ABPN MOC Change: PIP Clinical Down the Drain?

By now most diplomates of the American Board of Psychiatry and Neurology (ABPN) got the email message about the change in Part IV requirement for Maintenance of Certification (MOC) specifically about the Performance in Practice (PIP) modules:

“AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY EXPANDS

IMPROVEMENT IN MEDICAL PRACTICE (PIP) OPTIONS FOR DIPLOMATES

February 18, 2016, Buffalo Grove, Illinois — The American Board of Psychiatry and Neurology, Inc. (ABPN) has expanded the options for diplomates for their one required Improvement in Medical Practice (PIP) activity every three years to include any Clinical Module OR Feedback Module activity listed on the ABPN website. Effective immediately, this development now gives diplomates more flexibility with the Part IV requirement for their maintenance of board certification.

The ABPN Improvement in Medical Practice Unit is a quality improvement exercise designed to identify and implement areas for improvement based on the review of one’s own patient charts (Clinical Module), involvement in personal or institutional quality improvement activities, or feedback from peers or patients via a questionnaire/survey (Feedback Module).

“These additional options for fulfilling the requirements of MOC Part IV recognize the importance of patient and/or peer feedback to the process of physician quality improvement, and it should also make it easier for many ABPN diplomates to document their quality improvement activities,” said Larry R. Faulkner, MD, ABPN President and CEO.

More details, including full option lists for both the Clinical and Feedback Module activities, are available on the ABPN website.

The American Board of Psychiatry and Neurology, Inc. is a not-for-profit corporation dedicated to serving the public interest and the professions of psychiatry and neurology by promoting excellence in practice through certification and maintenance of certification processes.

For additional information, please contact Patti Vondrak, Director of MOC, at pvondrak@abpn.com.”

I checked with Patti Vondrak, with whom I’ve previously corresponded about the MOC, on whether this means what it seems to say. I told her I’m in the C-MOC and I need one PIP module. Does that mean it doesn’t have to be a Clinical PIP Module; it can be any one of the Feedback Modules?

If this is true, this essentially makes the PIP Clinical Module optional and this would help me because so few of them are relevant to my practice.

Patti’s answer?

“Yes, that is correct. You can fulfill PIP requirement of MOC by choosing one approved activity from the Clinical Module (chart reviews) list OR the Feedback Module (patient or peer surveys/questionnaire) list. We expanded the Part IV/PIP options.”

What this looks like is the ABPN’s work-around way of implementing a suggestion to make Part IV itself optional (“Based upon the feedback we have received from the AAN and the APA, the ABPN has respectfully asked the ABMS to consider modifying its 2015 MOC Standards so that Part IV is an optional component of MOC.”), ABPN Letter to Diplomates which was prompted by a letter from the American Psychiatric Association (APA) ABPN-Letter (1).

Although this change doesn’t go that far, it accomplishes almost the same goal. No one who doesn’t want to work on the PIP Clinical Module actually has to because they can substitute a Feedback Module. Most front line doctors don’t have time to fiddle with the PIP Clinical Modules on the ABPN MOC web site because so many of us are subspecialized it’s virtually impossible to find one which would be meaningful and worth taking time away from our practice for. That’s why we call the PIP Clinical Modules “busywork.”

Many psychiatrists are opposed to the Feedback Module also, especially if it involves asking patients for feedback because it seems intrusive and vulnerable to cherry-picking. There are other Feedback Modules which don’t require input from patients and, while they have the same weaknesses, are probably more acceptable to physicians and potentially could be more useful…although you could still argue against them.

It looks like the ABPN found out how to have it both ways: They technically don’t violate the American Board of Medical Specialties (ABMS) insistence on retaining Part IV because Part IV itself remains intact. On the other hand, psychiatrists are probably getting a break from the burdensome and wasteful PIP Clinical Module because, while Part IV is not optional–the PIP Clinical Module is. And those who prefer the darn thing can have it.

Dr. Amos red pants and red socks

Not time for red pants yet.

This could mean I’ll have to wear red pants on Monday. On the other hand, I still believe Part IV should go away. Furthermore, I think the 10 year recertification exam is impractical and should also be abolished. And I’m not the only one. APA Trustees had this to say:

Take note:

  • APA does not agree that there should be an exam every 10 years for MOC.

  • Certification of lifelong learning should be an integrated, ongoing process relevant to actual practice.

  • APA is willing to work with the ABPN to improve the MOC process.

  • For subspecialists taking a recertification exam, the ABPN should ensure that the exam primarily consists of questions related to the diplomates’ subspecialty. Any general psychiatry questions that are included should be relevant to the diplomates’ practice.

  • No psychiatrist should be forced to maintain her/his underlying general and subspecialty certification through more than one certification process.

I appreciate the direction in which the ABPN is moving. It needs to move more swiftly and with greater resolve. The political nature of the relationship between the ABMS and specialty certification boards like the ABPN is one thing. But the danger of scaring new scholars from pursuing careers in medicine at a time when physician shortages are at an all time historical high is another.

This MOC thing, as everyone in my department knows, is one of the issues which drives me toward retirement, early if I could manage it although the ACA health insurance costs are a barrier. My wife suggested we might cover them by opening a business–like a car wash. I’m not so sure about that, but I sometimes wonder if some of the Presidents and CEOs of specialty certification boards think they’ll lose their lucrative positions and have to work at the car wash if they’re not in lock step with ABMS decrees.

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