Value of the Continuing Certification Modules and Challenging the Status Quo

Support for MOC/OCC

Several prominent boards support MOC and OCC (Table). The ABMS states that specialty boards “are instrumental to the integrity of medical specialty care. They provide a trusted credential that is important to patients and relevant to physician practice.”²⁷

The American Board of Osteopathic Family Physicians² stated in 2012 that the “single examination model for certification is no longer the standard demanded by the public. [Osteopathic Continuing Certification] [W]ill help Osteopathic Physicians meet and exceed industry and regulatory standards [and] [W]ill be accepted for Maintenance of Licensure (MOL).”

However, in July 2018, the Vision Initiative²¹ hosted 21 hours of testimony from physicians, patients, and other stakeholders and distributed a survey to stakeholders. From the survey results,²² which comprised a convenience sample pulled from more than 34,000 physician responses, it was found that:

While a small percentage of physicians value MOC, a larger portion (of stakeholders) has either mixed views or do not value MOC…. Respondents want continuing certification to include a focus on relevant CME opportunities, self-assessment delivered at regular intervals, open-book testing, and an assessment of the quality and safety of the care provided.²²

Despite this conclusion, it appears ABMS will continue to use the existing modules.

Opposition to MOC/OCC

While most physicians agree that CME in their specialties is important, they disagree with the method of achieving certification. ²⁵ Physicians are adapting to utilize real-time information through podcasts, electronic textbooks, and various online resources to stay current with evolving best practices. Rote examination and entering patient data sets with self-assessments fails to help physicians remain current with the literature and advancements relevant to their fields.¹⁶

There are also concerns regarding the financial links between the ABMS and, to a lesser degree, the BOS, and funding institutions such as hospital organizations, pharmaceutical companies, and credentialing organizations. For example, the ABIM is nonprofit, but its financial counterpart, the American Board of Internal Medicine Foundation, is not.¹⁷ Likewise, the nonprofit ABMS is associated with the for-profit arms ABMS Solutions, LLC, and ABMS International, LLC, which are the primary sources of verifying physician certification and offering training to other countries on licensure and certification, respectively.^14,15

Multiple independent physicians and physician organizations are raising concern that these boards are adding onerous projects while benefiting financially. They argue that although lifelong education is necessary, the modules do not improve patient care or outcomes.¹⁸ In a survey of physician attitudes about MOC, Cook et al¹⁹ found that only 15% agreed that MOC was worth the time and effort and 81% found it burdensome. Less than 40% of respondents felt MOC activities contributed to professional development, and the perceived relevance of MOC was noted throughout physician specialties.

After hosting a dialogue on the MOC requirement, the American Academy of Neurology issued a position statement calling MOC Part IV “an unnecessary, onerous requirement” and urged the American Board of Physicians and Neurologists to repeal it.²⁰ The academy further noted that MOC programs “have become so unpopular that state legislatures are moving to limit the significance of MOC and some physicians are opting out of the predominant recertification system entirely.”²⁰

Certification Competition

Two major competitors, the NBPAS and the ABPS, assert that MOC and OCC are cumbersome and ineffective. According to a 2015 article in MDedge,¹³

The launch of the NBPAS’ program occurred just weeks before the [ABIM] announced drastic changes to its MOC process. In a frank announcement, ABIM apologized to doctors for an MOC program that “clearly got it wrong,” and pledged to make the program more consistent with physicians’ practice and values.

Both of the NBPAS and ABPS offer their own board certification. They still recommend board certification; however, they push for streamlining the certification process and eliminating re-certification testing in favor of focused CME in specialty-specific areas.^28,29 The focus is on continued lifelong learning instead of performing case logs and quality improvement projects.