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: