ABIM on MOC: 'We Got It Wrong'

Alicia Ault


February 03, 2015

UPDATED February 4, 2015 //The American Board of Internal Medicine (ABIM) announced significant changes to its maintenance of certification process today, and it also apologized to diplomates.

"We got it wrong and sincerely apologize," wrote ABIM President and CEO Richard Baron, MD, in a letter to diplomates. "We launched programs that weren't ready and we didn't deliver an MOC [Maintenance of Certification] program that physicians found meaningful," he said in the letter. "We want to change that."

"It's an amazing admission," Christopher J. White, MD, chairman of medicine at Ochsner Medical Center, New Orleans, Louisiana, told Medscape Medical News. "They're humble, and that's not a posture you're used to seeing from ABIM," said Dr White, who was a founding member of Physicians for Certification Change.

The protest against MOC started with a petition drive led by Paul Teirstein, MD, chief of cardiology and director of interventional cardiology for Scripps Clinic in La Jolla, California. The effort has morphed into an alternative certification process under the rubric of the National Board of Physicians and Surgeons (NBPAS), of which Dr Teirstein is now president.

In an NBPAS statement, he said, "[The] press release by the ABIM is clearly a step in the right direction.... However, it must be stressed that the changes disclosed today are only a very partial, incomplete fix. The remaining MOC requirements are still onerous, not clinically relevant and too expensive — and no adjustments to the price structure has been announced.

"Life-long learning does not come in a one size fits all package. No single program will ever meet everyone's needs. NBPAS provides physicians with a much needed alternative," Dr Teirstein concluded.

ABIM is not concerned about other such boards, and the rise of alternatives was not behind the MOC changes, Dr Baron told Medscape Medical News in an interview.

"There have always been other boards," he said. "What distinguishes ABIM is a pretty deep commitment to get a complicated job done right. What we're admitting today is there are parts of it we didn't get right."

2-Year Reprieve

Some of the changes essentially give physicians a 2-year break. MOC enrollment fees, for instance, will be held at 2014 levels through at least 2017.

The biggest relief comes in the form of a suspension of requirements for completing Practice Assessment, Patient Voice, and Patient Safety modules for at least 2 years. These requirements have been attacked as irrelevant by many of the MOC critics.

Diplomates will not see a change in their certification status if they have not completed these requirements. If they are not certified, but have met all the MOC requirements except for the Practice Assessment module, they will get a new certificate in 2015, according to ABIM.

Over the next 2 years, ABIM will be "entering into a conversation with the community about the right way to build the program," said Dr Baron. The idea is to find ways to measure and communicate physician knowledge, skills, and attitudes, he said.

Responding to another frequent complaint, ABIM will be changing the language describing diplomates on its website. Currently, they are listed as "meeting MOC requirements" or "not meeting MOC requirements."

For lifetime certificate holders, MOC is not required, so the language "was inaccurate," Dr Baron said. Now, diplomates will be listed as "participating" or "not participating." The change could take up to 6 months to make, but "I would see that as the outer bounds of how long it's going to take," he said.

ABIM will also now recognize most Accreditation Council for Continuing Medical Education–approved continuing medical education (CME) as counting toward the self-assessment of medical knowledge. ABIM has been awarding points for CME but has also been separately approving various CME products.

From now on, ABIM will not be doing any independent review, said Dr Baron.

Finally, the organization will be updating the internal medicine exam starting this fall and will tweak exams for other subspecialties after that.

MOC Still Here to Stay

Although it is acknowledging mistakes, ABIM has no intention of abandoning MOC. "It remains important for physicians to have publicly recognizable ways — designed by internists — to demonstrate their knowledge of medicine and its practice," wrote Dr Baron in the letter.

There is still a need to create a framework for keeping up in the discipline and being able to communicate to the public and to colleagues that physicians are keeping up, he told Medscape Medical News.

"We apologized because we rolled out a program that wasn't ready, and we're committed to creating one that meets the expectations of internists and the public," he said.

Dr White said it is important that ABIM is rethinking things. "Whether that will be enough or not, we'll have to wait and see," he said. "Some of my partners are telling me it's too little, too late."

Correction: Paul Teirstein, MD, is not the head of Physicians for Certification Change, as originally stated. He is the president of the National Board of Physicians and Surgeons. The text of this article has been updated to reflect this.


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