The American Board of Internal Medicine will be reinstating the certification of doctors who have recently passed the certification exam but had not been participating in the ABIM maintenance of certification (MOC) program.
ABIM President and CEO Dr. Richard Baron said the new annual MOC payment option resulted in recently certified physicians losing certification because they had not enrolled or paid for the MOC program in years when there was no requirement to do so.
“This policy had a particularly adverse effect on those who just completed training or were engaged in fellowship,” Baron wrote in a blog item posted Tuesday. “That did not seem right to me, to our Board, or to many other members of the internal medicine community.”
Newly certified physicians still must complete MOC requirements within five years to keep their certified status, Baron told Modern Healthcare, explaining that those who have not enrolled in the program will be publicly reported as “certified, not participating in maintenance of certification.”
The American College of Cardiology hailed the decision.
“By tying together board certification and enrollment in Maintenance of Certification, the American Board of Internal Medicine appeared to devalue the secure examination passed by recently-certified physicians, by setting different standards for them compared to those certified in previous years,” ACC President Dr. Kim Allan Williams Sr. said in a news release. “The ABIM should be commended for recognizing the negative impact of this policy on current and future employment opportunities, particularly for those in the early stages of their careers, and taking the steps necessary to reverse it.”
The decoupling of certification and MOC enrollment, according to the ACC release, was the “direct result of ACC's efforts over the last two months seeking an expedited resolution of this issue.”
The American Board of Medical Specialties' 24 boards had implemented maintenance of certification as a replacement of either lifetime certification or periodic retesting to test physician competency.
MOC in general and the ABIM's MOC program in particular have been under fire from American Medical Association members and specialty societies for lacking value and were perceived as income generators for the individual boards.
In a study posted July 28 on the Annals of Internal Medicine website, researchers from the University of California at San Francisco and Stanford University calculated that the average cost for internists participating in MOC over the next 10 years will be $23,607. Costs will range from $16,725 for general internists up to $40,495 for hematologists-oncologists.
The researchers calculated that 90% of these costs will be attributed to time spent on the program and the other 10% on fees. They calculated that 32.7 million internists' and internal medicine subspecialists' hours will be spent on MOC tasks over the next 10 years.
“The ABIM MOC program will generate considerable costs, predominantly due to demands on physician time,” the researchers concluded. “A rigorous evaluation of its effect on clinical and economic outcomes is warranted to balance potential gains in healthcare quality and efficiency against the high costs identified in this study.”
The ABIM began reforming its program back in February and Baron said at the time that the “ABIM clearly got it wrong.”
Last month, it eliminated a requirement that subspecialists such as interventional cardiologists had to pass certification "foundation" requirements in general cardiology to maintain their subspecialty certification.
In Tuesday's blog post, Baron noted that more changes were still forthcoming.
“I also would like all of you to know that this will not be the last program change that ABIM will make, and we know it isn't the last issue on which we are receiving feedback and guidance from the community,” Baron wrote.
He told Modern Healthcare the ABIM was engaged in conversations with the internal medicine community on how to make the MOC program stronger and more valuable. That said, Baron emphasized they were not turning back the clock to previous certification standards.
“There is a potential misconception that you don't need to continue maintenance of certification,” Baron said. “We are not going back to lifetime certification.”
