Perception of MOC Among US Physicians: Low Value, High Burden

Jennifer Garcia

October 11, 2016

US physicians are dissatisfied with current maintenance of certification (MOC) programs, and most feel MOC activities are a burden, according to a new cross-specialty survey published in the October issue of the Mayo Clinic Proceedings.

"In this national survey of US physicians, we found that physicians perceived that current MOC activities have little relevance or value and are neither well-supported nor well-integrated into their clinical practice," write David A. Cook, MD, MHPE, from the Mayo Clinic, Rochester, Minnesota, and colleagues.

The researchers surveyed US physicians between September 23, 2015, and April 18, 2016, using a two-tiered, self-administered, internet or paper questionnaire. Primary items addressed included value, relevance, integration, support, comprehensiveness in addressing professional development needs, overall burden, certification board financial interests, and public or patient attention to certification status. Secondary items centered on the value of MOC-related activities in supporting professional development and effect on patient safety.

The researchers reported a 21.6% response rate among the 4648 survey invitations sent and note that demographics were similar between respondents and nonrespondents. Approximately 99% of respondents had current board certification; the researchers excluded those without board certification from the analysis.

The authors found that 24% (200 of 842) of physicians agreed that "MOC activities are relevant to their patients, and 15% [122 of 824] felt they have value."

However, only 12% of respondents felt that MOC activities are well-integrated into their daily routine, and 81% indicated that they believed MOC activities to be a burden. The researchers found no association between attitudes regarding MOC and burnout, compensation model, certification status, practice size, location, or time since completion of training.

In addition, although attitudes varied statistically significantly (P < .001) across specialties, a low perceived relevance and value of MOC activities was noted in nearly all specialties.

"Physicians' perceptions must be counterbalanced by societal demands for competent physicians and high-quality care and for public accountability in this regard," write Dr Cook and colleagues. "Although limited research suggests that MOC helps to achieve these goals, the extent and value of these benefits remain controversial," they add.

In an accompanying editorial, James C. Puffer, MD, ABFM, from Lexington, Kentucky, writes: "The authors are to be applauded for the rigor of their study design and methodological approach, the meticulous design of their survey instrument, and the robust analysis of their data."

Dr Puffer acknowledges that methodological issues inherent in the study design may limit the ability to accurately interpret the results, but emphasizes, however, that these findings indicate a need for action that should not be ignored.

"The data suggest that displeasure with MOC is prevalent and that no single member board appears to be immune," he notes.

Dr Puffer specifically notes that 88% of respondents felt that MOC activities are not well-integrated into daily routines. Physicians are already encumbered by an ever-evolving medical delivery landscape, "and the last thing that they want to do is spend additional time, meeting yet another set of requirements that they find burdensome," he writes. "It is imperative that [American Board of Medical Specialties] member boards take these issues into account and redesign their MOC programs to become more efficient, meaningful, and impactful," he concluded.

The authors have disclosed no relevant financial relationships. Dr Puffer has disclosed that he is employed as president and chief executive officer of the American Board of Family Medicine.

Mayo Clin Proc. 2016;91:1325-1327, 1336-1345. Article full text, Editorial full text

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