Editor’s note: The following was sent to Virginia Moyer, MD, vice president for maintenance of certification (MOC) and quality at the American Board of Pediatrics a year ago. While the author ultimately completed MOC, lack of movement on this issue played a large part in the author’s decision to stop practicing.
Amy Baxter, MDIt is with a heavy heart and tears that I would like to let you know that I will be unable to continue practicing medicine due to an unfulfilled Maintenance of Certification (MOC) requirement. I conscientiously object to the quality requirement as implemented by the board.
By my own choice, I have been unwilling to complete a hand washing module for physicians who don’t have a consistent practice. I work one to two clinical shifts a week; I research, lecture, review science and work to help children’s vaccine pain with the other time. I believe in constant personal vigilance to maintain quality care.
I have participated in quality projects in the hospital, I have developed lectures, book chapters, and created and validated a scale to assess pediatric nausea that is used in hospitals and clinical trials across the world. I have asked the board to consider my work and my nausea scale publications; they do not consider these efforts an indication of “quality.”
While many good people have not been silent about their dissatisfaction with MOC, most physicians are not in a position to quit practicing. Instead, they are complaining, feel angry and frustrated, and believe they are justified in cheating the system.
Further reading: Eliminate MOC's cumbersome process and physicians will get on board
I have spoken to many who did do the hand washing module for compliance, and to a person they acknowledged making up data. Putting ethical, overworked, extensively trained and honorable people in a position of having to be dishonest or shoddy to comply with a regulation is wrong. It erodes the value and purpose of board certification.
The quality requirement of MOC has been the last straw that has stressed or even driven other pediatricians out of practice. My medical school roommate, who served an exclusively inner-city population, quit practicing. Many physicians are planning retirement based on when their certification runs out. How many productive years of highly-trained healthcare providers are we losing? We are straining to our healthcare system by stressing doctors. Losing pediatricians, or even wasting their time with pointless busywork does not serve our children well.
I share the value of continuing education and giving our children the healthiest lives possible. But two recent New England Journal of Medicine articles found that there is no difference in quality outcomes between grandfathered and MOC board-certified practices. The American Board of Internal Medicine has decided to allow a designation of “board certified without MOC.”
The current incarnation of the quality portion of MOC undermines the best health for children in our country. I do not want to quit my clinical practice. However, I believe the hand washing MOC requirement is a waste of time. When leaders do not listen to their constituents, it is not leadership. I believe until people quit practicing, the board will not truly realize how deeply their rigidity in this regard hurts pediatrics and their own reputation.
I hope the board is willing to reconsider their stance. If they do not, I understand that due to my noncompliance I will be unable to practice pediatrics.