Readers sound off on MOC and primary care delivery in our latest Your Voice.
In his opinion piece regarding maintenance of certification, (“Maintenance of certification exams have dubious value,” February 10, 2016), James Merino, MD listed major concerns of a wide number of physicians regarding the whole process of board certification. He stated that “The secure examination needs to be a thing of the past, and I hope that others will continue to protest until our voices have been heard.”
In 2011, the National Board of Clinical Medicine, Inc. (NBCM) was established, in part, to address similar concerns. The NBCM offers an option for physicians with regard to board certification, recertification and maintenance of certification. The format of the NBCM is a one-time, open book, at-home exam whose sources of questions are clearly listed for the physician to review. Questions are based upon published practice parameters and guidelines that relate to the clinical aspects of medicine.
So far, this has been established for allergist/immunologists. We have received overwhelmingly positive and enthusiastic support from physicians nationwide. The NBCM is recognized as a positive move with regard to board certification. Specialties other than Allergy and Immunology are welcome to be part of this process.
The NBCM strongly believes that board certification should be a positive process where learning occurs, and it should be voluntary. Physicians should have options regarding board certification. Board certification should be a voluntary process that offers value to the physician. It should not be used to discriminate against physicians with regard to hiring, insurance network participation or hospital staff privileges.
Medical Economics has been a leader in covering this topic. I am grateful that this magazine continues to offer insight and open discussion with regard to this very important and controversial topic.
Martin S. Dubravec, MD
The writer is the founder and chief executive officer
of the National Board of Clinical Medicine, Inc.
Next: Why the silence?
I have followed the entire ABIMMOC controversy from its inception and eventually joined the National Board of Physicians and Surgeons, applauding Dr. Teirstein and others for their dedication to a reasonable board certification process. I wonder when member boards will follow suit. Why the silence?
I am involved in the ABOG MOC process, which is very similar. I passed boards in 1994 with flying colors, promised board certification for life, then presto, MOC each year along with its $600-plus price tag this year. Simple math reveals tens of millions of dollars a year to fund an organization that lends little to no contribution to professional development for practicing clinicians.
Roger Brecheen, MD
Next: Physician extenders should be part of primary care delivery
I can understand Lee Morgentaler, MD’s concerns about “physician extenders” working in a capacity traditionally reserved for doctors. (“Physician extenders are not the same as doctors,” November 25, 2015.)
However, primary care has changed over the past few decades, and in most areas of the country primary care doctors’ roles have changed immensely. They are no longer the “do it all” doctors. Many no longer take care of hospital or nursing home patients. Others have limited their practices to only adult medicine but there are other changes as well.
The rapid advances in medicine, the regulations of insurers, and the threat of lawsuits all play a role. In additions many primary care doctors want more free time for family and for personal pursuits.
The point is that if physician assistants and nurse practitioners (PAs and NPs) practice within the limits of their training and abilities as recommended by the Institute of Medicine, they could and should join the primary care workforce.
The shortage of primary care doctors is acute and many are overworked and burned out. Nurse practitioners have already gained licensing rights to practice independently. Clearly they have an important role to play in providing primary care.
Edward Volpintesta, MD