Changes Coming to MOC: Will Physicians Get Relief?

Leigh Page

Disclosures

June 05, 2018

In This Article

Allowing Attestation

Some boards are making it easier for physicians to report CME and other activities without having to provide documentation. Here are some examples:

ABR. Beginning in 2016, physicians only need to attest "yes" or "no" to meeting each of the four requirements of MOC.[52]

ABPN. It now allows physicians to attest completion of MOC requirements without providing documentation.[33]

ABOp. Physicians can use the link on their MOC Status Page to attest to meeting CME requirements for CME. The board reserves the right to verify completion of CME by asking for documentation.[53]

ABNM. The board allows physicians to attest that they are meeting requirements without documentation requirement.[33]

Unresolved Issues

There are "grandfathered" physicians in most specialties—older doctors who don't have to go through the MOC process because they received their certificates before recertification started.

This unequal treatment has created cynicism among many physicians about the MOC. "The exemption of people who are the farthest out from formal training pokes a big hole in the narrative here," wrote a dermatologist commenting on a 2017 Medscape article on MOC.[45]

In 2014, the boards tried to prod older doctors to have some skin in the game by reporting them as "meeting" or not meeting MOC requirements. This change angered older doctors, who thought they'd never have to worry about participating in MOC.

Facing protests from older doctors, the boards changed the designation to "participating" or not participating in MOC. The change may not have satisfied anyone, but it may be as good as it gets.

Another unresolved issue about MOC is that it's supposed to be voluntary, but it really isn't. Hingle notes that if you're not MOC-certified, "you'd be in danger of losing your job" at hospitals in Springfield. McDonald says that even his own practice "requires that physicians maintain their boards."

This problem prompted legislators to pass laws barring hospitals and others from using MOC status for privileges and other matters.

Boards Under Enormous Pressure to Change

The next few years will be a crucial time for the MOC. As the boards introduce the new reforms, they will have to convince physicians that the new process is useful and not overly time-consuming.

It is no secret that the boards have been under unrelenting attack from many physicians who are unhappy about MOC. "People basically think [the MOC] is one big money-making racket for the certifying organization," a pulmonologist told Convene magazine.[54]

In an extraordinary action in 2016, trustees of the Pennsylvania Medical Society adopted a vote of no confidence against the ABIM and called for the entire leadership of the board to step down. The medical society stated that the ABIM process is "punitive," "needlessly time-consuming and takes physicians away from their patients," and "exorbitantly and unnecessarily expensive."[55]

Meanwhile, physicians' campaign against the MOC in state legislatures has been quite successful. So far, at least nine states have passed laws that bar hospitals, insurers, or licensing boards from requiring MOC participation, and there are active bills in 17 more states, according to a February 2018 report.[56]

The Texas bill, which had the support of the TMA, passed in June 2017 and became effective on January 1, 2018. The law leaves it up to each hospital medical staff to decide if ABMS recertification is required for privileges.[57]

Many doctors lobbied for the bill. Monday, the Houston neurologist, spent many days in the state capital working to pass the bill. "I was angry that physicians were being forced to go through a process that was supposed to be voluntary," Monday says.

The ABMS and its boards lobbied vigorously against the Texas bill and were very disappointed in the outcome. "This legislation establishes dangerous precedent by allowing the state to interfere with physician professional self-regulation," the ABMS said in a statement after the bill passed.[58]

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