Experts call for changes to MOC

The controversy surrounding the American Board of Internal Medicine’s Maintenance of Certification program continues, as the American College of Cardiology has asked ABIM to make changes to the program, and the Endocrine Society has asked ABIM to suspend the program entirely. Both are calling for research into the efficacy of ongoing learning programs.

Patrick T. O'Gara, MD, FACC, president of the ACC, professor of medicine at Harvard Medical School and director of clinical cardiology, said he is encouraged by changes made by the ABIM, but more of the MOC requirements need to be reformed.

New ways to earn credit

Patrick T. O'Gara

One improvement the ABIM could make, according to O’Gara, would be to develop a way to allow CME credits provided by accredited institutions such as hospitals, health care systems, the ACC or universities to count toward MOC credits.

“We would like the ABIM to develop the means by which attendees and learners can be accredited for legitimate CME activity in which their participation, interactivity and performance are actually measured so that our providers and members can accomplish both things at the same time,” O’Gara told Cardiology Today. “I think the posture of the ABIM during the meeting and in the ACC’s communications with the ABIM [was] very receptive and they seem to be very earnest in their understanding of our concerns. They have assured us that these kinds of recommendations are being taken under advisement at the level of their board of directors.”

Changes to testing structure

Speaking on behalf of the Endocrine Society’s Clinical Endocrine Education Committee, Graham McMahon, MD, MMSc, associate professor of medicine and associate dean of continuing education at Harvard Medical School, and endocrine fellowship program director at Brigham & Women's Hospital, said that the society supports ongoing education and the ABIM’s role in certification, but has asked the board to suspend the current system.

“This particular iteration of the design of the program has been problematic for our members and many other professional societies,” he said.

Part of the problem, according to McMahon, is that the exams are designed to cover a broader range of information than is required by most experienced specialists; most specialists become even more specialized over time. However, McMahon acknowledged that awareness of other conditions is needed to improve treatment.

“Ultimately, we have to remember that we are physicians first; even if we’re endocrinologists, we need to be able to recognize gastrointestinal diseases or neurological problems. Even if we’re not entirely expected to manage those conditions, we are expected to recognize other systems that cause issues in patients.”

However, he said testing that requires physicians to permanently memorize detailed information that is readily available and is not used in daily practice is illogical.

“I think we have to be deliberate about how we choose to assess our colleagues to maintain the quality of their care, and to design systems that reflect the way doctors provide specialty care today,” McMahon said. “They do need to have a strong foundation of factual materials retained, but we generally look up answers to drug doses or recommended next steps when we know what is going on with a patient. We don’t need to retain information that is ubiquitously available. It is totally appropriate to look things up, and our assessment systems don’t reflect that.”

McMahon said he is pleased with the changes the ABIM made in June, but the reforms need to be taken further.

Other concerns

O’Gara said the ACC does not support cessation of the program at this time. Other organizations are questioning the program, and several websites have appeared calling for changes or for physicians to take a pledge of noncompliance with MOC.

“I think that they have the right to exercise whatever judgment is appropriate for their practice and their patients, and for their reporting requirements to their hospital, health system or state licensing board,” O’Gara said. “There are differences of opinion on how to move forward with or without the ABIM. We are respectful of those other opinions but have charted a different course from those who advocate noncompliance.”

The MOC requirements are an additional layer of expectations at a difficult time for physicians, according to O’Gara.

“It’s fair to acknowledge that these changes are occurring in a climate in which cardiovascular medicine providers, like many other clinicians in the U.S., are feeling somewhat hounded by regulatory agencies and new obligations with respect to meaningful use criteria, public reporting, etc. It helps to understand the level of passion around this when it’s placed in the context of all of the other burdens that are being put on the shoulders of providers. People are feeling the strain.” – by Shirley Pulawski