More than two thirds of physicians (65 percent) believe the maintenance of certification (MOC) process adds no clinical value to their practice, according to a recent survey by MDLinx.
In fact, 55 percent of the 515 US primary care physicians and specialists surveyed would like to see MOC requirements discontinued altogether, while 48 percent believe a continuing medical education (CME) program would be a better alternative to the current MOC process. More than a quarter (26.8 percent) of the physicians polled were concerned about the cost of MOC and would like to see the process made more affordable.
MOC was created in 1990 by the American Board of Internal Medicine (ABIM). The process requires physicians to pass a test every 10 years to remain ABIM board certified. The MOC requirement applies to all physicians in internal medicine, including subspecialties, and the American Board of Medical Specialties (ABMS) oversees MOC for its 24 specialties. While MOC is not required for state licensure, many hospitals require MOC for admitting privileges or hiring, and insurance companies require it for inclusion on panels.
Because of physician pushback against MOC, many certifying boards have begun revising their programs. Beginning in June, internists and nephrologists were given the option of a 2-3 hour “knowledge check-in,” to be taken every two years at the physician’s convenience and on his or her own computer, rather than the longer test every 10 years. Also, according to Emergency Medicine News, the American Board of Emergency Medicine will give emergency physicians the choice of taking more frequent, one-hour-long tests instead of the current ConCert Examination beginning in 2020. They also can take the test again if they do not pass the first time.
But for many physicians, the changes haven’t come fast enough, and they are, instead, seeking state legislative solutions against the MOC requirements.
“Physicians are pushing legislation on the state level because they don’t trust the ABMS and its financial conflicts of interest,” says Paul Mathew, MD, a volunteer board member of the National Board of Physicians and Surgeons in Cambridge, Mass. “Many feel the only way to declaw the tiger is legislative action due to insurance companies and academic institutions having no reason to change their pro-MOC policies.”
According to Peter Margolis, MD, in his recent article for Gastroenterology & Endoscopy News, 12 states have already passed some form of anti-MOC legislation, including Arizona, Georgia, Kentucky, Maine, Maryland, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas and Washington. Legislation is pending or has been introduced in Alaska, Arkansas, California, Florida, Indiana, Iowa, Massachusetts, Michigan, Mississippi, New Hampshire, New Jersey, New York, Ohio, Oregon, Rhode Island, Utah, Virginia and Wisconsin.
Senate Bill 208 was introduced in the Indiana legislature back in January 2018 and currently sits in committee. The bill would prohibit hospitals from denying hospital staff or admitting privileges to a physician based solely on MOC. The bill also would prohibit insurers and HMOs from use MOC as the sole criteria for refusing to enter into a reimbursement agreement, denying reimbursement for a covered service, or setting reimbursement rates.
It’s not that most physicians are against continuing education, writes Deborah Abrams Kaplan. In fact, the doctors she interviewed for her recent Medical Economics article say they’re actually strongly in favor of continuing education, but it’s already required for state licensure. MOC, on the other hand, presents additional (and unnecessary) costs and burdens, tests on skills and knowledge unrelated to a physician’s practice, and ultimately adds nothing to a physician’s ability to treat patients.
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