Feedback to ABMS on MOC Now!

Wear 'em if you got'em!

Wear ’em if you got’em!

By now most board-certified psychiatrists have received the ABPN Letter to Diplomates letter announcing its suggestion to the American Board of Medical Specialties (ABMS) to make the controversial Part IV of the Maintenance of Certification (MOC) optional. It’s a major step forward and it follows the American Psychiatric Association (APA) letter, ABPN-Letter (1) sent ABPN only days ago.

The ABMS sent its own ABMS Letter To Diplomates announcing its continued support of all 4 MOC components but including a link to a form requesting feedback from us. Here’s my feedback, which I submitted this morning:

I appreciate the ABMS reaching out to board diplomates. I support the principle of lifelong learning but oppose MOC. I have discussed the issue with leaders in our department and with our hospital administration. After 19 years on staff and participation in MOC since its inception, I’ve just discovered that MOC is not part of our credentialing process nor is board certification an institutional requirement. This is a highly respected academic medical center with talented, creative, and dedicated faculty. It has been recognized by U.S. News and World Report as one of America’s best hospitals and 78% of patients would “Definitely” recommend us to friends and family.

We are moving toward a discussion about adding the National Board of Physicians and Surgeons (NBPAS, which does not require MOC) as an alternative to certification by ABMS and member boards based on the widely held view that MOC as it’s currently designed does not meet the needs of our physicians and patients. And the most recently published studies do not support the view that it changes patient outcomes (Gray, B. M., et al. (2014). “Association between imposition of a Maintenance of Certification requirement and ambulatory care-sensitive hospitalizations and health care costs.” JAMA 312(22): 2348-2357. Hayes, J., et al. (2014). “Association between physician time-unlimited vs time-limited internal medicine board certification and ambulatory patient care quality.” JAMA 312(22): 2358-2363.) You are the subject of a lawsuit filed in Federal court regarding the MOC in 2013. Newsweek even carried a story about the MOC controversy recently, characterizing it as the “ugly civil war in American medicine.”

The AMA House of Delegates in June 2014 adopted policy which recommended AMA oppose making MOC mandatory as a condition of licensure, work with the ABMS and member board to collect data on why doctors choose to maintain board certification or not, whether it influences doctors’ decision to retire early and impacts the physician workforce, practice costs and outcomes, all of which tends to throw doubt on the process.

I have personally authored resolutions to support lifelong learning and oppose MOC and Maintenance of Licensure (MOL) and they’ve both been adopted by our state medical society. Many states acted likewise. The APA and my state district branch have respectfully requested eliminating Part IV of the MOC as a required component and the ABPN in response has suggested to ABMS that Part IV be made optional. While I support this move I don’t think it should prevent diplomates and non-board certified physicians from seeking certification through organizations like the NBPAS. The ABMS apparently disagrees with the ABPN suggestion, which I think is a mistake.

I urge the ABMS to simply recognize that American doctors believe the current MOC program is not relevant to our practices, is not evidence-based and the most diplomatic and practical way to settle our long bitter dispute over it should be pursued as quickly as possible because we view it as an embarrassment to our profession. Most physicians blame the ABMS for this trouble.

If the ABMS were to make Part IV optional, many doctors in practice and in training might view it as a step in the right direction.

I urge all physicians to submit feedback via the link. The form apparently allows letters of considerable length, at least so far. There must be a thunderous response from every quarter making it clear to the ABMS we support the principle of lifelong learning and that MOC in its current form doesn’t embody the principle. Don’t forget the NBPAS Survey:

 

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Comments

  1. Board Certification is a scam.

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  2. Chris Harper, MD says:

    I’m opposed to MOC. Legal repercussions are plenty incentive for M.D.s to stay sharp, if their consciences aren’t.

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  3. Thank you for this piece, and persisting with your hospital credentialing committee – it is a beacon for the rest of us. Please give details on what you think is effective in having them move toward the NBPAS? Thanks, Paul

    Liked by 1 person

    • Thanks, Paul. I think what was probably most helpful was Dr. Teirstein’s slideset in the “Sample Letters and Powerpoints” on the NBPAS website, https://nbpas.org/.

      On the inside, it was challenging just to find out who I was supposed to talk to. I emailed several point persons on our executive committees including the co-Chief Operating Officer who, in the end, had the critical information which is now persuading my department leaders to consider the whole issue of MOC and board certification in a different light, especially now that the field is moving in the direction that I’ve been advocating for years.

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      • Great, what was the “critical info” ? And what really speaks to these people ?

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      • The most important items were that MOC is not a part of credentialing here and that even board certification is not an institutional requirement.

        I think what speaks to them is that the main difference between NBPAS and ABMS is that MOC is not required in NBPAS. You still need previous certification by an ABMS member board which probably doesn’t hurt the credibility of NBPAS to administrators. And I’ve been beating the drum supporting lifelong learning and opposing MOC and MOL for years here.

        I think it also helps that I’m transparent about my support of professional development with my case conference presentations on my blog site and publishing all of them with free access; they’re mostly done by residents and medical students.

        The other thing that helps is that I’ve authored resolutions against MOC and MOL through our state medical society, which were both adopted in the last couple of years.

        Another event that probably helped persuade the Chief Operating Officer (COO) was my attendance at a meeting about the Ongoing Professional Practice Evaluation Policy (OPPE) and the Focused Professional Practice Evaluation Plan (FPPE), more regulatory hoops via the Joint Commission. Because of my position as a general hospital psychiatric consultant, I’m essentially invisible to the metrics used to measure physician performance in OPPE, which I pointed out to the attendees as well as the speaker, who happened to be the COO. I also asked whether participation in the MOC would make a difference, which seemed to mystify many members of the audience, who are probably grandfathered. However, several docs did seem to get the irony–because MOC is widely deplored.

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