ABIM: Skip 10-Year MOC Exam by Passing Small Ones Online

May 06, 2016

The American Board of Internal Medicine (ABIM) will allow its diplomates to test out of a high-stakes exam every 10 years for maintenance of certification (MOC) by passing more frequent, but shorter, online exams beginning in 2018.

The ABIM plan, floated last year and formally announced yesterday, is the latest reform to its controversial MOC program, criticized by many physicians as a waste of their time and money.

Under the plan, physicians can take a series of short tests, no more frequent than once a year, on a personal computer at their home or office. ABIM would give them feedback on their performance so they can address knowledge gaps. If they perform well on the short tests, they need not take the 10-year exam to remain board certified.

Many physicians have told ABIM that there's nothing more nerve-racking than a daylong test every 10 years that determines whether they get recertified, said Richard Baron, MD, the group's president and CEO, in an interview with Medscape Medical News. And staying certified, after all, is often a condition of employment and hospital admitting privileges. Shorter, more frequent tests will lower stress levels, Dr Baron said. However, physicians who prefer a 10-year recertification exam still have that choice.

ABIM will issue a detailed description of its alternative testing option before December 31 after weighing public comments on the proposal. Initially, the opportunity to test out of the 10-year exam will be available in 2018 only to physicians maintaining board certification in internal medicine and perhaps one or two subspecialties. Other subspecialties will come on line as ABIM fine-tunes the arrangement.

Reforms Haven't Mollified Some Critics

The plan to give physicians a chance to skip the 10-year MOC exam comes on the heels of ABIM's announcement that it is testing the feasibility of an open-bookexam, with "open-book" meaning access to UpToDate, an online information resource for clinicians. Dr Baron told Medscape Medical News that the shorter, more frequent tests available to physicians probably will be open-book.

"We're still gaining experience with open-book in the pilot study," he said. "That will inform how we introduce it in the [alternative] assessments."

ABIM has been relaxing and revising its MOC program over the past 2 years in response to vociferous criticism that its requirements have become too burdensome and clinically irrelevant. Other boards under the umbrella of the American Board of Medical Specialties (ABMS) have drawn similar barbs. Recertification isn't necessary, though, for physicians boarded before 1990, when it was a lifetime credential.

One group of MOC malcontents, led by cardiologist Paul Teirstein, MD, formed a rival to ABMS called the National Board of Physicians and Surgeons (NBPAS), which claims to give physicians a more meaningful and less expensive path to recertification. ( Disclosure: Eric Topol, MD, editor-in-chief of Medscape, is a member of the NBPAS advisory board, an unpaid position.)

Despite all the reforms it's introduced, including the suspension of its unpopular practice assessment, patient voice, and patient-safety module requirements, ABIM still faces widespread animus, as do other ABMS boards. In April, Oklahoma enacted a law that aims to remove MOC as a condition for a physician to obtain a license, get hired and paid, or receive hospital admitting privileges. And Kentucky last month enacted a weaker version of the law that would prevent MOC from ever becoming coupled with licensure. Similar legislation is brewing in other states.

Dr Teirstein, for one, isn't mollified by ABIM's plan to let physicians test out of the 10-year MOC exam. He told Medscape Medical News that he's waiting for more details.

"Will ABIM be replacing one large, aggravating waste of time occurring every 10 years with 10 less aggravating wastes of time occurring once a year?" said Dr Teirstein, chief of cardiology and director of interventional cardiology at the Scripps Clinic in La Jolla, California. "Will the replacement activity improve patient care?"

Will Physicians Pay Less?

Dr Teirstein also wonders whether the test-out path for MOC will reduce the cost to physicians. Like others, he believes that the annual revenue generated by certification and MOC activities — almost $57 million, or 98% of total revenue in fiscal 2015, according to ABIM — is excessive, and creates a conflict of interest for the board.

Dr Baron said it's too early to estimate the cost of continuous testing. "We can't build the fee structure until we build the program structure," he said.

"We're very aware that people are concerned about cost," Dr Baron said. "We will be very mindful of that."

He also described ABIM's reliance on physicians to foot almost all of the group's expenses as a badge of professional independence.

"We don't accept pharma money, or money from industry," he said. "We're proud of the fact that all of the money comes from physicians."

A more important issue than cost, he added, is value — namely, MOC's value as a credential.

"There's a key role for a credential that tells others you're staying current," he said.


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