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New route to MOC is a hit with doctors


Use of longitudinal knowledge assessment far outpaces written exam for maintaining certification

Doctor filling out form by hand ©


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A large majority of physicians seeking to maintain their specialty certification are using the American Board of Internal Medicine’s (ABIM) longitudinal knowledge assessment (LKA) option to do so.

The ABIM, in a JAMA ”Viewpoint” article, disclosed that 80% of board-certified physicians are choosing the LKA over the long-form maintenance of certification (MOC) exam to renew their board certification.

Introduced in 2022, the advantages of the LKA are that it doesn’t require advance preparation, takes an average of only four hours per year to complete, and after answering the questions “provides the diplomate with immediate feedback, rationales, and references while offering the opportunity to provide critiques of the item to ABIM,” the article says.

Another advantage of the LKA, according to the article, is its lower cost compared to traditional certification. The ABIM charges physicians $220 annually to recertify in a single specialty and $110 for every additional specialty. Those who recertify by taking the written exam, rather than the LKA, also must pay a $700 test center fee.

According to an ABIM spokesman, physicians used the LKA to maintain about 51,300 certifications in 2022 and 2023, compared to about 13,600 maintained using the traditional written exam.

Robert O. Roswell, M.D., FACP, the article’s lead author, a professor of cardiology and science education at the Zucker School of Medicine at Hofstra/Northwell and an ABIM director, said the article was a response to “an increase in the number of questions and publications about the value of maintenance of certification” following the COVID-19 pandemic.

“This was written to share the robust analyses that support the benefit of MOC in terms of a host of patient outcomes, most importantly decreased mortality in the care provided by an ABIM Board certified physician. These associations with ABIM certification are important to share with ABIM diplomates, health systems, patients and the medical community,” Roswell added.

Maintenance of Certification has been a lightning rod for criticism since the ABIM began requiring recertification every 10 years for physicians who certified in their specialty after 1990. Opposition increased in 2014 when the ABIM announced it would require physicians to complete some MOC requirements on three- and five-year cycles. That change sparked the formation of a competing certifying organization, the National Board of Physicians and Surgeons (NBPAS).

While the ABIM subsequently modified some of the 2014 requirements, it did not entirely placate critics of the MOC process. An August 2023 petition on the website calling for its elimination drew 15,000 signatures. The following month, the American College of Cardiology and three other cardiovascular societies announced they were jointly applying to create their own certifying board separate from the ABIM, in part due to dissatisfaction with MOC.

In January of this year an NBPAS representative claimed in an article written for Medical Economics that “the cost and burdens associated with MOC remains a significant factor driving physicians out of medicine. Roswell disputes the charge, noting that MOC was instituted well before physician burnout was a problem. He also points to the numerous other administrative requirements doctors have had to face since MOC was instituted.

“To say that maintenance of certification is the main cause of burnout, not the pandemic, the economy, the coding and billing, all the requirements that have gone on, to specify one particular thing that began before we began seeing so much burnout, I don’t think is accurate,” he said.

Roswell, whose clinical practice is in a cardiology intensive care unit, says the LKA has helped identify gaps in his knowledge. “The people I see come in with a cardiac diagnosis, but they obviously have other problems like diabetes and thyroid issues,” he says. “By doing that LKA I’m learning where my gaps are in internal medicine as it relates to the patients I care for in the cardiac ICU.

“If we can build that value to other physicians where they see how the LKA could help them in their day to day practice,” he adds. “I think we wouldn’t see as many questions about maintenance of certification and people would see its actual benefit.”

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