Georgia Passes Far-Reaching MOC Bill
The Georgia bill initially limited all potential uses of MOC, including for admitting privileges at private hospitals in addition to those at state-owned facilities. However, the limitation on private hospitals was dropped as part of a compromise during the legislative process, says Steven Walsh, MD, an anesthesiologist and president of the Medical Association of Georgia.
“What led to the push is that physicians were just feeling more and more of a burden in time and money placed on them in qualifying and participating in the MOC exams,” he says. “Within our medical community, there are objections to the way that many of the specialty boards implement their MOC process.”
Cody McClatchey, MD, a board member of the Medical Association of Atlanta and chair of the public policy committee of the Georgia chapter of the American College of Physicians (ACP), says physicians in the state are very pleased with the new law. While there could be “some friction” about the provision regarding staff privileges at private hospitals being stripped from the bill, he hasn’t heard much discontent about that compromise to date.
McClatchey, an internist in Atlanta, believes doctors in his state are taking a wait-and-see approach to ABMS member boards’ actions to respond to physician concerns. “We’re still in kind of a transitional time for that,” he says. “They’re moving in the right direction, and there seems to be dialogue.”
Physicians in the state are committed to continuous education, but ABMS testing gets too far into minutiae and covers areas irrelevant to a physician’s practice, says Jacqueline Fincher, MD, a partner at the Center for Primary Care in Thomson, Georgia, and board of regents member for the ACP’s Georgia chapter.
“This law enables internists here in Georgia not to have to worry about losing their credentials,” she says. “State licensure has certain criteria you have to meet every year in terms of continuing education. Patients want to know their doctor is knowledgeable and treats them well. I’ve never had a patient ask me if I’m board- certified.”
Fincher says that while she finds it somewhat disappointing that private hospital privileges were excluded from the bill, they might feel pressured to drop the requirement anyway. “The private hospitals, if they choose not to implement this [voluntarily], they risk losing physicians,” she says. “I think that will resolve itself.”
Texas Poised to Follow Georgia’s Lead
The Texas bill, cosponsored by two physicians, limits MOC use for licensure, insurance reimbursement and staff privileges at non-academic, non-cancer center hospitals. Others may limit MOC’s use for these purposes, but that decision must be made at the individual hospital level and not corporation-wide for those hospitals that are part of larger groups, says Carlos J. Cardenas, MD, president of the Texas Medical Association.
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“It empowers each independent medical staff to opt out of the MOC requirement,” says Cardenas, a gastroenterologist at Doctors Hospital at Renaissance in Edinburg, Texas. “It’s the medical staff, rather than a corporate entity, saying what it [the MOC policy] is going to be.”
In a state where about two-thirds of physicians are in either sole proprietorships or two-doctor offices, Cardenas thinks that the majority of his colleagues believe that MOC had grown “out of touch with the practice of medicine, in terms of what they were doing in their own specialties,” he says.
“The concern on the other side was, ‘What will be the metric?’” But he adds that state licensure and continuing medical education (CME) seemed adequate to most physicians in the state.
Testifying on behalf of the Texas Medical Association, Kim Monday, MD, a neurologist from Houston, told the Public Health Committee of the state’s House of Representatives that MOC could be compared to attorneys needing to retake the bar exam every 10 years.
“Most physicians feel initial board certification is necessary to validate expertise following residency and training programs,” Monday said. “However, we find the continuous maintenance of certification process to be burdensome, expensive and filled with irrelevant curriculum.”