Suspend New MOC Rules, Endocrine Society Urges ABIM

Kathleen Louden

July 28, 2014

The Endocrine Society is asking the American Board of Internal Medicine (ABIM) to suspend its new requirements for maintenance of certification (MOC) until the board analyzes "all possible unintended consequences" of these conditions, according to a statement.

The restructured recertification system, which ABIM implemented this January, places unreasonable financial and time constraints on physicians that could take away from endocrinologists' time with patients and negatively affect patient care, the society contends.

The changes include the need for physicians who are recertifying to pay higher fees and have more frequent participation in MOC activities.

"Endocrinologists have always been advocates for maintaining self-education and practice self-assessment, but some of the changes instituted by ABIM are burdensome to our members," Endocrine Society spokesperson Graham McMahon, MD, told Medscape Medical News.

"We want to make sure the time and effort spent in MOC is educationally effective and productive," said Dr. McMahon, chair of the society's Clinical Endocrine Education Committee and an endocrinologist at Brigham and Women's Hospital, in Boston, Massachusetts.

Accompanying the statement was a copy of a June 5 letter from Teresa Woodruff, PhD, Endocrine Society president at the time, to ABIM president Richard Baron, MD, in which Dr. Woodruff listed concerns about the new MOC requirements on behalf of the society's more than 17,000 members. Besides the alleged potential for reduced access to care when there is already a shortage of endocrinologists, the society claimed there is no scientific proof that mandatory participation in MOC activities improves the quality of patient care.

Dr. Woodruff called for a moratorium in the new requirements while proposing that ABIM research the impact of MOC on the workforce and access to specialty care.

No Suspension Planned

The ABIM, however, will not suspend its new MOC requirements, according to an ABIM spokesperson, William F. Young Jr, MD. Dr. Young is chair of ABIM's endocrine specialty board and a member of the newly created ABIM Council, which oversees all aspects of MOC, as well as chair of the endocrinology division at Mayo Clinic, in Rochester, Minnesota.

"ABIM is truly committed to a continuous MOC program," Dr. Young said when asked by Medscape Medical News to comment on the Endocrine Society's request.

Previously ABIM MOC participants had a 10-year cycle to earn MOC points and could do all of their MOC activities in the year before their recertification exam if they chose, which Dr. Young said was not the intent of the MOC process. Now participants must complete at least 1 MOC activity every 2 years and earn 100 points every 5 years.

Assessment of medical knowledge and performance every 10 years is no longer sufficient in this rapidly changing medical environment, ABIM explains in its MOC program information, citing evidence from the National Research Council.

"This ongoing certification assessment should ensure competency in our medical specialty and demonstrate that a physician is staying up-to-date with medical knowledge and practices," Dr. Young said.

Dr. Young said he understands that busy endocrinologists might feel that MOC adds yet another demand when they must deal with healthcare reform, electronic medical records, required quality-improvement measures, and other changes.

"It's a rocky time in healthcare. No question about it," he said, "But for ABIM, this change was overdue."

Although the number of MOC credits has increased, ABIM estimates that, based on surveys of its members, participants would need to spend 5 to 20 hours a year to meet MOC requirements.

"This is not a massive time commitment," Dr. Young stated.

He disagreed with a claim in Dr. Woodruff's letter that the new program doubled the costs of direct fee payments to ABIM. Only the number of MOC points required has doubled, he said.

The 10-year enrollment fee this year for 1 subspecialty certificate is $2560 (which includes the cost of the secure exam), an increase of $720 from last year's $1840. Unlike previous years, diplomats can pay an annual fee of $256 for a subspecialty and do not have to prepay for 10 years.

In addition, the enrollment fee includes access to all of ABIM's medical knowledge and practice-assessment modules, which can also earn continuing medical education (CME) credits.

However, endocrinologists who complete MOC modules produced by external organizations, such as the Endocrine Society, may have to pay those external organizations fees for them, which has led to complaints from some physicians.

Dr. Young said ABIM recognizes that many organizations do a good job of developing MOC materials. He anticipates that ABIM will expand the range of medical knowledge (MOC Part 2) materials that it accepts for MOC points and is open to exploring its pricing structure.

Reporting MOC Status a Matter of "Transparency"

The Endocrine Society also has asked ABIM to not begin publicly reporting which physicians are "meeting MOC requirements" until 2019.

Previously ABIM announced that those who do not participate in MOC will be listed as "certified, not meeting MOC requirements" until their 10-year certification expires. The same applies to physicians who passed their board exam before 1990 and received a certification that was valid indefinitely under a grandfather clause.

In addition to meeting MOC point requirements, these grandfathered physicians also will need to sit for a recertification exam by the end of 2023 to continue to be reported as "meeting MOC requirements."

The move to public reporting of MOC status stemmed from ABIM's commitment to transparency, Dr. Young said.

This change is likely the reason why MOC enrollment has substantially increased this year, with ABIM reporting that 81% of endocrinologists with time-limited certifications are enrolled in MOC as of May 1 .

MOC is a very expensive undertaking with unclear added benefit to my clinical practice.

One new participant is Marla Barkoff, MD, an endocrinologist at the University of Illinois Hospital & Health Sciences System, Chicago, who obtained her ABIM board certification in endocrinology, diabetes, and metabolism in 2009. Dr. Barkoff told Medscape Medical News that she enrolled in ABIM MOC this spring for the first time.

She said she joined the MOC program partly because of ABIM's decision to publicly report whether its board-certified physicians are "meeting MOC requirements" or "not meeting MOC requirements."

"What impact will MOC reporting have on me as a practicing endocrinologist? No one really knows," Dr. Barkoff stated. "I didn't want to take the chance that not meeting MOC requirements would have a negative impact. I feel I have to participate."

Dr. Barkoff said she supports the need for CME. "But," she commented, "it is unclear what additional benefits MOC activity will have in addition to the 50 annual CME credits I strive to earn each year."

Her main complaint with the MOC program is the cost. Dr. Barkoff said the new option for yearly payments of the enrollment fee made joining the MOC program "more palatable."

However, she objects to paying an enrollment fee on top of the actual costs for education and practice-assessment modules. Because she completes MOC materials and courses through organizations other than ABIM, she must pay for them, since only ABIM's products are included in the program fee. In addition, some of the CME credits she must earn to maintain her licensure in Illinois do not convert to MOC, meaning she must pay to complete both CME and MOC activities.

"MOC is a very expensive undertaking with unclear added benefit to my clinical practice," Dr. Barkoff said.

Apparently she is not alone in her sentiments. A cardiologist-initiated petition for ABIM to recall its MOC changes has obtained nearly 18,000 signatures since it opened March 10.

The Endocrine Society is not the only endocrinology group that has objected to aspects of the new MOC system. On May 12, the American Association of Clinical Endocrinologists adopted a position statement advocating for a new process of certification.

ABIM Feedback Forthcoming

To address concerns raised about MOC, ABIM convened a summit on July 15 with representatives of the Endocrine Society and 25 other internal medicine subspecialty organizations. The recommendations from each society are under discussion by the ABIM executive board, according to Dr. Young.

"All suggestions made will be considered, and communication from ABIM will be forthcoming," he said.

Dr. McMahon said he was encouraged by ABIM's receptivity to listen to the subspecialty organizations. "We are confident that ABIM will find a way to work with us in serving our profession," he said.

Dr. Young is a past president of the Endocrine Society and the current chair of ABIM's endocrine subspecialty board. Dr. McMahon and Dr. Barkoff have disclosed no relevant financial relationships.


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