Physicians Are Outraged Despite ABIM Apology for MOC Mess

Neil Chesanow

Disclosures

February 19, 2015

ABIM on MOC: 'We Got It Wrong'

It's extraordinary when an august and powerful medical board publicly admits to making a major blunder. But that's exactly what the American Board of Internal Medicine (ABIM) was forced to do in early February when physicians across the country, in an equally extraordinary event, rose up in unity and cried "Foul!" at the ABIM's decision to make its maintenance of certification (MOC) requirements even more arduous than they already are.

In response to the tsunami of criticism from doctors, ABIM president and CEO Richard Baron, MD, wrote in a letter to board diplomates: "We got it wrong and we sincerely apologize," as a recent Medscape Medical News report detailed.[1]

The protest against MOC started with a petition drive led by Paul Teirstein, MD, chief of cardiology and director of interventional cardiology at Scripps Clinic in La Jolla, California.[1] 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.

Although it is acknowledging mistakes, ABIM said it has no fear of alternative boards or competing certification processes, and no intention of abandoning MOC.[1] "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.

Few doctors agreed. Medscape received hundreds of comments from physicians, the vast majority of whom expressed outrage at ABIM—as well as other specialty boards—for forcing doctors to jump through an ever-greater number of hoops to maintain their certification, when the doctors are already voluntarily undergoing continuing medical education (CME) to keep their knowledge up-to-date.

"The system isn't focused on relevance but rather on taking money from the pockets of doctors," an anesthesiologist fumed, echoing a common meme among physicians about the mercenary nature of the MOC enterprise. "Why should a successfully practicing physician jump through all these hoops at great expense while disturbing their practice as well as their private life? I've seen many physicians spend countless hours studying for exams while putting their families' lives on hold. We've suffered enough during our initial certification and jumped through all the hoops, only to have to suffer more now."

"It is incredibly good news to see ANY board-certifying agency blink in the face of physician protest," a pediatrician cheered, reflecting the schadenfreude that many doctors expressed. "I wish I were an internist," he wrote. "Pediatricians tend to be such docile and spineless creatures that there has been much less opposition to the American Board of Pediatrics MOC process, which is equally inane and clinically useless. Congratulations to any and all internists who had the courage to oppose the ABIM."

Many doctors who offered comments felt that MOC had more to do with lining the pockets of doctors who were ABIM leaders than with maintaining the quality of patient care. "MOC should be abandoned," a family physician decreed in a much-repeated sentiment. "After years of education, physicians keep up in their discipline through continuing medical education. That was the purpose of CME, wasn't it? MOC has been nothing but meaningless and expensive."

Quite a few doctors wrote that they'd had enough and planned not to maintain their certification. "I agree that the only answer will be not to recertify," an internist concluded. "It is plain extortion. We physicians have to eventually take a stand and reclaim a profession that has been hijacked by greedy payers and con artists posing as our own, like the ABIM."

Some physicians expressed suspicion at the ABIM's mea culpa. "Sounds a little bit contrived," a pulmonologist believed. "What exactly are they apologizing for? I can't seem to figure it out. What we need is affordable, regular, open-book, and shorter examinations relevant to our field of practice. Is this really all that complicated?"

"Reasonable physicians agree that continuing education has value for both patients and practitioners," an internist reflected. "State medical boards require that we demonstrate an ongoing commitment to self-education, not just on general knowledge but also on end-of-life care and controlled-substance prescription. But," he added, "every internist I know views MOC as a transparent money grab (worse for MDs with multiple certifications) with a 'company store' flavor designed to assure additional purchases (eg, MOC courses). A half-hearted apology and delay of irrelevant components shows that ABIM leadership remains more tone deaf than responsive to the needs of members whom they supposedly 'represent.'"

Other doctors took umbrage with having to submit to any sort of periodic test. "I have to put my practice essentially on hold for 6 months to start studying for my interventional cardiology board recertification exam," a cardiologist lamented. "Absolutely and wholly unnecessary. Unlike some, I have been plagued my whole life by 'standardized' tests. I am not a good test taker. According to my patients and my hospitals, however, I am a pretty good doctor."

He was far from the only doctor to question the usefulness of the MOC exam. "Taking a secured 8-hour exam on topics we rarely see and then having to make a treatment decision in 2 minutes or less is not how medicine is practiced in the real world," commented an internist, speaking for many.

A number of doctors pointed out that the hassle of MOC compliance would be likely to contribute to the physician shortage. "With a significant number of older (read: without 'lifetime' certification) physicians looking at the direction medicine is taking and considering early retirement rather than continuing to practice, the ABIM will serve to make the physician shortage more acute," an internist observed. "With the aging of the population, internists will be increasingly vital to the nation's health care. The ABIM got it wrong, but they get their money from the MKSAP [Medical Knowledge Self-Assessment Program], the review courses, and then, of course, the MOC tests. Self-serving."

"Way too little, way too late," wrote a family physician, summing up the general consensus among the doctors who contributed comments. "Minor changes, proposed to placate the masses? Lifetime certificate holders are exempt? The good old boy network is alive and well."

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