet about Dr. Paul Teirstein’s Perspective article in the New England Journal of Medicine (NEJM) yesterday and retweeted it. The tweet above is my own and, as usual I ask the million dollar question “Who’s listening?” Nobody ever answers.

The American Board of Medical Specialties (ABMS) is the granddaddy instigator for the controversial Maintenance of Certification (MOC). The other important groups who I hope are paying attention are hospitals, third party payers, and state medical boards.

That’s because MOC has spread into almost every nook and cranny in our health care system. Hey, nobody even wants to talk about it too loud in academic medical centers, I guess because of the fear that the Accreditation Council for Graduate Medical Education (ACGME) will pull the accreditation of their residency programs.

Rank and file doctors who have to put up with timewasters like the MOC are great at talking to each other about the issue.

There’s just one problem with that–we can’t seem to do anything about it.

I think it’s fine to make grand speeches about how “…it’s time for practicing physicians to take back the leadership of medicine.”But how?

You know this reminds me of a kitchen table talk my wife and I had about Keurig the K-cup coffee maker being the subject of 14 lawsuits. It’s violation of antitrust laws, similar to the lawsuit filed by the Association of American Physicians and Surgeons (AAPS) against the ABMS last spring regarding MOC.

The Keurig empire is accused of building a monopoly on the coffee business. The ABMS and member boards are accused of running a monopoly on recertification materials.

Hey, we have a Keurig coffee maker. We like it but we’re noticing that the K-cups are getting more expensive.

So is a lawsuit the best way to break the back of Keurig or the ABMS? You could just stop buying K-cups and the required machine to defeat Keurig. There are plenty of cheaper coffee makers out there. Lawsuits drag on for years. You can switch coffeemakers overnight.

It’s not so easy to ditch the MOC although the petition to boycott it is still getting signatures.

The trouble is that there are not a lot of alternatives to MOC. To be sure, Dr. Teirstein is forming his own alternative to MOC:

From: An Interview With MOC Dissenter Paul Teirstein

I have launched a second certifying body. It’s called the National Board of Physicians and Surgeons, we have some board members (maybe you’ll be a board member, Bob), and some very high-quality institutions, and we are going to certify physicians as a substitute for MOC. The requirements are going to be fairly simple and relevant. There will be three or four requirements, and you have to be certified by an ABMS board initially. We’re not taking that on. I think the fellowship process is great, it’s like a final exam for residency and fellowship. I think most people agree that it’s okay (not perfect, but okay). You’ll also have to have a valid medical license and not to have been denied privileges recently in your specialty. Then the key requirement is 50 hours of continuing medical education, provided by an ACCME-accredited provider over 2 years. And the cost will be far lower. The cost will be as little as possible. For the full Medscape article, see tweet (registering with Medscape is free by the way):

So do we really need the K-cup?



  1. Jim,

    I was hoping you caught the MOC perspective pieces in the NEJM. The monopoly certainly had their own perspective. “Maintenance of Certification 2.0 – Strong Start, Continued Evolution” – indeed!

    I would really like to see Dr. Teirstein’s initiative (or something like it) take off. If the APA had any focus on the psychiatrists in the trenches it would follow Teirstein’s approach using Focus.

    My only modification would be that the annual CME was more focused on bringing all specialists up to speed with the same material. That is a far more effective way to address professional education than an expensive “guess what I am thinking” exam based on the fallacy that “the public cares” about whether their physicians take a useless exam.

    Liked by 1 person

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