ABIM and MOC: ACP Helps Physicians Fight Back

Sandra Adamson Fryhofer, MD


October 15, 2014

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Hello. I'm Dr Sandra Fryhofer. Welcome to Medicine Matters. The topic: MOC, and complaints about the American Board of Internal Medicine's (ABIM) maintenance of certification (MOC) program for internists. Leaders of the American College of Physicians (ACP) speak up for physicians. Here's why it matters.

ABIM was created in 1936. The goal: to distinguish internists who met peer-reviewed, established standards from those who could not or chose not to do so. That same year, the first ABIM examination was administered. In 1986, the ABIM board of directors voted to end lifetime certification. In 1990, all new ABIM certificates were limited to 10 years.

In 2005, self-evaluation—a practice assessment—became a requirement for MOC. Several practice improvement modules (PIMs) were introduced. In 2010, MOC credit was given for involvement in quality improvement activities. In 2014, ABIM introduced what they call "a more continuous" MOC process, a process that ACP leadership describes as the straw that broke the camel's back.

In an editorial[1] in Annals of Internal Medicine, leaders challenge ABIM's new MOC process as being time-consuming and costly, with unclear benefits to patient care. Many internists consider the MOC process as busy work that depletes time, money, and the joy of practicing medicine. Many also question the value of the secure exam as not relevant to their personal practice or to how medicine is currently practiced.

Understand that the first-time failure rate of this expensive, high-stakes exam has increased from 10% to 22% over the past 5 years. The editorial says the current process puts too much focus on metrics, administrative process, and finding substandard doctors that in theory place the public at risk, instead of encouraging ongoing education and professional development.

There is also concern that the substantial time spent on ABIM MOC could be better spent on other, more educationally sound activities. ABIM had the chance to defend their view of evolving professional self-regulation in an editorial[2] in the same Annals edition.

These editorials appeared in May 2014—the same month that ACP, on behalf of 14 medical societies, sent a formal letter to ABIM outlining their many concerns. ACP has thrown down the gauntlet, and the heat is on.

On August 7, 2014, ACP's Executive Vice President and CEO, Steve Weinberger, sent a letter to all ACP members informing internists that ABIM had agreed to make at least some changes to the MOC program regarding the secure exam. These include lowering the retake cost; changing the patient survey to a patient voice requirement; and forming a new ABIM committee to look at expanding MOC options for clinically inactive and less clinically active physicians, including researchers, academicians, and administrators.

The letter also clears up some confusion about certification and licensure. It states that ABIM has clarified it does not believe MOC should be required for maintenance of licensure (MOL), but it does believe a physician who chooses to engage in MOC should be exempted from any additional MOL requirements.

On August 15, 2014, more news from ACP—this time about the confusing way in which ABIM reports whether a diplomate is participating in the MOC program. Their current wording is: Meeting maintenance of certificate requirements: Yes/No. This statement is especially confusing for those with time-unlimited certificates, the so-called grandfathers or grandmothers. Physicians with time-unlimited certificates could be listed as certified but not meeting requirements. Requirements? The use of the word "requirements" is problematic because MOC participation is voluntary. ACP thinks the word "requirements" should be removed.

Pressure from ACP may be helping. ABIM now admits this language does seem to be causing legitimate confusion. Duh. ABIM says it's now exploring what changes to the reporting language can be made.

This is why physicians need organized medicine—to speak with one collective voice on their behalf. This fight is far from over, and one can only hope that continued dialogue between ABIM and ACP can bring about new change. Let's hope ABIM listens.

For Medicine Matters, I'm Dr Sandra Fryhofer.


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