AMA Sings Same Tune as MOC Critics

December 09, 2014

A grassroots rebellion in medicine against maintenance of certification (MOC) programs received support from the American Medical Association (AMA) last month when its House of Delegates voted to make MOC more physician-friendly.

Critics of MOC programs operated by members of the American Board of Medical Specialties (ABMS) call them expensive, time-consuming exercises in busywork. Specialty boards such as the American Board of Internal Medicine (ABIM) defend MOC as a way for physicians to demonstrate to the public that they are keeping up with their chosen field. ABIM's MOC program in particular has come under fire this year. More than 19,000 physicians have petitioned the board to rescind new requirements for physicians with 10-year board certifications to earn credits for lifelong learning and self-assessment, testing, and practice improvement every 2 years, which is a faster pace than before. The petition demands that the ABIM base board recertification simply on an exam every 10 years.

Before the House of Delegates' meeting last month in Dallas, Texas, the AMA already was on record as sympathizing with the critics. Its official principles on MOC stated that "any change in the MOC process should not result in significantly increased cost or burden to participants." In addition, time demands of MOC "should not reduce the capacity of the overall physician workforce."

In June, during the AMA's annual convention in Chicago, Illinois, the House of Delegates rejected a proposal to declare a MOC moratorium until research showed that the process improved patient care, Family Practice News reported. The delegates did agree to continue deliberating on complaints about MOC programs, however. Four months later, in Dallas, they adopted additional MOC principles that reflect concerns raised by many physicians. The principles, set forth in a resolution, read as follows:

  • MOC should be used as a tool for continuous improvement.

  • MOC activities and measurements should be relevant to clinical practice.

  • MOC should be based on evidence and designed to identify performance gaps and unmet needs, providing direction and guidance for improvement in physician performance and delivery of care.

  • Actively practicing physicians should be well-represented on specialty boards developing MOC.

  • The MOC process should not be cost prohibitive or present barriers to patient care.

  • The MOC program should not be a mandated requirement for licensure, credentialing, reimbursement, network participation, or employment.

  • The MOC process should be evaluated periodically to measure physician satisfaction, knowledge uptake, and intent to maintain or change practice.

  • Specialty boards, which develop MOC standards, may approve curriculum, but should be independent from entities designing and delivering that curriculum and should have no financial interest in the process.

Approved on November 10, the resolution also calls on the AMA to work with the ABMS to eliminate assessment modules on practice performance, as currently written, from MOC programs. Physicians consider these modules, which require them to complete a quality-improvement project, to be especially difficult and frustrating.

Although the AMA delegates cast a critical eye at MOC programs, the association affirmed MOC goals. "AMA policy supports physician accountability, life-long learning, and self-assessment," stated a recent article in AMA Wire, the group's online news publication.

The ABMS Says It Is Responding to Complaints

Paul Teirstein, MD, the cardiologist in La Jolla, California, who organized the petition drive on the ABIM's MOC requirements, said the revised AMA position "is a step in the right direction."

"Most of the policies will resonate well with practicing physicians," Dr Teirstein told Medscape Medical News. "I wish they had gone further and adopted the policy of [continuing medical education] replacing MOC."

For its part, the ABMS has been addressing the AMA's concerns about MOC, according to Mira Irons, MD, the organization's senior vice president for academic affairs. In January 2014, the ABMS board of directors adopted new standards for MOC developed after 2 years of deliberation and mirroring comments from more than 600 individuals and groups.

"The comments pretty much aligned with what was in the AMA resolution," Dr Irons told Medscape Medical News. "There wasn't anything in the resolution we hadn't heard before."

The new MOC standards, which take effect in January 2015, ask specialty boards as they operate MOC programs "to be mindful of burden and cost, and also to ensure that they are relevant to a physician's practice," she said.

Dr Irons said that contrary to what some physicians believe, the ABMS has never asked anyone to make MOC a condition of licensure. "That is a misconception," she said. The ABMS has nothing to do, she added, with hospitals and third-party payers requiring MOC for their own special purposes. Those are "decisions that they make for their own organizations," said Dr Irons.

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