The MOC Controversy: What’s at Stake for Healthcare?

You’ve probably heard the rumblings over physician Maintenance of Certification (MOC). It’s a tale of two radically different approaches.

Currently, physician recertification is handled by the American Board of Medical Specialties (ABMS) and its member board, the American Board of Internal Medicine (ABIM). The recently updated MOC requirements include ongoing engagement in various medical knowledge, practice-assessment, and patient-safety activities, physician assessment every two years, and passage of a secure exam in one's specialty every 10 years.

Support is gathering for an alternative certification program offered by the National Board of Physicians and Surgeons (NBPAS) that reportedly is less costly and takes a fraction of the time required by the current MOC program.

Alternative Approach Gains Momentum

A pro-NBPAS online petition posted last March has gained almost 23,000 signatures. It claims that ABIM’s requirements are unreasonable and have questionable value. As one physician comments on the petition site: “I have never been asked by a patient if I am certified.” It calls on ABIM to recall the changes it has made in MOC and institute a simple pathway consisting of a recertification test every 10 years.

Other physicians point to growing evidence that the current MOC program can improve physician performance and patient outcome, encourage innovation and lifelong learning. They say any change in the program threatens the status of the profession.

Is it a threat, or welcome relief? How would the change affect patient care, if at all? How would it affect physicians and their careers? What does it mean for the future of healthcare?

The Basic Pros and Cons

Let’s start by taking a look at the basics. The Jan. 8, 2015 issue of The New England Journal of Medicine published two divergent opinions on MOC, and it’s an excellent resource for understanding both sides of the argument, where each side is “coming from.”

In his anti-MOC piece, cardiologist Paul Teirstein, MD, from La Jolla, Calif., writes that the ABIM has grown into a large business enterprise, noting that in 2012, the year of its latest IRS filing, the ABIM received more than $55 million in fees from physicians seeking certification. “MOC fees range from $2,715 to $3,335 every 10 years; on top of these are costs for travel to testing centers, review courses, and time spent away from practice. I believe that, like the rest of the medical community, the ABIM should focus on efficacy while cutting its costs and lowering its fees.”

There is no doubt that Teirstein is serious in his quest, and the support he has gathered is impressive. But what about supporters of the current MOC requirements? For one, they point to the fact that some hospitals and insurers require physicians to pass it, and some physicians see opposing it as a threat to job security.

“There’s growing evidence that MOC can improve physicians’ performance and patients’ outcomes,” write Drs. Mira B. Irons and Lois M. Nora in their pro-MOC piece in The New England Journal of Medicine. They cite a Mayo Clinic validation study showing a positive association between MOC scores and improved outcomes of diabetic and pediatric patients in the study.

Keeping an Eye on the Outcome

As a provider of locum tenens physicians to hospitals nationwide, LocumConnections is following this closely, and continues to provide quality providers that meet the credentialing requirements of our partners. Hospitals and their medical staffs need to address their requirements clearly for ongoing certification to promote quality physician credentials, and avoid the unintended consequences of inappropriate revocation of staff physician’s privileges.

Especially with the growing physician shortage, all of us in healthcare must work to make it easier for smart professionals who want to practice medicine to be able to do so without unnecessary regulations and restrictions. At the same time, we recognize the critical principle that providers stay up to date in their specialty.

So we’ll be watching as the debate unfolds. Meanwhile, we’ll continue to do what we do best: providing quality physicians with up-to-date credentials to hospitals that need them.

By Talbot “Mac” McCormick, MD