First State Goes MOC-Free, Others May Follow

April 22, 2016

Oklahoma this month became the first state to enact a law aiming to remove maintenance of certification (MOC) as a requirement for physicians to obtain a license, get hired and paid, or secure hospital admitting privileges.

Days before, Kentucky's governor signed a more limited measure that prohibits making MOC a condition of licensure.

Similar laws are brewing in other states as the widespread rebellion against MOC programs operating under the American Board of Medical Specialties (ABMS) takes a more militant turn.

Internists and internal medical subspecialists arguably have been the fiercest critics, protesting that the MOC program of the American Board of Internal Medicine (ABIM) wastes their time and money and does little to nothing to improve their patient-care abilities. The ABIM, in turn, says it's open to reform, but nevertheless wants to promote lifelong learning in its ranks.

Many physicians who detest MOC say they're obliged to participate in it anyway because board certification in their specialty is often a prerequisite for employment and hospital admitting privileges. Physicians who were board-certified before 1990 don't have that problem because their certification is for life.

The Oklahoma law, signed by Governor Mary Fallin on April 12, represents an attempt to decouple MOC from a physician's ability to make a living. It states that nothing in its laws for allopathic and osteopathic physicians shall be construed to make MOC "a condition of licensure, reimbursement, employment, or admitting privileges at a hospital in this state."

How the law changes the professional landscape for Oklahoma physicians remains to be seen. Nothing in it explicitly forbids a hospital from making MOC a condition for admitting privileges. However, the new law could allow a physician to challenge any such requirement "as interfering with the practice of medicine," said Wes Glinsmann, director of legislative and state political affairs for the Oklahoma State Medical Association, which supported the measure.

"We'll see what happens," Glinsmann told Medscape Medical News.

Michigan Bill Is Tougher

Meanwhile, Michigan legislators are considering a tougher version of the Oklahoma law.

The Michigan measure expressly forbids hospitals from denying a physician admitting privileges solely on the basis of MOC. Insurers would face a similar prohibition against making MOC a prerequisite for reimbursement. In addition, Michigan's medical and osteopathic boards could not make MOC a condition of licensure. The Michigan State Medical Society is backing the legislation under the banner of its Right2Care campaign.

Another variant of the Oklahoma law is on the table for the Missouri General Assembly. That measure would prevent Missouri's oversight board for allopathic and osteopathic physicians from requiring MOC for licensure, something that many physicians nationwide fear is taking shape in their state. "Current requirements including continuous education shall suffice to demonstrate professional competency," states the bill, supported by the Missouri State Medical Association.

More broadly, the Missouri bill says the state shall not require any form of board certification or MOC for someone "to practice medicine within the state."

The Missouri bill essentially duplicates the law that Kentucky Governor Matt Bevin signed on April 8. As elsewhere, that state's medical society was a cheerleader for passage.

Hospitals Have Right to Use MOC as Credential, ABMS Says

Lois Margaret Nora, MD, the president and CEO of the ABMS, has mixed feelings about the new Oklahoma law.

Dr Nora told Medscape Medical News that she's not bothered by the law's attempt to keep state licensure separate from MOC. "The ABMS position has always been that MOC should not be a requirement for medical licensure," she said.

What bothers Dr Nora is the idea that hospitals should not be allowed to use MOC as one part of their credentialing process. Hospitals should have that right, she said.

Hospitals, Dr Nora added, did not adopt board certification as a credential simply because the ABMS demanded it.

"They adopted it because they recognized board certification as a quality indicator," she said. "Wouldn't it be a shame if you couldn't have your neurosurgical procedure done at a facility that wanted to say board certification is part of the credentialing process?"

Dr Nora said she interpreted the Oklahoma law as not prohibiting hospitals from considering board certification when they screen medical staff candidates. She didn't want to speculate, though, on how physicians might base a court challenge on the statute.

Dr Nora acknowledged that MOC has sparked pushback in the medical community. Constituent ABMS boards such as the ABIM have revamped their MOC processes in response, she said, drawing positive feedback from many physicians. "We take criticism seriously."

At the same time, the ABMS is not backing down in its defense of MOC and board certification. "Many people rely on it when they choose a surgeon or a pediatrician for their child," she said. "We believe strongly that a rigorous program of MOC is important.

"And many physicians agree with this philosophy. They take great pride that they are maintaining their MOC."

Follow Robert Lowes on Twitter @LowesRobert.

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