Where Do You Stand?
Hertz, Beth Thomas, Medical Economics
MAINTENANCE OF CERTIFICATION PROCESS SPARKS DEBATE
Continual learning and growth is a goal most members of the medical community agree is important. The introduction of the maintenance of certification (MOC) process in recent years, however, has evoked strong feelings from some physicians who already are feeling overburdened by their workload and other requirements.
MOC is a continuous professional development program that replaces traditional recertification with ongoing learning activities. Although specific requirements vary by boards, the overarching guidelines stem from the American Board of Medical Specialties (ABMS), which has 24 member boards that certify doctors.
The ABMS describes its MOC program as the most extensive of its kind.
"Rather than the traditional recertification process, which relies on the demonstration of competency via methods such as periodic tests or the accumulation of credits at educational meetings, [the program] is an active process of assessment and continuous professional development that requires participants to keep pace and demonstrate ongoing competency with advances in the field of medicine throughout their entire careers," it states in its explanatory materials.
The four-part process includes licensure and professional standing (including an unrestricted license to practice medicine); lifelong learning and self-assessment; cognitive expertise; and practice performance assessments.
According to the ABMS, more than 750,000 physicians hold certificates from its member boards, and about 300,000 have met the requirements or are engaged in ABMS MOC program activities.
Although many of them are doing it, many are quick to express their discontent. Family medicine physician Douglas L. Lefton, MD, who practices in Fairlawn, Ohio, summed up the feelings of many physicians: "I find this process to be complicated, frustrating, time-consuming, and expensive."
Leaders of the certifying boards, however, staunchly defend their programs as valuable- and voluntary.
Kevin B. Weiss, MD, MPH, ABMS president and chief executive officer (CEO), says that ABMS surveys show that the public wants doctors to be involved in ongoing learning, and in fact, that many patients would change doctors if they learned their physician did not participate.
'We set high standards that let the public know physicians are involved in an activity with vigorous standards in which their knowledge and ability is being assessed," Weiss says.
Such self-regulation is crucial to the medical profession, he adds. "We need to do this. It is an obligation of the profession to do it and do it well. Our challenge is to do it to the standards that doctors and patients expect."
The recertification process is constantly being adapted and updated, Weiss says. Originally, certification required a one-time test. About 20 years ago, periodic tests were instituted for recertification, and about 10 years ago, the four-part process listed above began. About 3 years ago, the board raised its standards even further, he says.
New principles set to begin in 2015 include shifting MOC from 7- to 10-year cycles into requirements for annual activities. Weiss says the process will involve less emphasis on testing with more transparency, more patient and peer surveys, more self- assessment activities, and more disclosure of physician conflict of interest.
He acknowledges that MOC activities take time to complete but says that is the nature of ongoing learning, "The alternative is not to take time for professional development," he says.
Another change that is expected is the incorporation of the "meaningful use" of health information technology (HIT) in the MOC program.
"Aligning MOC and meaningful use of HIT will help to facilitate physicians' knowledge, skill, and use of HIT and in turn can improve physician performance and patient outcomes," Weiss says. …