Getting Small Again About MOC

So I contacted a few people at PubMed and our university library…and a contact at the American Board of Psychiatry and Neurology (ABPN) about this Maintenance of Certification (MOC) thing.

I believe I’ve been assigned a person at ABPN who has a better than fair sense of humor and may have an affinity for rock and roll.

Anyway, I sent a message to The University of Iowa health science library and PubMed:

To Whom It May Concern,

Is PubMed or other medical literature database available to any physician who requests it, not just those employed at large academic centers?

Does PubMed charge physicians in private practice for access and how much?

Is there any program or service available that would allow any physician, whether or not they’re affiliated with an academic medical center, access to a resource like PubMed either at reduced cost or free?

The replies were quick and clear and I combined them into a message to the ABPN:

“Anyone with an internet connection can go to and search PubMed for free. The guidelines on accessing full-text here:

Diplomates may be able to access articles that are available free from publishers or via PubMed Central. If an article is not available for free, they have some other options:
1. they can obtain it from interlibrary loan if they have library access
2. they may be able to obtain it from their local public library (some charge small fees)

If a library has a subscription, they may purchase a copy directly from it for a smaller fee than a commercial provider

I am not aware of anywhere people could subscribe and get full access to databases like a large academic center library provides and even they are unable to provide access even for a fee.

However, what if the ABPN and centers with such resources partnered somehow?

Would it be possible for a medical specialty board such as the American Board of Psychiatry and Neurology (ABPN) wanted to check to see if a diplomate were using PubMed regularly as a way to verify compliance with the requirement to engage in the core competency of practice-based learning and improvement? Currently, this must be fulfilled by accessing (often at a substantial price to the diplomate) the Performance in Practice (PIP) activity which has a framework designed to help the diplomate track what he/she does clinically for patients while comparing it with what the medical literature in the form of reviews and studies recommends. The ABPN doesn’t want patient data; all they require is a check box indication that the diplomate has done this, which can be tracked on the ABPN web site.

If the ABPN could access a diplomate’s PubMed activity, I wonder if this would be equivalent to the current PIP activity procedure—which thousands of physicians abhor as a waste of their time, mainly because so many of the approved activities are not relevant to our practices because they are connected to specific patient populations with specific problems we may never see.

Could that be an alternative to the PIP? The PIP could remain an alternative for those who find it useful.” I got a quick reply:

“Good afternoon, Dr. Amos-

Thank you for your ‘red pants’ suggestions and input regarding the MOC ways.

While we do require that the PIP/QIs be ABPN-approved (so that they meet our criteria), there are several options to satisfy the requirement:

1. Select one from the Approved Products List developed by one of the psychiatry/neurology organizations.  Each activity takes you step-by-step through the PIP Clinical Module.

OR, if you don’t find one that looks relevant to ones field of practice,

  1. You have the option of seeking individual preapproval for either one that you develop, or one that you may already be doing as a QI project in your hospital/institution.  Here is the Individual Preapproval Request form:

We are also accepting of institutional QIs approved through the ABMS Portfolio Program, as well as OPPEs completed in accredited institutions.

That said, I thoroughly enjoyed reading about the CPCPs at Iowa, and have since submitted a recommendation for further consideration.”

Dr. Jim Amos Red Pants TodayI gotta tell you I liked that, even though it was really just a nice way of saying “No.” Anybody who knows about my Red Pants Revolution for Lifelong Learning probably has it going on. After my message thanking her, she came right back:

“You are certainly welcome.

Let me know if you are interested in submitting an individual QI for consideration.  Once approved, the template/process could be used by other Iowa colleagues.”

One thing is clear; if you don’t keep your sense of humor about this issue, it can get to you. I know…I’ve lost it a few times. So developing a habit of mindfulness about MOC and getting small every now and then helps me…and I try to teach that to my trainees. It helps to have a rock and roll heart.

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  1. Have you considered developing and submitting a PIP activity for approval?


    • In fact, I’ve been thinking about working on PIP activity for delirium with one of the residents. Why not? It would at least be relevant to what I do as a psychiatric consultant.


      • I hope you do. It’ll be interesting to see if they approve it. What I don’t understand about PIP modules is that they assume you’re doing something wrong, and that there’s a published best practice or practice guideline that will fix it.


      • That’s exactly the problem with it. I’ve heard that some diplomates don’t get credit for doing PIP modules because they really don’t have any room to improve. If they tell the truth about it…they don’t get PIP credit. Damned if you do and damned if you don’t. Docs do them simply because it’s a Part IV requirement…empty mouse clicking.

        If ABPN could track PubMed (or similar) activity, I think that would be equivalent to tracking PIP module activity, especially since you can’t enter confidential patient data. You’re just mouse-clicking attestation either way.

        If you think about it, why else would a doctor be searching PubMed, other than to help improve patient care?


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