Alicia Ault

March 22, 2016

WASHINGTON ― Although other boards continue to tinker with maintenance of certification (MOC) requirements for their physician members, the American Board of Psychiatry and Neurology (ABPN) is not likely to make any major changes anytime soon.

The ABPN has made some changes for 2016 — for instance, making the requirements for Part IV, the Improvement in Medical Practice module, which is also known as the Performance in Practice (PIP) module, more flexible. But nothing bigger is on the horizon, said Jeffrey Lyness, MD, psychiatry director for the ABPN, professor of psychiatry and neurology, and senior associate dean for academic affairs at the University of Rochester School of Medicine and Dentistry, in New York.

He reviewed the MOC requirements for psychiatry and geriatric psychiatry here at the American Association for Geriatric Psychiatry (AAGP) 2016 Annual Meeting.

Psychiatrists Happy

The backlash against the MOC requirements has been especially strong from diplomates of the American Board of Internal Medicine (ABIM), but psychiatry, in general, has not registered as many, or as strong, objections.

"My sense is that overall, our diplomates have been more satisfied than our colleagues," Dr Lyness told Medscape Medical News. "It doesn't mean everybody's happy," he said.

"Over time, it's becoming clearer to people what they have to do, and also, the requirements are getting more flexible," Dr Lyness said.

For the PIP this year, ABPN diplomates can choose either a clinical or a feedback module. In 2015, the clinical module was required, and in 2014, diplomates were expected to do both. "Now it's one or the other," said Dr Lyness.

Psychiatrists can receive clinical module credit for a wide variety of activities, including completing institutional quality improvement (QI) activities that meet ABPN requirements, completing professional QI activities, such as participating in registries, and through meaningful participation in the American Board of Medical Specialties' (ABMS') Portfolio Project.

Feedback module requirements can be met through patient or peer surveys, for example, institutional peer review and supervisor evaluation.

Completing Part IV is a three-step process that includes initial assessment, identifying areas that need improvement and implementing an improvement process, and then undertaking a reassessment.

Another new requirement beginning in 2016 is that psychiatrists who are being certified or recertified must take a patient safety course. The ABPN will list approved courses on its website, said Dr Lyness.

For now, however, the ABPN is not looking at dropping either Part IV or the 10-year recertification examination, he added.

A Matter of Balance

In February 2015, the American Academy of Neurology urged the ABPN to eliminate Part IV, and the ABIM has suspended the requirement entirely. The ABMS has said that Part IV is required of everybody, and yet has done nothing to the ABIM, said Dr Lyness.

"So we've been watching that pretty closely," he said, but the ABPN is not taking any similar action.

"On the one hand, we do not want to jeopardize our certificates by doing something that eventually has the ABMS telling us that we've invalidated our certificates," he said. "On the other hand, if the ABMS is really not going to make Part IV required, we may not want to require it either."

For now, "we're an ABMS member board, and we adhere to the ABMS requirements," said Dr Lyness.

In September 2015, the American Board of Anesthesiology said it was replacing the 10-year examination with an online learning tool that quizzes physicians on a continuous basis. Shortly thereafter, the ABIM said it was considering eliminating the examination and replacing it with a similar model of continuous online testing.

Dr Lyness said that the anesthesiology board had briefed the ABPN on its model, which is "clearly allowed by the ABMS." The psychiatry board is "in concept open to alternatives," he said, but it is investigating how such a test would be administered, whether it would be a reliable measure, and whether a small number of questions every month or every year would be less or more burdensome.

In looking at the MOC overall, "we have to balance credibility with cost and the burden or convenience factor for our diplomates," said Dr Lyness, adding that the ABPN was "trying to steer a reasonable ground."

Dr Lyness reports no relevant financial relationships.

American Association for Geriatric Psychiatry (AAGP) 2016 Annual Meeting: Session 207, presented March 18, 2016.

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