MOC Exam: Take It or Not?

Shelly Reese


August 03, 2016

In This Article

Physicians Are Looking for Answers

"I have doctors call me at least once a week and ask, 'What should I do?' and I don't know how to answer," says Dr Paul Teirstein, chief of cardiology at the Scripps Clinic in San Diego, California, and president of the National Board of Physicians and Surgeons (NBPAS), an alternative certifying body. Today the fledgling organization certifies 3900 physicians and is growing at a rate of about five physicians per day, he says.

For his part, ABIM President Dr Richard Baron argues that, although changes are forthcoming, the situation is still clear for physicians facing near-term recertification: They should take the exam. The MOC program is constantly evolving, he says. "The exam is a living document. If you are taking it in the next year it may well have different features than it had before, and 2 years from now there will be different options as well."

The ABIM is tweaking the MOC exam process. It is currently piloting an open-book approach and in January 2018 will begin offering physicians a choice between the 10-year exam and shorter, more frequent assessments. But those down-the-line changes shouldn't have any bearing on physicians' attitude toward the test in the meantime, Dr Baron says.

"Any innovation is going to take time and is not necessarily going to be better than what went before," he says. "For those whose certification expires this year or in 2017, they should log into their status page at and it will tell them what they need to do under today's rules. We have a program in which we have confidence and which we stand by."

Is It Really Voluntary and Optional? Most Say No

For physicians who simply can't stomach the prospect of sitting for another MOC test, the options and consequences are murky.

Not all hospitals require board certification. In the United States, 19% of licensed physicians are not board certified, Dr Baron says. That means roughly 1 in 5 US physicians makes a living without board certification—evidence, he says, that certification is both voluntary and optional.

To date, 40 hospitals that do require certification have been willing to accept NBPAS certification as an alternative.[1] NBPAS requires doctors to obtain initial board certification from the ABMS or American Osteopathic Association and to provide evidence of 50 hours of continuing medical education (CME) during the previous 24 months.

For many doctors "it has not been an issue," says Dr Teirstein, "but for some it has been a very painful problem." Some hospitals have refused to reappoint physicians who do not maintain ABMS-member board certification, he says, noting that the root of the problem often lies with insurers.

"The number-one reason we have for hospitals not accepting the NBPAS alternative certification is provider contracts with insurers that require physicians to be American Board certified," he says. "That's a stumbling block. We've contacted insurers and they don't have any time for us. Basically it's not an issue that's on their radar or that they care about. They see this as a doctor issue."


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