Family Physician Participation in Maintenance of Certification

The American Board of Internal Medicine’s administrative data shows similar patterns of engagement in Maintenance of Certification (MOC) (85% completion rate and 90% enrollment rate for physicians with time-limited certificates) as found in Xierali and colleagues for Family Medicine.

While specialty board certification remains a voluntary process and only an undifferentiated medical license is required to practice in the United States, practically speaking, most physicians choose to certify with the American Board of Medical Specialties upon completion of training. The challenge for the certifying boards, as noted by Miles, is to keep the process relevant for the physicians and meaningful for the public. As certifying organizations we have the responsibility to assure the public that physicians are competent to practice through assessment programs that adhere to sound measurement principles. But we need to ensure also that we are asking physicians to engage in assessments that help them better understand how to improve patient care, and when possible, allow those activities to count for multiple reporting purposes – Maintenance of Certification, Maintenance of Licensure, pay for performance – to reduce the reporting burden on physicians.

We also need to continuously evaluate whether our programs are effective and implement changes to improve/enhance our programs regularly. ABIM has recently begun giving physicians performance feedback in our Diabetes and Hypertension Performance Improvement Modules to help physicians understand how they compare to their peers. Some evidence exists that when made aware of performance as compared to their peers, physicians are encouraged to improve due to this friendly form of competition.[CDC site -http://www.cdc.gov/vaccines/recs/rate-strategies/adultstrat.htm, An ABIM survey comment –"It was useful to see the comparison of my performance against my peers (the reference group)". ]

Competing interests:   Drs. Rebecca Lipner and Eric Holmboe are employed by the American Board of Internal Medicine

The American Board of Internal Medicine's recent Levinson and Holmboe article ("Maintenance of Certification in Internal Medicine," Archives of Internal Medicine, January 24, 2011) has been rewritten, regurgitated and republished from journal to journal in hopes of promoting their own ABIM-sponsored propaganda. Xierli et al's efforts here on behalf of the American Board of Family Medicine are no different: These are Board-funded studies promoting their own Board's agenda and protecting a payroll.

Moreover, if the best claim the American Board of Pediatric's MOC can make is a "10% improvement in hand hygiene rates" among physicians - as Miles reports in his editorial "Maintenance of Certification: The Profession's Response to Physician Quality" - then we as a profession are in deeper trouble than I already feared. (1,2)

It's preposterous that hard-working, hand-washing, ethical physicians who practice daily patient care (and already maintain their licenses with good standing and mandatory CME) should be forced to do more. What other profession submits to such unjustified and unproven requirements?

Even more troubling is that while MOC is currently voluntary, that might not be the case in the near future. The Federation of State Medical Boards (FSMB) is working at the State level to link MOC to Maintenance of Licensure, or MOL. If this is achieved, the process will no longer be voluntary and will become compulsory for maintaining one's license to practice medicine. This would be a dramatic change in licensure and would apply to all physicians and not just those grandfathered. (Documentation for this can be checked here: http://www.fsmb.org/pdf/mol-board-report-1003.pdf and here http://www.fsmb.org/m_mol_reports.html).

Obviously we all work hard to stay up-to-date and remain well-educated. The real data and proof of competence, professionalism and excellence lie in excellent patient care and referrals of friends, colleagues and loved ones from those same patients as well as from professional colleagues. In effect, every patient is a recertification test and proof of maintenance of certification. No one, except the Boards, benefits from a physician taking time away from his or her practice and patient care to do costly, time-consuming and clinically irrelevant secure examinations, PIM's, and peer and patient reviews. In its current form, MOC has no place in the life of a practicing physician and should most certainly never be made mandatory or be tied to state licensure.

We believe the real motivation behind MOC is not patient care, but money. Unless we practicing physicians get off our collective seats and stop tacitly accepting mandates placed upon us by self-appointed physician bureaucrats, the future of medicine will be grim indeed.

Ron Benbassat, MD, Internal Medicine, Beverly Hills, CA and Martin Dubravec, MD, Allergy and Asthma Specialists of Cadillac, Cadillac, MI

1. Strasburger VC and Members of the Editorial Board: Ain't Misbehavin': Is it possible to criticize Maintenance of Certification (MOC)? Clinical Pediatrics 2011; in press [will be in the July issue]
2. Steele RW and Members of the Editorial Board: Maintenance of Certification: Was it broken and did we fix it? Clinical Pediatrics 2011; in press [will be in the July issue]

Competing interests:   None declared