I enjoyed reading Dr. George Dawson’s recent blog post on Maintenance of Certification (MOC) in which he supports the principle of lifelong learning while questioning the American Board of Medical Specialties (ABMS) attempt at modeling the principle, known as MOC. I applaud his decision to participate in the alternative certification board, the National Board of Physicians and Surgeons (NBPAS).
I have supported the position of Dr. Paul Teirstein, MD, one of the leading physicians spearheading NBPAS, and I’ve recommended that the University of Iowa Hospitals and Clinics (UIHC) consider accepting NBPAS as an alternative to the ABMS MOC. Three Iowa hospitals already do so.
I’ve also completed two surveys recently, requesting feedback about MOC, one of them written by the ABMS and the other from Dr. Westby Fisher. I suggest any physicians interested in providing feedback about MOC complete both. This is not the first time I’ve provided feedback to the ABMS about MOC.
As most of my readers and trainees know, I’ve been in phased retirement and expect to be fully retired by 2020. Because of that, I’ve decided not to seek continued certification through either NBPAS or ABMS. I chose not to pay the fee required by the American Board of Psychiatry and Neurology (ABPN) to sit for the recertification examination. Consequently, that has resulted in my being identified as “Certified” although “Not Meeting MOC Requirements.” This is data about me as a physician which is readily available to the public and other organizations. I think it’s unfortunate that it tends to convey the impression some physicians are less qualified than others based on their certification status alone.
I’m aware that declining to sit for what would have been the last MOC recertification examination in my career might not be viewed as much of a protest, especially in an academic medical center which so far has not required MOC participation or, for that matter, board recertification, as a condition for clinical privileges.
All I can say in reply is maybe that should prompt some to question the importance of MOC if highly ranked university medical centers seat credentialing committees which continue not to insist on MOC participation by the talented and highly qualified researchers and clinician educators they continue to recruit and retain.
I’m also aware that many physicians are not in a position to decline participation in MOC. Some organizations and health insurers demand it, prompting several physicians and state legislators to collaborate toward adopting or consider adopting laws to discourage it.
To be fair, MOC is often not the only criterion that organizations use to ensure patients are getting the best health care available. And there are many who work diligently to improve the MOC process and believe it works (Pato, Brooks, Tieder, Stoff). Enhancing the motivation for physicians to participate in MOC is complicated and needs to consider different practice environments, physician burnout, and financial incentive programs which have typically attracted few physicians overall (Glover).
It’s difficult to find much information on PubMed about MOC, whether you search using the Most Recent or the Best Match filter. In both, I found a paper by two doctors which appeals to my sense of humor as well as to my sense of fair play. The first author is a Singapore physician, for whom the dollar cost of recertification was over $10,000. His nerves took a beating as well as his bank account. Speaking of banking, here is the authors’ final observation:
Physicians should be able to choose a programme that best fits their scope of practice. However, it is likely that, besides the efforts put in by physicians themselves as a commitment to professionalism, the economic price will be borne by patients in the name of public assurance of medical competence and safety. If the burden becomes too onerous, one can always become a banker.— Teo, B. W. and S. Subramanian (2015). “Maintenance of certification: the price of medical professionalism is $10,108.05, two weeks leave and five white hairs.” Singapore Med J 56(4): 181-183.
“It is far better to light the candle than to curse the darkness”—attributed to William L. Watkinson in a 1907 sermon according to Quote Investigator.
Pato, M. T., et al. (2013). “Journal club for faculty or residents: A model for lifelong learning and maintenance of certification.” International Review of Psychiatry 25(3): 276-283.
Brooks, E. M., et al. (2017). “What Family Physicians Really Think of Maintenance of Certification Part II Activities.” J Contin Educ Health Prof 37(4): 223-229.
Tieder, J. S., et al. (2017). “A Survey of Perceived Effectiveness of Part 4 Maintenance of Certification.” Hosp Pediatr 7(11): 642-648.
Stoff, B. K., et al. (2018). “Maintenance of Certification: A grandfatherly ethical analysis.” Journal of the American Academy of Dermatology 78(3): 627-630.
Glover, M., et al. (2017). “Participation and payments in the PQRS Maintenance of Certification Program: Implications for future merit based payment programs.” Healthcare.
Teo, B. W. and S. Subramanian (2015). “Maintenance of certification: the price of medical professionalism is $10,108.05, two weeks leave and five white hairs.” Singapore Med J 56(4): 181-183.