AMA adopts principles for maintenance of certification

AMA Wire
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Physicians voted Monday to update the AMA’s policy on maintenance of certification (MOC) during the 2014 AMA Interim Meeting in Dallas. The adopted policy outlines principles that emphasize the need for an evidence-based process that is evaluated regularly to ensure physician needs are being met and activities are relevant to clinical practice.

The MOC principles will now include:

  • MOC should be based on evidence and designed to identify performance gaps and unmet needs, providing direction and guidance for improvement in physician performance and delivery of care.
  • The MOC process should be evaluated periodically to measure physician satisfaction, knowledge uptake, and intent to maintain or change practice.
  • MOC should be used as a tool for continuous improvement.
  • The MOC program should not be a mandated requirement for licensure, credentialing, payment, network participation or employment.
  • Actively practicing physicians should be well-represented on specialty boards developing MOC.
  • MOC activities and measurement should be relevant to clinical practice.
  • The MOC process should not be cost-prohibitive or present barriers to patient care.

The policy encourages specialty boards to investigate alternative approaches to MOC and directs the AMA to report annually on the MOC process.

The American Board of Medical Specialties (ABMS) is the organization responsible for developing the MOC process. ABMS works with its 24 member boards in the ongoing evaluation and certification of physicians.

AMA policy supports physician accountability, life-long learning and self-assessment. The AMA will continue to work with the appropriate organizations to ensure the MOC process does not disrupt physician practice or reduce the capacity of the overall physician workforce.

In June, the AMA and ABMS convened stakeholders in Chicago to discuss Part III of the MOC exam, focusing on the value of MOC Part III and innovative concepts that could potentially enhance or replace the current thinking around the secure exam requirement of MOC.

Get more news on policy adopted at the 2014 AMA Interim Meeting at AMA Wire®.

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MOC is part and parcel of board certification, a voluntary process; if hospitals and other organizations choose to use board certification as a credentialing tool, that is their business. Board certification, which includes MOC and other requirements, has been shown in multiple studies to improve care. That said, it should continue to help practitioners expand their knowledge and improve they care they deliverl
As a generalist Med/Peds Physician Board Certified by both the Amer. Board of Pediatrics and the ABIM for over 20 years with non-lifetime certification for both, I have always found the ABP exams to be much more primary care focused than either the initial or subsequent MOC ABIM General IM exams. In fact, it was particularly galling when attending an IM MOC Prep course 3 years ago to have the faculty cardiology lecturer say that we needed to memorize some information being presented based on ABIM core content even though he had never seen a case in his 20+ years in cardiology practice. He explained however that the ABIM likes to ask questions about it on the exam nonetheless.<br/> On my most recent ABIM exam, the 1st time pass rate for the already Board Certified Internists taking it was 84%. This contrasts with my recent ABP Pediatric MOC Exam which had a ~95% pass rate for the Board Certified Pediatricians taking it. My ObGyn wife's recent ABOG MOC exam also had a >90% pass rate. Who does the ABIM think they have to be so hard on practicing Board Certified Internists? What about those Physicians practicing Internal Medicine who never have been Board Certified? An argument can be made that maybe the ABIM should focus on testing them rather than "punishing" practicing Internists who have always been Board Certified, are Physician Leaders of their clinical organizations and delivery systems, have never been sanctioned by their State Licensing Board or Medicare/Medicaid, and WHO have been recognized by 3rd party payors for their clinical quality.<br/> MOC secure exams, particularly for ABIM because of their higher fail rate, have turned into a cottage industry where MOC Prep courses proliferate and which cost thousands of dollars for registration, travel, hotel, and time away from practice, let alone to pay for the MOC processes and secure exam.<br/> Again, the ABIM MOC exam process was more onerous that the one I took for ABP. The latter did not require fingerprints or palm prints, for example. It also was only 2 modules instead of 3, making it a 1/2 day exam instead of an all-day exam. And why does a computerized exam take weeks, even months to tell the testers the outcome of their exam? The actual taking of the ABIM secure exam feels like I was being booked for a minimum security prison. Again, we are all already Board Certified, have not been charged with anything more than a traffic violation for 99+% of us, but this feels threatening and demeaning. <br/> MOC as administered by ABMS Boards is intended to ensure clinical knowledge and allegedly competency (although I am not aware of any study that clearly demonstrates that the latter is true). However, Insurance Payors are increasingly using it to determine participation in their plans, never an intended end result of Board Certification, I don't believe.<br/> Let's put the fun back into MOC and clinical lifelong learning. I would much rather, if there is to be a "corrective action" from a MOC secure exam (rather than lose my Board Certification), have to take a certain number of CME credits in the clinical areas in which my exam indicated I am not as knowledgeable. Or even retake an exam in the areas I didn't perform as well in to meet a predetermined pass rate, kind of like CPA exams.
MOC is totally separate from certification, no matter how much the ABMS wants to connect the two. No high quality outcomes studies exist for MOC, which judged by recent physician sentiment, has been a failure. Hospitals should not be allowed to require MOC for privileging since MOC has no substantiated value and has never been shown to be as good as self-directed CME for maintaining one's knowledge. <br/> <br/> It truly is not "their business." It is our business, and we need to be sure no actions are taken without well-accepted studies of performance and outcomes. The only thing MOC is widely accepted to acheive is increasing ABMS and specialty board revenues
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