The MOC Debate Hits Home

Pennsylvania Medical Society

By: Leslie Howell, director of CME, training, and physician leadership programs, PAMED


Rarely does an issue simultaneously instill great passion and considerable angst for physicians at the level that we are seeing for the American Board of Medical Specialties’ (ABMS’) Maintenance of Certification™ (MOC).

Most physicians will concede that the expressed intent of MOC is appropriate: to ensure the patient community that physicians are continuing to assess and improve their knowledge and capabilities after graduate medical education (GME) training. It goes without saying that physicians are committed to lifelong learning and continuous improvement. However, this same group also contends that the current processes and practices in place across the various specialty boards are cumbersome, costly, and significantly cutting into their time with patients.

Of the four components of MOC — (I) licensure and professional standing, (II) lifelong learning and assessment, (III) cognitive exam, and (IV) practice performance assessment — the exam and the practice performance assessment appear to be the areas of greatest concern. The exam component, in particular, has been under a great deal of scrutiny. Input we’ve received from Pennsylvania Medical Society (PAMED) members thus far indicates that it is viewed as an uncertain measure of a physician’s actual skill in his or her specialty and is punitive. Consequently, many fear that failing the exam will result in a loss of privileges at hospitals, insurance reimbursements, network participation, and possibly even employment.

PAMED has formed a Task Force on Continuous Professional Education to examine MOC in its current form and the concerns circulating throughout the state and to seek input from Pennsylvania’s physicians. The goal: reshape MOC, in whatever future form it might take, into a process of continuous learning and improvement based on evidence-based guidelines, national standards, and best practices that is relevant to what a physician actually does within his or her practice of medicine and one that enhances, rather than impedes, the care of patients.

Delegates at the 2014 House of Delegates meeting, held October 17-19 in Hershey, debated the merits of the task force’s initial recommendations, as well as other resolutions and reports related to MOC. One of the documents developed by the task force and adopted by the PAMED Board is a Maintenance of Certification Statement of Principles which outlines PAMED’s position on what MOC should be:

• PAMED is committed to lifelong learning, cognitive expertise, practice quality improvement, and adherence to the highest standards of medical practice.
• PAMED supports a process of continuous learning and improvement based on evidence-based guidelines, national standards, and best practices, in combination with customized continuing education.
• The MOC process should be 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.
• Board certificates should have lifetime status, with MOC used as a tool for continuous improvement.
• The MOC program should not be associated with hospital privileges, insurance reimbursements, or network participation.
• The MOC program should not be required for Maintenance of Licensure (MOL).
• Specialty boards, which develop MOC standards, may approve curriculum, but should be independent from entities designing and delivering that curriculum, and should have no financial interest in the process.
• A majority of specialty board members who are involved with the MOC program should be actively practicing physicians directly engaged in patient care.
• MOC activities and measurement should be relevant to real world clinical practice.
• MOC process should not be cost prohibitive or present barriers to patient care.

The delegates also asked that several items be referred to the AMA:

• Work with the ABMS to eliminate practice performance assessment modules as currently written from the requirements of MOC.
• Develop and disseminate a public statement, with simultaneous direct notification to the American Board of Internal Medicine (ABIM) and other ABMS-sponsoring boards that their current MOC program appears to be focused too heavily on enhancing ABIM revenues and fails to provide a meaningful, evidence-based, and accurate assessment of clinical skills.
• Investigate and/or establish alternative pathways for MOC.
• Report back to the House of Delegates at the Annual AMA Meeting in June 2015.

The delegates also recommended that PAMED ask the AMA to revoke its support for MOC if no action is taken by the ABMS in working with the AMA to make MOC requirements less onerous.
PAMED will continue to support efforts to create a reasonable and economical assessment process that provides physicians with the information necessary to improve the quality and efficiency of their practices.
Meanwhile, to get more input from PA’s physicians, PAMED will be emailing physicians a brief survey the week of November 10. Please watch for this email. It will take no more than two minutes to complete so please add your voice to the conversation!

For more information on PAMED’s Task Force on Continuous Professional Education or next steps on MOC, please email Scot Chadwick at schadwick@pamedsoc.org or call Scot at (717) 909-7814.

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