September 21, 2016

ORLANDO, Florida — A physician revolt against Maintenance of Certification (MOC) flared up yesterday here at the American Academy of Family Physicians (AAFP) 2016 Congress of Delegates, but the instigators fell short of achieving one of their prime objectives.

The majority of delegates chose not to demand the end of the mandatory "high-stakes" recertification exam conducted every 10 years by the American Board of Family Medicine (ABFM).

The stakes are indeed high, according to MOC critics. Failing the test can jeopardize one's livelihood, given that a physician's hospital privileges and employment often depend on board certification. And many physicians across multiple specialties say that ongoing MOC requirements have gotten stricter and more expensive but have not improved their ability to care for patients.

Some medical specialty boards — notably the American Board of Internal Medicine — have heeded the complaints and are moving toward shorter, more frequent tests. The ABFM is exploring that approach as well.

The House of Delegates of the American Medical Association (AMA) sought to hasten this process a few months ago, when it passed a resolution calling on specialty boards to retire high-stakes certification exams. However, when a similar proposal surfaced this week at the AAFP Congress of Delegates, family physicians, by and large, held back.

In battles over scope of practice, the AAFP has touted the recertification exam as a way to distinguish its members from nurse practitioners and other nonphysician clinicians. "We take a tough test that other people don't have to," the AAFP has argued.

We take a tough test that other people don't have to.

Since 1969, when the ABFM was founded, periodic recertification has been required. In contrast, until 1990, other medical specialty boards granted lifetime certification.

If the high-stakes test is eliminated, some delegates warned, a "race to the bottom" of clinical standards could ensue.

But the elimination is just acceptance of reality, according to Luke Lampton, MD, a member of the Mississippi delegation, which sponsored the resolution.

The recertification test, he pointed out, contributes to the worrisome problem of physician burnout, so a strong response is required. "If something is causing burnout, we should stamp it out," he said. "We need to stamp out the high-stakes exam."

Most delegates weren't ready to say yes. They approved a version of the resolution that omits the provision targeting the recertification test but preserves other proposed MOC reforms. But delegates referred the issue to the AAFP board of directors for further deliberation, so MOC dissidents came away with a modest victory.

As passed, the resolution urges the ABFM to streamline the entire MOC process and to reduce its annual cost. It also calls on the ABFM to make it easier for family physicians who were once board-certified to re-enter the MOC program.

In addition, the resolution mandates that the AAFP work with the American Board of Medical Specialties, the umbrella organization for all specialty boards, so that it does not hinder the ABFM as it overhauls MOC for family physicians.

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