— Physicians push back on “burdensome, costly” program
Jennifer Henderson, Enterprise & Investigative Writer, MedPage Today
August 4, 2023
A Change.org petition calling for an end to maintenance of certification (MOC) requirements, administered by the American Board of Internal Medicine (ABIM), has reached 10,500 signatures and counting.
In the petition, started July 21 by Aaron Goodman, MD, an associate professor in the Division of Blood and Marrow Transplantation at the University of California San Diego, the writers state that its physician signers “firmly believe that the MOC program has become burdensome, costly, and lacks evidence to support its effectiveness in improving patient care or physician competence.”
Goodman told MedPage Today that while he loves his job and clinical medicine, he feels physicians too often deal with bureaucratic parts of practice. As for his views on the MOC program, “This is not protecting patients from anything,” he said.
Goodman said that he is not arguing against measures, such as initial certification or continuing medical education (CME), but instead the MOC requirements, which he feels are ineffective, time-consuming, and expensive, as detailed in the petition, which is addressed to members of the ABIM.
The petition writers proposed several alternatives to MOC requirements, such as “voluntary, accessible, and evidence-based” CME programs; peer evaluation and feedback; and “specialty-specific pathways that allow physicians to tailor their professional development to their individual needs and areas of expertise.”
Throughout its history, board certification has evolved from a lifetime credential to one that requires periodic renewal, and then to one with a renewal process that includes additional assessments, as MedPage Today previously reported. As it stands, MOC requirements need to be met by physicians, in addition to requirements from the state stating that physicians must obtain CME credits to keep their licenses.
MOC requirements can cost physicians hundreds of dollars a year and serve as a significant portion of revenues for boards with high-earning executives. Physicians have little choice but to comply; otherwise, they’d face not being employed by hospitals or paid by insurers. All the while, many have argued there’s simply not enough data to show that MOC requirements make physicians any better.
Though the MOC program was “originally intended to uphold the standards of medical practice and promote lifelong learning,” it has instead “evolved into a complex and time-consuming process that poses significant challenges to practicing physicians,” the writers of the petition noted.
“Many physicians find themselves having to choose between investing valuable time and resources in MOC compliance or dedicating those resources to improving patient care and staying up-to-date with the latest medical advancements,” they continued.
“Moreover, there is limited empirical evidence supporting the notion that MOC participation leads to improved patient outcomes or better physician performance,” they added. “The lack of transparency regarding the program’s financials and its overall effectiveness raises concerns about the motivations behind its perpetuation.”
Paul Teirstein, MD, president of the National Board of Physicians and Surgeons (NBPAS), which was formed in 2015 to provide an alternative to the MOC program and has since certified more than 12,000 physicians, told MedPage Today that he recently became aware of the petition and fully supports the effort launched by Goodman.
“We have been fighting this fight now for 8 years, and we are making a lot of progress,” Teirstein said of his own efforts with the NBPAS.
“I think it’s wonderful that [more] doctors … are now learning about the outrageous requirements of continuous maintenance of certification,” he added, “and they are reacting the way that Dr. Goodman reacted, which is outraged.”
ABIM did not immediately respond to MedPage Today’s request for comment regarding Goodman’s petition. However, in outlining the value of MOC on its website, ABIM states, in part, that “there is compelling evidence showing that MOC improves value of care without sacrificing quality and that board certified physicians command higher salaries.”
Goodman said that he plans to continue to call attention to the issues outlined in his petition, including through outreach to hospital credentialing committees and professional societies, among other entities.
“Physicians are very politically different, but this is something that is spreading across the aisle,” Goodman said. “The only way we’re going to fix some of the issues physicians face is to take back some of our ownership.”
Jennifer Henderson joined MedPage Today as an enterprise and investigative writer in Jan. 2021. She has covered the healthcare industry in NYC, life sciences and the business of law, among other areas.