ABIM Suspends Controversial MOC Requirements Through 2018

December 16, 2015

In a policy retreat longer than Napoleon's march from Moscow, the American Board of Internal Medicine (ABIM) once again has relaxed its controversial requirements for maintenance of certification (MOC).

ABIM announced today that it is lifting the requirement that physicians earn MOC credits for improving patient care and safety and incorporating their preferences in medical decision-making for an additional 2 years. The three MOC activities in question go by the name of Practice Assessment, Patient Safety, and Patient Voice. The organization told diplomates in February that they won't have to complete these requirements, widely lambasted as busywork, for at least the next 2 years. The latest decision extends the suspension through the end of 2018.

In a news release, ABIM stated that it based its decision on feedback from internists and internal medicine subspecialists and the organization's commitment to "recognizing meaningful activities physicians are already doing in practice." To make its requirements less burdensome to diplomates, ABIM has been approving more continuing medical education activities undertaken apart from recertification as counting toward MOC credit.

Today's announcement follows a string of ABIM concessions to opponents over the past year. In June it said that it would update its recertification exam. A month later, ABIM said that physicians certified in nine IM subspecialties would no longer have to maintain underlying board certifications. In perhaps the biggest bombshell of the year, ABIM said in September that it would consider replacing its 10-year MOC exam with shorter, more frequent testing that physicians could take at home or in the office. The 10-year exam is unpopular because flunking it can endanger a clinician's hospital privileges and employment, which often hinge on board certification.

Criticism of ABIM's MOC program came to a full boil in 2014 after the recertification process sped up that year for physicians with a 10-year certification. Before 2014, they could earn MOC credits for exercises in lifelong learning and self-assessment, testing, and practice improvement in the year before their 10-year recertification exam. Since 2014, they have had to earn points for accredited education modules on a continual basis — at least 10 every 2 years and 100 every 5 years.

The revolt against the new rules led to the formation of a rival recertification body called the National Board of Physicians and Surgeons (Disclosure: Eric Topol, MD, editor-in-chief of Medscape, is a member of the NBPAS advisory board, an unpaid position.)

The group's president, cardiologist Paul Teirstein, MD, told Medscape Medical News that suspending the requirement for Practice Assessment, Patient Safety, and Patient Voice activities for 2 more years is a positive change, but that ABIM should eliminate it altogether.

"It's pretty meaningless," Dr Teirstein said. "It sounds good on paper, but it doesn't help anybody. Most physicians are doing practice improvement through other mechanisms."

ABIM's MOC program still remains too complicated and expensive, he said. "We are still looking for a very simple, non-onerous method of pursuing lifelong learning."

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