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    MOC reform: Latest developments

    Pediatricians now have more choices, as well as decisions to make, regarding participation in MOC.

    EDITORS' NOTE

    This article's views do not necessarily reflect those of Contemporary Pediatrics, the editors, or the Editorial Advisory Board.

     

    Although I’ve been writing articles for Contemporary Pediatrics since 1988, I have never received as much supportive e-mail as I have in response to my 2 maintenance of certification (MOC) articles published in the January 2015 issue. (See “MOC controversy: Issues and answers” and “MOC: A view from the trenches.”)

    More: MOC: Myths, facts, and FAQs

    Much has happened since these 2 articles were published. The recent sequence of events involving MOC is not unlike a television soap opera, whose plot line is filled with all sorts of twists and turns! There is now an alternative Board providing MOC certification for physicians, and, in the near future, the American Board of Pediatrics (ABP) MOC system is likely to undergo significant revisions.  

    The story so far

    In 2010, the American Board of Medical Specialties (ABMS) and its member boards drastically changed the model of certification to today’s model that is based on continuous “maintenance” of certification. As a consequence, in 2010, the ABP began issuing certificates with no end dates. Pediatricians were listed either as “participating in MOC” on the ABP website or “not participating in MOC.” According to data provided by the ABP website, as of December 2013, approximately 34% of the pediatrician workforce has a permanent certificate; 54% of pediatricians have time-limited certificates; and about 11% of pediatricians have let their ABP certificates lapse.

    The ABP maintains that MOC assures the American public that pediatricians practice the highest quality medicine. The mission statement of the ABP declares, “The American Board of Pediatrics certifies general pediatricians and pediatric subspecialists based on standards of excellence that lead to high-quality healthcare during infancy, childhood, adolescence, and the transition into adulthood."

    However, MOC has been widely criticized by practicing physicians of all medical specialties, who argue that there is no evidence that MOC improves patient care. It is expensive as well as time consuming, and it takes valuable time away from patient care. The Association of American Physicians and Surgeons has filed an antitrust lawsuit against the ABMS seeking to stop the MOC program from continuing.

    Many pediatricians have been critical of the ABP MOC program. Joseph Zanga, MD, past president of the American Academy of Pediatrics (AAP), founder of the American College of Pediatricians, and now chief of pediatrics at Columbus Regional Health Systems, Columbus, Georgia, has been a long-time opponent to MOC. He wrote in the Georgia AAP Chapter newsletter a few years ago that there is:

    ·      “No Proof of Demand—except created by the ABP. . . . In practice our public votes with its feet, or via their attorneys, about our competence. No peer-reviewed study has every verified the demand in recertification’s 20-year history.”

    ·      “No Proof of Efficacy—which surely could have been studied. The process has not demonstrated improved care of patients, nor has the reported health of children improved because of it. With approximately 40% (of approximately 90,000) of ABP-certified physicians in the Lifetime Certified category, a well-designed study could have, prospectively or retrospectively, given the ABP data upon which to proceed (or not)." 1

    Another advocate for MOC reform has been Meg Edison, MD, a Michigan-based pediatrician in general practice who is one of several founders of the website www.Rebel.MD. She has authored several compelling anti-MOC blog posts on the site. As an interesting aside, Edison’s state medical society has successfully passed a resolution that would prohibit tying medical licensing to MOC participation, joining several other state medical societies including Washington and New York that have done likewise.

    NEXT: How ABIM has changed its MOC

    Andrew J Schuman, MD, FAAP
    Dr Schuman, section editor for Peds v2.0, is clinical assistant professor of Pediatrics, Geisel School of Medicine at Dartmouth, ...

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    • [email protected]
      Same issues in psychiatry: Just passed my MOC(k) boards in abpn. But guess what! I'm not done... now I'm to pay equivalent of 1 hour wage yearly for next 10 years to police my record for Board approved courses- not the same ones I will use to update my medical license in order to maintain my Certification. 1 hour of hard earned money tending to sick patients, fights over approved medication, and filling out of numerous papers in an era of paperwork reduction! So what do I refer to myself if I chose not to follow these mandates- "board *decertified* or board uncertified after these next 3 years pass? I just got my new business cards from Vista print.
    • MARYHJOHNSON
      I have dutifully complied with MOC - and must continue to do so because my job (as a hospitalist) requires it - but I was one of the first lone voices to say, "This is getting pretty burdensome and stupid" (back in 2010 - on my blog - Dr. J's Housecalls - Google "Independence Day"/Dr. J's Housecalls). Like other disgusted Pediatricians on these forums/boards, I have written impassioned letters to past and current Board presidents - to no avail (or response). I've even had my comments banned on the ABP's President's blog (no explanation given). During my latest MOC cycle, I passed a proctored exam (during perhaps the worst period of my professional life) where I was treated like a CRIMINAL, and completed my PREP/PIR and the UTTERLY RIDICULOUS "Part 4" requirements a year and a half early. This past week, I got a "gentle reminder" in the mail - from Virginia Moyer (VP of ABP MOC and "Quality") - that I have until December to write a check for $1304 - so I can have the privilege of repeating the process all over again. If I have any questions or concerns, I have been directed to contact some faceless/nameless money-changer on "the MOC Administration team". And I have to ask, WHAT IS THE POINT? I have already expressed my concerns - about a process that brought me no small amount of humiliation, pain and anxiety (which I have been uncharacteristically - for a doctor - open about). No one is listening. Nothing is changing. For the record maintaining CME is fine with me (I do it anyway). So is an open-book/low pressure/integrative learning process - as we once had with online re-certification. But the MOC process now is purely and simply legalized extortion - stupidly expensive and embarrassingly repetitive/demeaning to its Diplomats. It's generated a cottage industry where EVERYTHING is about robbing certified doctors blind (well, at least those who are not "grandfathered" in). And isn't it interesting that I do not see lawyers or hospital executives being put through this unique brand of torture to prove their worth?
    • Dr. nudelman
      These so-called "changes" to the travesty called MOC amount to nothing more then putting lipstick on the proverbial Pig. The ABP is just a self-serving retirement home for non-practicing physicians who are laughing all the way to the bank. Sadly, the AAP is in cahoots with them. After 25 yrs of being taken advantage of by both organizations, I am quitting them and using the ABPS instead. Good Riddance!
    • Anonymous
      Thanks to Dr. Schuman for this article. I have recertified twice in the past. It is a waste of time & money.I let my ABP certificate lapse. I refuse to pay any more money to AAP & ABP. MOC is exploitation of hard working, practicing physicians who are a majority by smaller number of unethical ones in our profession. They are in complete denial, but MOC needs to be abolished to create a better future for younger physicians.
    • Dr. Vic Strasburger
      I really wish Contemporary Pediatrics (and the AAP) would stop cheerleading for the American Board of Pediatrics and MOC. These changes are relatively minor and don't address the real and urgent need for reform. MOC should be online, inexpensive, an annual UPDATE with new and useful information to pediatricians, and a short quiz at the end to demonstrate that the material has actually been assimilated.

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