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Experts from ABMS, ABIM discuss role of MOC at ACP Internal Medicine Meeting

BOSTON — Today at the ACP Internal Medicine Meeting, experts from the American Board of Medical Specialties and the American Board of Internal Medicine, discussed the controversial process of Maintenance of Certification.

“This is about our professional responsibilities as it relates to keeping up, maintaining our skills, maintaining our contract to society, however you would like to term that, but our fiduciary responsibility in terms of who we are as internists and who we are within the context of our medical community,” moderator David A. Fleming, MD, MA, MACP, president of ACP, said during the session.

David A. Fleming

Controversy surrounding the program's efficacy has been growing, and many physicians have spoken out against MOC, questioning the value of ongoing learning programs and voicing concerns about the financial burden of meeting new requirements and the additional work the program will add to their busy schedules. In response to this criticism, in February the ABIM suspended the Patient Voice and Patient Safety program for 2 years.

The ACP “feels very strongly that we do have an obligation for lifelong learning that we need to embrace,” according to Fleming. In addition, the college feels compelled to offer opportunities for physicians to complete MOC through organizations with which they have an “arm’s length relationship,” so as to minimize conflicts of interest, he said.

According to Mira Bjelotomich Irons, MD, senior vice president of academic affairs at the ABMS, she has heard positive messages from individual physicians during the debate and dialogue surrounding MOC. Among them, that MOC is useful and leads to targeted learning, or that the exam preparation process taught them a lot, despite their worries. However, one of the most important things the board has heard is that the program does not work for some physicians, whether related to part 3 (the secure exam) or part 4 (quality assessment/practice performance).

Irons said the ABMS has laid out a framework for specialty boards to follow to implement the MOC program in a way that makes the most sense for their specialty, with a special focus on reducing burden, including costs and increasing relevance and meaning for physicians.

One of the most difficult challenges of MOC, for physicians and organizations like ABMS and ABIM, is part 4 – quality assessment and practice performance. According to Irons, communication, coordination of care and systems-based practice are some of the hardest areas to assess. However, she noted many boards are becoming innovative, using registries and Ongoing Professional Practice Evaluation (OPPE) metrics to quantify quality and practice performance.

According to Clarence H. Braddock, III, MD, MPH, MACP, chair elect of the ABIM board of directors and vice dean for medical education at UCLA David Geffen School of Medicine, some boards ─ specifically anesthesiologists ─ are offering simulation education to help physicians complete part 4.

Over the last year, Braddock said the ABIM has been working to make part 4 more efficient and less difficult for physicians. Since the ABIM's February decision to suspend its part 4 requirements for at least 2 years, the discussion has broadened to include leadership of specialty societies and practicing internists.

“I invite you to continue in a dialogue that will help meet patients’ needs, help meet the needs of the profession and continue the public trust,” Irons said. – by Stacey L. Adams

For more information:

Fleming DA, et al. Pursuing professional excellence: The role of Maintenance of Certification. Presented at: ACP Internal Medicine Meeting; April 30-May 2, 2015; Boston.

Disclosures: Braddock and Fleming report no relevant financial disclosures. Irons is employed by the ABMS.