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Author's view of MOC unrealistic

I believe the article "Maintenance of certification [MOC] has value for physicians and their patients," (Viewpoint, October 25 issue) is out of touch with reality.

There are other ways to participate in a "peer-developed, externally validated system," such as the Medical Knowledge Self-Assessment Program of the American College of Physicians or the Endocrine Self-Assessment Program of the Endocrine Society, which are both fractions of the cost of MOC.

Author Lois Margaret Nora, MD, JD, MBA, says the MOC process is unproven due to its "relative youth." However, voluntary recertification was started in 1974 by the American Board of Internal Medicine (ABIM). Surely some information could have been ascertained regarding the value of MOC over the past 48 years.

Voluntary recertification was the precursor to MOC. Mandatory MOC, otherwise known as time-limited certification, came about because very few diplomates participated in voluntary recertification. I'm sure Dr. Nora is aware of the increased fees and revenue that accrue to ABIM and other boards from continuous repetition of testing. Perhaps the American Board of Medical Specialties (ABMS) and member boards don't want to do a study in age-matched physicians who do and do not participate in MOC because if it showed no benefit from MOC, their tollbooth would close.

In my experience, the majority of physicians who participate in MOC and share their feelings about the program find the process to be essentially irrelevant and filled with attention to miniscule details of little clinical importance. I don't need to spend all that money to commit to quality patient care, and I demonstrate my dedication to my patients, community, and family daily without ABIM or ABMS assistance.

Can Dr. Nora answer why a secure test is needed when physicians have immediate access to clinical support on smartphones or computers? Does the secure test exist only as a source of revenue to the member boards?

Why is certification now timelimited? Is it to coerce diplomates into incessantly studying for tests and paying outlandish fees for member boards? Isn't it a cruel joke to call MOC "voluntary" with time-limited certification?

When can the ABMS demonstrate it is actually benefitting patients and physicians? When is the ABMS going to listen to the large and rapidly growing number of diplomates who think the MOC process is too expensive, intrusive, and onerous? When are the member boards going to lower the outrageous salaries of their leaders who are paid from the MOC tollbooth? These salaries are a clear insult to diplomates paying the exorbitant MOC fees. When are the member boards going to address the complaints of the participants in its programs?

When is the ABMS going to act on Dr. Nora's words? Actions speak louder than words, Dr. Nora.

Marc S. Frager, MD

Boca Raton, Florida

Testing doesn't make better docs

I disagree with Dr. Nora's opinion on maintenance of certification (MOC).

I am a family physician in practice for 12 years. I have worked in community health and private practice. I am medical director of an internal medicine clinic and involved in administrative duties. I see and talk to my patients and cover preventive health at office visits. I have built a full practice in less than 2 years of patient referrals, based on what I do.

I am a very good physician and must say that testing does not make a better physician. I work with doctors who test in the top 5% of their class and pass multiple boards yet lack the human skill set to offer good, compassionate patient care.

I learn more from up-to date and active continuing medical education courses than American Board of Family Medicine modules.

In addition, I have never been proficient at testing because I think of the entire differential diagnosis and find there is never enough information in a single test question. …

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