Refining the Paradigm: The Transition from Recertification to Maintenance of Certification

Introduction

Family practice has long been a leader in recertification. In 1969, the American Board of Family Practice (ABFP) was the first specialty board to issue time-limited certificates and to require mandatory recertification every 7 years. The founders of the ABFP had the foresight to create a process that has served the specialty well for the past 34 years. Recently, the American Board of Medical Specialties (ABMS), sensing growing and repeated outside threats to medicine, developed a strategic plan that would assure the American public that all medical specialists would meet the highest standards of competency. They defined competency and mandated that “maintenance of competence should be demonstrated throughout the physician’s career by evidence of lifelong learning and ongoing improvement of practice.” More important, they designed a process called Maintenance of Certification (MOC), in which every board-certified specialist in the United States would be expected to participate.

The ABFP has been developing a unique program for family physicians within the framework specified by the ABMS. I talked with James C. Puffer, MD, Executive Director of the ABFP, to learn more about how family practice will approach these new requirements. For a full transcript of this discussion, go to www.abfp.org.

Q. What is the “Maintenance of Certification” program?

A. Maintenance of Certification is intended to measure continuously the ongoing competencies of practicing physicians in every specialty. These competencies are medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice.

The ABMS has developed a framework of 4 components that will measure the 6 competencies continuously: evidence of professionalism, evidence of self-assessment and lifelong learning, evidence of cognitive expertise, and evidence of assessment of performance in practice. Each member board of the ABMS will be required to develop specific mechanisms for assessing diplomates in each of these 4 areas.

Q. When will the ABFP launch its Maintenance of Certification program?

A. The ABFP will phase in its MOC program beginning January 1, 2004 and extending to 2010. The first group who enter the MOC program will be those who certify or recertify in family practice in 2003.

Q. What is meant by the phrase, ‘Refining the Paradigm - the Transition from Recertification to Maintenance of Certification’?

A. The components of our recertification process that have been used for close to 30 years are strikingly similar to the 4 components of the MOC process. Therefore, unlike other specialists, our diplomates will at least have had some experience with the basic aspects of the process. By way of example, we have required a full and unrestricted license in every state in which the diplomate practices, 300 hours of Continuing Medical Education (CME), a recertification examination, and the Computerized Office Record Review (CORR). Each of these 4 recertification components needs only to be modified slightly to meet the new requirements for MOC established by the ABMS. That’s why we are calling this “refining the paradigm” rather than making a paradigm shift to an entirely new and different model.

Q. What does the successful launch of the MOC program mean for family practice diplomates and the specialty?

A. The MOC program will provide the mechanism by which we can continuously assess the competencies of the practicing family physician and do so in a scientifically reliable and valid manner. Our hope is that the federal government, third party payers, and state licensing boards will recognize this and use the information to replace current or future requirements that impose tremendously burdensome tasks on the busy, practicing family physician. By taking the lead in this area, we envision the MOC process as a value-added component of the physician’s practice. Not only could this program potentially avoid time-consuming tasks, such as quality assurance audits by third-party payers and relicensing exams by state licensing agencies, it will also assure that family physicians stay abreast of the state of the art in our specialty and, more important, apply it to the care of their patients.

Q. Whom does it affect?

A. This will affect every single diplomate of the ABFP, although the program will be phased in, so it won’t affect everyone at once. From this point forward, those who will either certify or recertify under the old process will immediately enter into the MOC program. They will be issued a certificate good for 7 years, as has always been done, and enter the 7-year MOC cycle. In order to maintain their certificate, they need to successfully complete all 4 components of the MOC process during that 7-year period.

Q. What will diplomates need to do to satisfactorily complete those components?

Q. How do I prepare for the MOC?

A. We are collaborating with all stakeholders in our specialty to ensure that they are fully aware of how we plan to proceed with the MOC process. We would expect that they will develop unique CME programs which will be targeted at helping family physicians.

Q. Do I have more than one opportunity to take various components of MOC?

A. Of course, as in the past, one will need to maintain a current and unrestricted license throughout the MOC cycle. With respect to Part 2, self-assessment and lifelong learning, the clinical self-assessment modules may be taken as many times as necessary to pass. The cognitive examination will be given multiple times per year, and therefore, there is the possibility that if the exam was failed early in the sixth year, after satisfying all other components of MOC, it could be taken again later in the year. If the repeat exam was failed, it could be taken again early in the seventh year with the possibility of taking the exam yet again later in the seventh year if failed. So theoretically, the exam could be taken as many as 4 times in an attempt to pass within the MOC cycle.