Statement from Richard J. Baron, MD, MACP, President & CEO of the American Board of Internal Medicine regarding anti-MOC petition
Philadelphia, PA, April 28, 2014 – ABIM has heard from many diplomates about their frustrations to the changes to the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) process. They have concerns about relevance, cost and the time it takes to complete MOC. A petition, signed by more than 10,000 physicians, raises many important issues.
The focus of the petition is to eliminate all the MOC requirements except for the every-ten-year exam because of the burden and the expense. We have heard from other diplomates that they don’t believe they should have to do an MOC exam, and that they should only have to submit continuing medical education (CME) to maintain their certification. We hear from many diplomates who believe lifetime certificates are unfair, and we hear from those who hold lifetime certificates who believe they should not have to do anything in the ABIM MOC program. Meanwhile, large numbers of internists have chosen to use the new MOC requirements to demonstrate to their peers and their patients that they are keeping up and engaged in ongoing assessment.
As medical knowledge and practices continue to change, a continuous MOC program tells the community that a physician is staying up-to-date, has met a knowledge standard established by his or her physician peers, and is engaged in ongoing assessment of his or her practice.
We do recognize that there is a cost – for the large majority of our physicians, the entire program costs from $200 – $400 per year. The fee for the new MOC program includes not only the first exam attempt in each certification area but also unlimited access to ABIM's Self-Evaluation of Medical Knowledge and Self-Evaluation of Practice Assessment products, the other components of the MOC program, many of which earn CME credit (again at no additional cost). Our fee structure covers the costs of developing and administering the secure, computer-based exams at test centers nationwide, as well as the ongoing development and release of all ABIM self-assessment products. I encourage the petition signers to visit ABIM's revenue and expenses for more information.
One of the biggest critiques I hear from physicians is that they should get credit for things they are already doing. Since many of them haven’t engaged in MOC for a number of years, they may not know about the many opportunities for physicians to earn MOC credit for activities not developed by ABIM. From participating in sessions at annual society meetings to quality improvement activities in their home institutions, there are a myriad of new options for earning MOC points. Our estimate – based on survey data provided by diplomates themselves – is that to continue to meet MOC requirements takes anywhere from five to 20 hours a year. The year you take your exam, the time commitment is, of course, longer.
There is a good deal of research demonstrating the value of MOC: from the validity of the examination, to the importance of independent assessments – clinicians are not good at evaluating their own weaknesses. All of this research drives and informs our program requirements and product development. And while the petition questions the value of our knowledge and practice assessment modules, diplomates who complete them report they are valuable, and that they learned something about their clinical domain or their practice. But I agree – they could be better. And we can and will create even more avenues for physicians to get MOC credit.
ABIM is taking steps to ensure that the practicing physician plays an active part in developing our requirements and approving our products. We have recently changed our governance structure so that all of our specialty boards include at least one internist in non-academic community practice as well as two public members, and we have affirmatively recruited internists with a diversity of skills and practice settings.
ABIM's mission is to enhance the quality of health care by certifying internists and subspecialists who demonstrate the knowledge, skills and attitudes essential for excellent patient care. As the requisite knowledge, skills and attitudes evolve, so must our program and our requirements. While we recognize that the program is not perfect, an every-ten-year process is not sufficient to attest that our certified physicians are keeping up.
Please know that we take very seriously the feedback we hear about our products and programs. MOC is a continuously evolving program in which we focus on improving the value and relevance of the credential, and we continue to welcome constructive diplomate feedback on how to enhance our assessments.
There are now nearly 150,000 physicians engaged in the ABIM MOC program – with more than 50,000 enrolling in the last four months. Our obligation to those diplomates is to provide a program that they find relevant and meaningful, that meets them where they practice, and gives them credit for the relevant work they are doing. Physicians have been proud of their board certification and have used it, appropriately, to distinguish themselves from others who have neither their training nor experience. In a changing world with multiple ongoing expectations from health care institutions and the patients whom we serve, ABIM means for our credential to reflect something about individual diplomates that is current, recent, relevant and rigorous. We will always be balancing multiple possible approaches for how to best fulfill that commitment, and we will be incorporating the petitioners' views in our thinking and planning as we continuously evolve our program to make it better.
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For more than 75 years, certification by the American Board of Internal Medicine (ABIM) has stood for the highest standard in internal medicine and its 20 subspecialties and has meant that internists have demonstrated – to their peers and to the public – that they have the clinical judgment, skills and attitudes essential for the delivery of excellent patient care. ABIM is not a membership society, but a non-profit, independent evaluation organization. Our accountability is both to the profession of medicine and to the public. ABIM is a member of the American Board of Medical Specialties. For additional updates, follow ABIM on Facebook and Twitter.