Heart Societies Ready to Split From ABIM Over Long-Standing MOC Disputes

September 22, 2023

What if cardiology were no longer an internal medicine subspecialty? Four leading cardiology societies have announced plans to create a new certification process that is independent of the American Board of Internal Medicine (ABIM) maintenance of certification (MOC) system.

As envisioned, the new "independent, self-governed" entity would supplant the ABIM's long-standing and widely criticized MOC system and establish cardiology as its own specialty with its own subspecialties. Long in coming, it is only the latest response to many in the field who for years have charged that the MOC system is needlessly burdensome and expensive.

"It's time to have a dedicated cardiovascular medicine board of our own," said B. Hadley Wilson, MD, in the group's announcement. "Cardiology is a distinct medical specialty, and physicians want and deserve a clinical competency and continuous certification program that is meaningful to their practice and patients."

Hadley Wilson, Sanger Heart & Vascular Institute Vascular Kenilworth, Charlotte, North Carolina, is president of the American College of Cardiology (ACC), one of the four societies spearheading the initiative along with the Heart Failure Society of America (HFSA), the Heart Rhythm Society, and the Society for Cardiovascular Angiography & Interventions.

Their September 21 statement says that the consortium will apply to the American Board of Medical Specialties (ABMS) to request an independent cardiology board that follows a "new competency-based approach to continuous certification — one that harnesses the knowledge, skills and attitudes required to sustain professional excellence and care for cardiovascular patients effectively."

It continues, "The new board requirements will de-emphasize timed, high stakes performance exams in the continuous certification process and instead will focus on learning assessments to identify gaps in current knowledge or skills."

"The new board's focus on competence in the pursuit of continuous certification is a needed paradigm shift for the field," states HFSA President John R. Teerlink, MD, University of California, San Francisco, and the San Francisco VA Medical Center, in the announcement.

"I commend these professional cardiovascular societies for taking on this important challenge," Deepak L. Bhatt, MD, MPH, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York City, told theheart.org | Medscape Cardiology by email.

"This is an incredible opportunity to redefine what ongoing cardiovascular education means to the contemporary practicing cardiologist in a way that is relevant to improving the care of actual patients," said Bhatt, who chairs the ACC Accreditation Oversight Committee.

"There needs to be an agile, personalized, convenient, and effective system to assist practitioners to stay current with new knowledge and demonstrate the necessary competencies," Harlan Krumholz, MD, told theheart.org | Medscape Cardiology in an email.

"There is a deep sense in the profession that the current approaches do not meet the needs of clinicians or society," said Krumholz, Yale School of Medicine, New Haven, Connecticut, who has sat on the ABIM board of directors.

"This effort, which now will create competition, has the potential to spark innovation," he said. "The key is that any approach needs to ask the question, Is the cost and effort producing benefit for patients and society? If it is not, we have not found the right system."

In a statement in response to the new development, ABIM said it plans to continue "offering and administering" its existing MOC programs across all specialties.

"Any physician choosing to maintain their ABIM certification in these disciplines will continue to have a pathway with ABIM to do so," it says. "Questions about the cardiovascular organizations' announcement and how it may affect individual physicians are best answered by those organizations."

The process of approving the heart societies' application to ABMS "is expected to take several months," their announcement states. If approval is granted, "it will then take several additional months before initial certification and continuous certification and competency programs would begin."

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