Changes Coming to MOC: Will Physicians Get Relief?

Leigh Page

Disclosures

June 05, 2018

In This Article

A Push to Focus Beyond Subspecialty Level

Now subspecialty groups are asking for exams that focus on fields within their subspecialties. The American College of Cardiology (ACC) and the American Society of Clinical Oncology (ASCO) have been making this request to the ABIM, a Medscape article reported in 2017.[40]

For example, the ACC wants exams targeting cardiology subspecialties like interventional cardiology, electrophysiology, advanced heart failure cardiology, transplant surgery, and adult congenital heart disease, the article reported.

Slicing and dicing the test too much, however, could harm its validity. The Medscape article paraphrased Richard Baron, MD, president of the ABIM, saying: "ABIM can't subdivide its assessments into too many categories with too few doctors in each. Instead, he said, the board might work with the medical societies to pick three or four major subfields in each subspecialty and build assessments by tapping their societies' knowledge of those domains."

Since the Medscape article, the ACC, ASCO, and ABIM do not seem to have made any further public comments on plans for more focused testing.

Exams Can't Focus on Your Particular Practice

The ideal exam would measure what each physician is actually doing in his or her practice and then put together a test to reflect that knowledge. But no board is doing this, and they may never do so. That is, physicians may always have to deal with MOC questions that have nothing to do with what they do in actual practice.

For example, Hingle says that she would prefer to take an exam covering just the outpatient setting, where she works, but the ABIM's general internal medicine exam forces her to answer many questions about hospital-based practice, and this is confusing. "Treatment in the outpatient setting can be very different from the hospital setting," she says, citing different ways to treat high blood pressure and heart failure.

Hawkins, the new ABMS leader, addressed this issue as leading author of a 2016 article, written when he was still at the AMA.[39] Theoretically, boards could offer practice-specific testing, the authors wrote, but it would very difficult. For instance, boards would have to identify each physician's scope of practice and then "decide whether this scope is limited to common, or includes infrequent, conditions."

This would pose "significant challenges for test construction, delivery, and standard-setting," they concluded. "The process would be expensive, and attaining a sample large enough to set performance standards or to provide meaningful feedback data would be prohibitively difficult."

Instead, the authors proposed "a modular approach" that offers "a set of different examinations reflecting usual variations in practice." Some boards are taking that approach.

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