MOC changes gives physicians more flexibility, ABIM officials say
While arguing that board certification is a tool to regain patient trust, the American Board of Internal Medicine (ABIM) defended its own credibility with its member physicians while outlining testing options to provide internists with greater flexibility.
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Starting in 2018, internists can choose to participate in two-year assessments, a move officials say will provide physicians with a “more flexible, lower-stakes” option for maintenance of certification (MOC).
The move is an effort by ABIM to blunt criticism of MOC from physicians who say the program is burdensome and does not reflect the knowledge used in practice daily. It was developed as part of a multi-year effort to gather feedback from thousands of internists on how the program can be improved, said Marianne M. Green, MD, a member of the ABIM board of directors and senior associate dean for Medical Education at the Feinberg School of Medicine at Northwestern University.
“We are no longer this top-down organization,” she said during a presentation at the American College of Physicians (ACP) conference in San Diego. “ABIM is changed. With the collaborative efforts of people like you, we can be an organization where certification means something.”
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ABIM officials argued that in today’s uncertain world, professional certification is vital to establishing trust. They pointed to studies indicating patients do not trust their doctors as much as they used to and often rely on “fake news” confirming inaccurate misconceptions. Richard Baron, MD, ABIM’s president and chief executive officer, said physicians grapple with “the tenacity and power of wildly inaccurate information” every day in their practices, and that board certification offers a defense.
“I don’t think we can assume as individuals or as a profession that deference and trust is a given for doctors,” Baron said. “I think we all have to think about how trust is built in the new world. ABIM has been thinking a lot about this.”
Yul Ejnes, MD, a member of the ABIM board of directors and a practicing internist in Cranston, Rhode Island, outlined the testing options beginning in 2018:
More flexibility. Dubbed the “knowledge check-in,” the 2-year test can be taken with the help of a yet-to-be-named online reference source, and can be taken at home or at a testing center. Results will be available instantly.
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Lower stakes. If a physician fails one 2-year test, it does not mean an automatic loss of certification. If a doctor fails two consecutive 2-year assessments, then additional steps-including taking the long-form, 10-year exam-will be required to maintain certification, according to ABIM. Physicians can still choose to take the 10-year exam to renew certification.
No consequences in 2018. Physicians who need to recertify in 2018, the first year this new option will be available, will also have a grace period of sorts. There will be no consequences for failing the test in 2018, but skipping the test would result in loss of certification. Failing the test in 2018 will require taking the test again two years later.
What about certification in 2017? Physicians whose certification is up in 2017 will have to take the traditional 10-year exam.
What about subspecialties? Subspecialties will be offering the new check-in by 2020. Some subspecialties will be moving to the new option sooner than that.
During the question-and-answer session, some audience members argued that ABIM needs to do more work to gain trust from physicians. Charles Cutler, MD, a frequent critic of ABIM and the MOC process, said that ABIM pays its staff and directors often exorbitant salaries from the revenues collected by physician fees.
“ABIM spends a lot of money,” Cutler said. “It’s not your money, it’s our money. It just doesn’t make sense to me all the money that is being spent. … I think a monster has been created here.”
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Baron responded that ABIM is focused on improving for the future, and that the organization provides its financial information on its website. He stressed that ABIM uses its revenues efficiently and transparently.
“We stand on our record at this time,” Baron said.
Louis Saravolatz, MD, an internist who serves as governor of ACP’s Michigan chapter, said that ABIM needs to take the criticism delivered by physicians such as Cutler seriously, because many internists feel the same way.
“There clearly needs to be an effort to build trust with the ABIM going forward,” he said.