A reader writes that maintenance of certification (MOC) requirements have not been shown to improve quality of care, and are damaging medicine's feeling of collegiality.
Thank you for publishing Rachael Zimlich’s article in Medical Economics (“MOC needs revision before physicians will recognize value,” eConsult, November 17.) As you know, many practicing physicians are becoming angered over MOC and find it not beneficial to their individual practices and quite burdensome. Properly done scientific studies have never proven MOC to improve the quality of care.
Shouldn’t MOC have been scientifically tested prior to its mandate? I am quite worried that MOC is damaging camaraderie in the House of Medicine especially in my field of OB/GYN.
In Los Angeles we are seeing dramatic dropoffs in attendance to our grand rounds, local meetings and academic symposia. The hours that the non-grandfathered physicians have to spend to meet MOC requirements, meet all their needs for CME and given the hours that we all work, limits the extra hours available for us to partake in what were once very well attended, high-quality educational meetings and forums.
Analysis of attendance data from American Congress of Obstetricians and Gynecologists national and regional meetings show dramatic dropoffs. My hypothesis is that the drop in actual numbers, as well as percentage of Fellows attending, is mostly due to MOC. Membership in our organizations has also markedly decreased.
In your issue of February 10, 2012, I wrote, “Clearly, MOC has evolved into a costly burden to physicians, patients, and healthcare. The boards and their MOC program have become a profiteering juggernaut without any reasonable proof of benefit, efficacy, or patient protection, and compliance is slowly being tied to the privilege of practicing medicine. As physicians, we should demand evidence-based analysis of strategies proposed to improve our ability to practice, just as we do our research. We should not give in to potential threats of government mandates.”
Just like the response to the death of Libby Zion, well-meaning people often institute change that actually is more harmful than beneficial.
MOC is one of the ideas that need to be put on hold and further evaluated academically. How many of our departments at our leading teaching hospitals are having a hard time dealing with work hour limits of their resident staff? How many people have been injured by handoffs that would not have occurred if not for work hour limits?
How do we justify damaging physician collegiality, damaging camaraderie, wasting limited valuable hours, the creation of an excessive “teach for the test” mentality without evidence that MOC improves the quality of healthcare? Everyone agrees that physicians must continue their education. We are never done learning. The debate is about whether physicians should determine how and what they learn, or some outside, self-appointed as well as self-serving, board?
No other profession mandates MOC. Not lawyers, not accountants, not dentists, not architects, not engineers, not airline pilots and not nurses or nurse practitioners. Our courts, teeth, buildings and bridges are not falling apart.
Half of the counties in America do not have one obstetrician to deliver a baby. Perhaps those OBs who are being paid almost $600,000 annually- not including other benefits and compensation-to create and administer MOC should leave their ivory tower and actually practice medicine.
Howard C. Mandel, MD, FACOG
Los Angeles, California