How ABMS, other specialty boards are confronting MOC changes

Leaders of the American Board of Medical Specialties (ABMS) and its member boards say they’ve been searching for the right path since deciding to take the MOC process beyond the once-per-decade requirement and add elements like subspecialty tests and patient ratings to the process.

Maintenance of certification: inside the physician revolt

“We heard physicians didn’t like the stress and cost of examinations. They weren’t finding that the board approved-materials were as relevant as they needed to be. They didn’t find the system as user-friendly as they needed it to be,” says Lois Nora, MD, JD, president and chief executive officer of  ABMS. “Many of our boards now have better systems in place for recognizing learning activities and giving credit.” 

The American Board of Internal Medicine (ABIM), the center of the firestorm during the past couple of years, plans to spend 2016 considering recommendations to make its MOC process less burdensome, says Richard Baron, MD, president and chief executive officer of ABIM.  “For example, we know that many people are unhappy with taking the exams in a testing center,” he says. “Testing centers assure that the person you think is taking the test, is actually the person taking the test. It’s an important thing for credibility. So we’re looking at different kinds of remote proctoring options. Are there ways people can establish their identity?”

MOC, recertifications are ‘cancers’ doctors should rally against

The ABIM updated its MOC exam last fall by asking practicing doctors to review the blueprint and make sure questions reflected what they were seeing in their practices. “We’re certainly hearing that some people say it covered obscure things, but we’re hearing many more people say it had a good reflection of what they see in their practice,” Baron says. “There was a sense that people may have felt more comfortable with what was on it.”

Next: The "biggest disconent" with the exam

The American Board of Anesthesiology (ABA) has unveiled what it calls Maintenance of Certification in Anesthesiology Program (MOCA) 2.0. It replaces the once-per-decade exam with a requirement of 30 exam questions per quarter, based on feedback from physicians that they previously did nothing about MOC for 9½ years and then crammed for the exam, says James Rathmell, MD, board secretary for the ABA.

Doctors put MOC on blast

“The biggest discontent was that the exam doesn’t help diplomates to stay current and take care of patients,” he says. “What came up is that, ‘If we were fed information a little bit at a time, every day or every week throughout a 10-year cycle, and then if we got things wrong, the system would tell us why, and give us information to study and learn, and then test us at a regular interval.’ That’s what MOCA 2.0 is.”

The American Board of Emergency Medicine (ABEM) received strong criticism that the patient safety module it developed in conjunction with the American College of Emergency Physicians, was too time-consuming, hard to pass and irrelevant to day-to-day practice, says Barry Heller, MD, ABEM president. So it has suspended that module to revise it and make it more relevant.

The ABEM also altered its practice improvement standards to include a wider variety of diagnoses that are not necessarily seen in the emergency department every day, Heller says. “We’ve made plenty of changes, and we’ve not had quite the pushback that many of the others boards have had,” he says. 

Teirstein and his supporters acknowledge the reforms among the ABMS boards but still have questions and complaints. For example, Teirstein charges that ABIM and others boards still have a “conflict of interest” in that they stand to earn money from exams and other MOC requirements; and that while the ABA’s MOCA 2.0 is “inventive,” for example, “they didn’t change the cost at all.

Next: "I don't think the final shot has been fired on this whole affair"

“We’re listening. We’re trying to reinvent this,” he says. “Take the money out of it, and see what you come up with. We don’t make any money. We’re designed not to make money.” 

Geoffrey Rose, MD, chief of cardiology at Sanger Heart & Vascular Institute in Charlotte, North Carolina notes that if a doctor wanted to maintain certifications in internal medicine, cardiology and a subspecialty, that could amount to three exams within a decade. “You see how the requirements start to build up,” he says, adding: “I don’t think the final shot has been fired on this whole affair. I think the temperature has certainly cooled. It has been defused. But I don’t think we necessarily know the right and clear path forward.”