'There is still work to be done': ABIM maintenance of certification program faces scrutiny

Key takeaways:

• IDSA called on ABIM to improve its maintenance of certification program so it is more clinically relevant.
• ABIM said it recognizes the need to improve its programs.

ABIM said it is looking forward to communicating with physicians to improve its maintenance of certification programs after recent criticism.

Steven K. Schmitt, MD, FIDSA, president of the Infectious Diseases Society of America (IDSA), called on ABIM to make several changes in a letter published Dec. 1, 2023, in Clinical Infectious Diseases.

“IDSA has worked closely with ABIM for years to provide feedback on the MOC program,” Schmitt wrote. “It is our hope that we can continue a dialogue and work with ABIM to create an [maintenance of certification (MOC)] program that improves clinical practice, optimizes patient care and supports lifelong learning.”

Specifically, Schmitt requested that ABIM change the MOC program to make it more relevant to the scope of practice, clinically meaningful, inclusive of infectious disease physicians and supportive of their continuous learning.

“Active participation in recertification programs should be feasible and without undue burden,” Schmitt wrote. “Any requirements for professional development beyond ID fellowship training should provide added value and not be duplicative of existing requirements already in place.”

This is not the first time ABIM’s program has been the subject of controversy. In 2015, ABIM announced immediate and significant program changes after the internist community raised concerns that the program was not keeping them up to date in their field. The following year, the organization’s board of directors voted to not require MOC practice assessments for 2 years, again based on feedback from the internal medicine and subspecialty community. More recently, other specialty societies participating in the ABIM MOC, including the American Society of Hematology, have expressed similar concerns, Schmitt wrote.

To maintain both licensure and board certification, Schmitt noted that ID physicians must “go through an intensive, multilayered set of programmatic requirements.” These requirements are time-consuming, he wrote; for both ID and internal medicine licensure and recertification, the time it takes a physician to complete their requirements can range from an estimated 25 hours per year to approximately 62 hours per year.

IDSA surveyed its members in September 2023 to learn more about their satisfaction with the current ABIM MOC program. Overall, 57% of members said MOC did not help them stay up to date in ID, 69% said it did not positively impact their clinical practice, 82% said the time and cost required is a burden and 79% said they were concerned about burnout.

After careful consideration, IDSA has determined the program “is not a good metric for measuring ongoing competence in the field,” and must be “modified to meet the current demands of the workforce,” Schmitt wrote.

“The majority of physician respondents reported the MOC program adds no clinical value, does not positively impact clinical practice and contributes to burnout,” Schmitt wrote. “Additionally, the program cost and time requirement surfaced as serious issues that must be addressed.”

The concerns were spread across all stages of IDSA members’ careers, Schmitt wrote, but they were even more common among physicians early in their career: 76% said it did not positively affect their clinical practice, 81% said the time required was a burden, 92% said the annual cost was a burden and 86% said they were concerned about burnout.

“This is particularly alarming, as the workforce pipeline and recruitment into the field of ID are issues of critical concern given current and projected workforce shortages,” he wrote.

In a statement to Healio, ABIM said the organization “sincerely listens to feedback from the physician community and professional medical societies in an effort to deliver the best assessment programs possible.”

ABIM introduced the Longitudinal Knowledge Assessment (LKA) — a new assessment option — in 2022 because of that feedback, the organization said. There are more than 40,000 physicians involved in the LKA, which was not released in infectious disease until January 2023, according to the statement.

“[Physicians] are choosing it four to one over the traditional 10-year Maintenance of Certification exam, and the majority share positive feedback about their experience via post-exam surveys,” the organization said in the statement.

Schmitt outlined several steps he wrote IDSA strongly urges ABIM to take immediately, including:

• streamline the MOC process;
• lower the MOC fees;
• remove any redundancies between MOC requirements and the requirement to report CME to ABIM;
• allow physicians answering questions to consult a colleague like they would do in practice;
• eliminate the time restrictions for each LKA question so physicians can research the answers like they would in their practice; and
• reduce the number of LKA questions physicians receive every 3 months to no more than 15.

Taken together, Schmitt wrote that the changes “will help to ensure the MOC program is clinically relevant, flexible, supports continuous learning and does not create undue burden.”

“We recognize there is still work to be done, and look forward to continued dialogue with the community so we can enhance and improve our programs to best meet the needs of today’s practicing physician,” ABIM said in the statement.

References:

• IDSA Calls for Substantive changes to ABIM’s MOC Program. https://www.idsociety.org/news--publications-new/articles/2023/idsa-calls-for-substantive-changes-to-abims-moc-program/. Published Dec. 14, 2023. Accessed Jan. 2, 2024.
• Schmitt SK. Clin Infect Dis. 2023;doi:10.1093/cid/ciad760.