MOC Critics Offer an Alternative for Board Certification

Marcia Frellick

January 14, 2015

A week after two divergent perspectives on maintenance of certification (MOC) appeared in the New England Journal of Medicine, the author of the opposition paper has offered an alternative route to board certification.

In a press release made available January 14, cardiologist Paul Teirstein, MD, from La Jolla, California, announced a continued certification program offered by the National Board of Physicians and Surgeons (NBPAS) that is less costly and requires a fraction of the time required by the MOC program offered through the American Board of Medical Specialties (ABMS). The NBPAS website lists 11 physician board members.

Initially, NBPAS will certify only physicians in internal medicine specialties and subspecialties and family practice, founding board member Gregg Stone, MD, professor of medicine at Columbia University in New York City, told Medscape Medical News. Other specialties will follow, he said, although he did not specify a time frame.

Cost is $169 for 2-year certification, no matter the number of specialties, NBPAS says. The American Board of Internal Medicine (ABIM) lists recertification costs of $2000 to $2500 over the course of 10 years. The NBPAS website says the application takes less than 15 minutes to complete.

Will Qualifying Bodies Accept It?

However, the value of the new option is unclear. Currently, some hospitals and insurers require physicians to pass MOC, and some physicians see not certifying as a threat to job security.

"This is a grassroots movement which will grow in acceptance relatively rapidly," Dr Stone said. "I state that because of the widespread outpouring of support we've received" for an alternative to MOC.

He said he is confident that the numbers of supporters will change demands of certification. In the press release, Dr Teirstein notes that more than 20,000 physicians have signed an online anti-MOC petition.

"It will be very important that we do establish that a widespread number of hospitals and insurers recognize this alternative method of board certification," Dr Stone said. "I think having societies behind the alternative board...and most importantly tens of thousands of providers behind an alternative to the standard MOC process, will be quite convincing to the qualifying bodies."

He says the requirements for the new certification will demonstrate lifelong learning after original certification, but with less cost and time. Among requirements are that a physician:

  • must have been previously certified by an ABMS member board;

  • must have a valid, unrestricted license in at least one US state; and

  • must have completed a minimum of 50 hours of continuing medical education within the past 24 months, provided by a recognized provider of the Accreditation Council for Continuing Medical Education.

ABMS Draws Distinction Between Groups

Lois Nora, MD, JD, president and chief executive officer of ABMS, noted that the point the groups agree on, based on information in the press release, is that initial certification by an ABMS board is essential.

After that, she drew a distinction between the groups.

"We have been recognized by health systems, hospitals, insurers and the public for decades as the board certification process and now [MOC] process that people place their trust in, and the preeminent forum of professional self-regulation. I think we are a fundamentally different organization," she told Medscape Medical News.

Further, she said, one cannot compare ABMS with "a [MOC] process that requires continuing medical education in an amount less than some states would require for medical licensure."

The ABMS website lists whether a physician is board certified and also lists whether they meet MOC requirements.

"We want to be sensitive to all the burdens physicians are under and make this a program that is meaningful and relevant to them," Dr Nora said. "We believe that it is for many physicians. But first, second, and third, professional self-regulation exists for the people we serve, and those are the patients, the families, and communities."

Caution Warranted if Switching, Some Say

Westby Fisher, MD, an internist with NorthShore University Health System in Glenview, Illinois, and a clinical associate professor of medicine at University of Chicago, told Medscape Medical News that physicians considering the alternate certification should "look before you leap."

Although he applauds the new board's plan, he says it will not pass scrutiny under the Affordable Care Act. He explains his reasoning in a recent blog post: "Unless it contains all of those pieces outlined by ABMS, it will not be a legal entity. Unless we change the law, any subsequent board that tries to replace the current system is not likely to succeed," Dr Fisher writes.

Personally, he says, after passing MOC certification three times, he will not pursue it when his renewal date comes up in 10 years. But he says the new proposal is not a viable alternative.

He says he would encourage physicians to work to "make sure their hospital credentialing boards do not include MOC as a condition of remaining credentialed."

Dr Nora is employed by the ABMS. She is a coauthor on work describing the ABMS MOC program. Dr Fisher and Dr Stone have disclosed no relevant financial relationships.

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