MOC Exam: Take It or Not?

Shelly Reese


August 03, 2016

In This Article

The Power of Certification

Dr Meghan Edison, a pediatrician in Grand Rapids, Michigan, understands the power of insurers all too well. Dr Edison, who earned board certification in 2003 and is NBPAS certified, made a very public decision not to renew her MOC. In December she wrote an open letter to the American Board of Pediatrics (ABP) explaining that she was giving up her certification and posted it on her website. Although she had completed the board's proprietary CME modules and passed the MOC exam, Dr Edison opted not to write the $1300 check that would complete the recertification process.

"I really don't think the ABP will be able to end MOC until we are allowed to stop participating," she wrote. "In order for us to stop participating, we have to conquer the one thing that keeps us in compliance: fear." Within 2 months, she says, Blue Cross Blue Shield of Michigan/Blue Care Network called to say that she could no longer see BCBS/BCN patients. After pushing back and demanding written notification, the insurer agreed to grant her a grace period to complete her recertification, she says.

"I have until December 31 to comply and pay the ABP $1300—plus a $200 late fee—or I won't be able to see my patients," she says. Dr Edison knows that she may have to pony up and recertify. She's hoping that legislation currently under consideration in Michigan, which would prevent insurers from using MOC as a condition of payment, will pass before then.

Still, she says, her predicament makes her point eminently clear. "If your hospital privileges or your insurance are tied to MOC, it's not voluntary. Maintaining your certification should be such a minor thing, and yet it's become quite powerful. How did this happen?"

What Does the Future Hold?

While many physicians like Dr Edison wonder how the situation arose, perhaps even more wonder where it is headed.

Dr Jonathan Weiss, an internist in Monticello, New York, who is ABIM and NBPAS certified, opted to let his ABIM subspecialty certifications in critical and pulmonary care expire rather than face yet another round of "ridiculous tests that were just a waste."

The consequences, he says, were swift. In addition to clinical care, Dr Weiss used to perform about a half dozen independent medical examinations for private companies each month. "When my pulmonary certification expired on December 31, 2015, all of those private companies told me they couldn't use me anymore." The reason? "Their client businesses are lawyers and the clients wanted the certification." When he informed the companies that he was certified by the NBPAS in pulmonary care, "they basically said, 'That's interesting,' but they haven't reinstated me."

Dr Weiss says that despite the financial hit he has taken, he has no regrets. "The burden of maintaining certification was just too oppressive." That said, he's glad his underlying internal medicine certification remains in place for the next 6 years.

Deciding on whether to recertify with an ABMS board "is a very personal choice and one with not a small degree of personal professional danger," he says. "We encourage mass noncompliance, but of course that's a bold step and not everyone is going to do it."

In fact, many staunch MOC opponents acknowledge that noncompliance represents a professional risk they simply can't take.

The Reality of the Situation?

Dr David Siegler, a pediatric neurologist in Tulsa, Oklahoma, who introduced anti-MOC resolutions at the Oklahoma State Medical Association that later shaped the state's anti-MOC legislation, admits that he would be uncomfortable giving up his American Board of Psychiatry and Neurology (ABPN) certification at this point.

Although in April Oklahoma became the first state to pass legislation preventing MOC from being required for a license, hospital privileges, insurance reimbursement, or employment, some hospitals in the state are pushing back and insisting that they can use MOC as a condition for privileges and employment, says Dr Siegler, who is also certified by the NBPAS.

Until lawyers thrash out the reach of the new law, "I would hate to encourage someone to not take the test," he says. "As much as I want mass noncompliance, I know that for an individual it really hurts" to suffer the potential professional consequences.

For the moment, he says, "This is a hoop that we must jump through that really determines our ability to practice as physicians and that holds us hostage for payment and for staff privileges."


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