Radiology Board Plans to Drop 10-Year MOC Exam

Ken Terry

June 01, 2016

The American Board of Radiology (ABR) has announced that it plans to eliminate the requirement that radiologists take an examination every 10 years in order to maintain their board certification.

In a May 18 press release, the ABR said that in the second half of 2018, it will pilot a continuous testing approach that could replace the 10-year exam. If all goes well, the new system will be rolled out to all ABR diplomates "as early as mid-2019," the board said.

According to an article in AuntMinnie.com, an ABR spokesperson confirmed that "the exam is going away."

Although this change will affect only radiologists, it represents another crack in the wall of the maintenance of certification (MOC) regime that the American Board of Medical Specialties (ABMS) and its constituent specialty boards impose on board-certified doctors. In September 2015, a task force of the American Board of Internal Medicine (ABIM), the board that spearheaded the adoption of MOC, released a report calling for major changes in the ABIM's approach.

The task force recommended replacing the ABIM's 10-year MOC exam with "more frequent, less burdensome assessments." These short tests could be taken at home or at the workplace and would be designed to assess competence in "essential contemporary knowledge." The focus would be on cognitive and technical skills rather than on more difficult-to-measure areas, such as communication, teamwork, empathy, and quality measurement, that are part of the current MOC program.

Similarly, the approach that the ABR outlined in its email would focus on weekly emails with links to questions that are relevant to radiologists' areas of practice. The questions can be answered one at a time or in small batches. Radiologists will get immediate feedback on the accuracy of their answers, along with a critique of the answers and educational material.

Radiologists who are due to take their 10-year MOC exams by March 2, 2017, will still have to complete them this year, according to the email. For other ABR diplomates, the exam requirement will be deferred until the new MOC process is available in their discipline, the news release said. But diplomates must continue to meet the board's other requirements for MOC.

Still, "The design of this pilot is a work in progress, and some details, including the launch timeline, may well change over the next year," according to the ABR release.

Rebellion Picked Up Steam

The ABMS and its constituent boards have been under increasing attack over the MOC exams in recent years. The Association of American Physicians and Surgeons in 2013 filed a lawsuit against the ABMS and its member boards, including the ABR, claiming that the boards were using MOC to generate tens of millions of dollars in revenues. That suit is ongoing.

In 2014, the ABIM introduced changes to make MOC activities more continuous, rather than just once-in-a-decade preparations for the recertification exam. Internists rebelled, demanding that the ABIM base recertification solely on the MOC exam.

A 2015 study in the Annals of Internal Medicine calculated that MOC would cost physicians about $5.7 billion over the next 10 years. Only about 10% of that was for exam fees; the rest reflected the amount of time doctors had to spend preparing for the exam and on other MOC activities. The study projected that doctors would have to devote 26% more time on MOC than they were already doing.

MOC proponents argue that the MOC program is necessary to ensure that physicians maintain their medical knowledge. But some primary care physicians have objected that the exam questions are subspecialty oriented and don't test them on the knowledge they need in daily practice.

The pressure on the specialty boards to change their approach has continued to grow. In June 2014, the American Medical Association's House of Delegates voted in favor of assessing the feasibility of a study on MOC's impact on the medical profession. And in October 2014, the American College of Physician's (ACP) Board of Regents said the ACP "does not support using participation in MOC as an absolute prerequisite for state licensure, hospital credentialing, or insurer credentialing."

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