The ABMS reports that some 500,000 physicians are engaged in MOC. Many have spent this year talking about how much they dislike the program.
In June, physicians at the American Medical Association House of Delegates meeting railed against MOC as too time-consuming, too expensive and having too little value. They called on the AMA to explore conducting a study to evaluate the impact MOC is having on workforce, practice costs, and patient outcomes, safety and access.
The American Board of Internal Medicine, the largest specialty board, with more than 200,000 doctors certified in internal medicine and 20 subspecialties, has been the target of physician wrath this year. An online petition to return certification to a once-every-10-years process was posted in March and has since collected almost 18,600 electronic signatures.
In May, the American Association of Clinical Endocrinologists issued a statement (PDF) expressing its support for lifelong learning. But the statement also noted the AACE's initial reservations about MOC 13 years ago and said how its opinion of it now is even lower.
“Physicians who have gone through MOC have found it to be of little value,” the AACE stated. “AACE believes that ABIM MOC requirements place an undue burden of time and energy on the practicing physician, taking the physician away from patient care, in pursuit of an activity with no proven benefit to physician or patient. AACE strongly discourages connecting ABIM MOC with hospital privileges, maintenance of licensure or insurance credentialing.”
It also noted that the process is irrelevant to patients.
“Independent surveys indicate that most patients do not understand the concept of an independent certifying organization outside of state medical licensure,” the AACE stated. “Patients largely choose their doctors based upon recommendations from others including other doctors.”
This last statement might be outdated, according to the ABMS. It reported that it receives more 1 million annual visitors to its Certification Matters website which allows patients to check their doctors' certification status.
The AMA also went on record as opposing any attempts to make MOC participation a requirement for medical license renewal. But Dr. Mira Irons, the ABMS senior vice president for academic affairs, said the ABMS opposes this, too.
“We never wanted that MOC should be a requirement for licensure,” she said.
The ABMS goal is to align MOC requirements with any continuing medical education or state licensing criteria other regulatory bodies may demand of physicians. So, while MOC participation would never be mandatory in itself, Irons said, MOC participation “sets a higher bar” and would ultimately fulfill any continual-learning obligations other regulatory boards would require of physicians.
“Physicians themselves like to keep up,” Irons said. “We're lifelong learners by nature.”
MOC standards continue to evolve and the ABMS is listening to the feedback it receives, Irons said. The ABMS received some 600 comments on its new standards (PDF) being implemented in 2015.
“The boards do constantly review MOC programs to see that they're doing what they were intended to do,” Irons said, noting that the goal is to strive to make the program increasingly relevant while also being more convenient with its testing locations and less burdensome in terms of time consumption.
To facilitate this, the ABMS and the Mayo Clinic developed the Portfolio Program, which the ABMS describes as an initiative by which organizations can “sponsor and support multiple well-designed quality-improvement efforts involving physicians across multiple disciplines.” Doctors can then work with their institution to satisfy the MOC program's “Part IV” requirements for quality improvement by doing a project in their own practice setting.
“It addresses the relevance question,” said Dr. David Price, who was named director of the Portfolio Program in June. “The projects are based on the population of patients they're taking care of.”
Price, also director of medical education for the Colorado Permanente Medical Group in Denver and the Permanente Federation in Oakland, Calif., said 1,400 Kaiser doctors are working on 60 quality-improvement projects that satisfy MOC criteria.
He acknowledged that physicians at large organizations have an advantage because they can rely on an internal information technology department for support and data extraction.
Much of the criticism of the ABMS and its MOC program involves confusion over the role medical specialty boards play, said Dr. Peter Angood, president and CEO of the American Association for Physician Leadership (formerly the American College of Physician Executives).
“The role of the 24 specialty boards is to protect the public and not to be advocates for the physicians they certify,” Angood said.
Follow Andis Robeznieks on Twitter: @MHARobeznieks