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    MOC reform: One year later

    This article reports the latest developments in the process of reform for the American Board of Pediatrics’ Maintenance of Certification (MOC) requirements, what transformations already have occurred, and what changes still lie ahead.

    It's been over a year since the American Board of Pediatrics (ABP) announced its intentions to overhaul the maintenance of certification (MOC) process. In this reportorial article, I'll bring you up-to-date with current MOC requirements and the changes likely to occur over the next year. In addition, I'll provide some updates regarding several developments that pertain to MOC opposition.

    MOC circa 2016

    In 2010, the American Board of Medical Specialties (ABMS) and its member boards 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 current data provided by the ABP website, as of December 2015, approximately 34% of the pediatrician workforce has a permanent certificate and 53% of pediatricians have time-limited certificates. These numbers are essentially unchanged from 2013. Of note is that about 14% of pediatricians have let their ABP certificates lapse, which represents a small increase from 11% in 2013 (Figure).

    Related: 9 opinions on your professional societies

    The situation that ultimately caused many of the member boards of the ABMS to consider a "gentler" approach to MOC involved a directive imposed on membership by the American Board of Internal Medicine (ABIM) in 2014. In that year, the ABIM mandated that member physicians participate in MOC every 2 years. Additionally, grandfathered ABIM physicians began to be listed as "certified, not meeting MOC requirements" on the ABIM website if they didn't register for continuous MOC.

    In response to written protests from over 20,000 internists, the ABIM issued an "apology" letter that indicated that the ABIM would suspend several of its Part 4 requirements and change the language reporting a diplomate's MOC status on its website. The letter also indicated that the ABIM will update the MOC written exam to make it more relevant to current practice.

    This event led to the development of an alternative board (more on this later) as well as the expectation among other physicians that their own boards would begin embracing "reform."

    Changes in ABP MOC

    Over the past year, the ABP began to solicit feedback from member pediatricians and expressed its intention to make MOC requirements less rigorous and more relevant to pediatric practice. The 2016 annual report from the ABP was recently published, and it includes much information regarding what transformations already have occurred and what is likely to happen to the 10-year recertification exam (MOC part 3).

    Firstly, in response to discussions surrounding the quality assurance (QA) projects required for Part 4, the ABP now provides full 40 credits for pediatric practices that have achieved National Center for Quality Assurance (NCQA), patient-centered medical home (PCMH) status. Many practices have sought this certification, which I detailed in a previous Peds v2.0 article, "Home sweet 'medical home'" (Contemporary Pediatrics, November 2013). Achieving PCMH status assures patients (and insurance companies) that practices have met or surpassed quality benchmarks. This enables certified practices to prove eligibility for quality payment incentives offered by many Accountable Care Organizations (ACOs) and insurance companies. It should be noted however, that the ABP only provides MOC Part 4 credit for PCMH certification via NCQA, which is just one of several organizations that provide PCMH certification. These include URAC (formerly the Utilization Review Accreditation Commission), the Joint Commission, and the Accreditation Association for Ambulatory Health Care.

    The ABP also provides MOC credit for participation in state or national quality initiatives. For example, the American Academy of Pediatrics' (AAP) Division of Chapter Quality includes several ongoing quality projects involving asthma care, attention-deficit/hyperactivity disorder (ADHD) diagnosis and management, immunizations, and mental health and adolescent substance abuse. Now MOC Part 4 credit is also granted for small practices that design and pursue their own QA projects, such as undertaking a project to improve rates of handwashing among providers and staff.

    NEXT: A new exam format

    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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    • MARYHJOHNSON
      I just signed the Peds4MOCReform petition and have forwarded it to several of my Pediatric friends/colleagues. . . I have passed this thing three times - the last time in 2013, during perhaps the most trying/awful time of my professional life (and given my horrific experience as a public-servant-turned-medical whistle-blower back in the days of "Hillary's village" that's saying a lot). . . Responding to a request for feedback at the end of this last exam, I wrote the ABP's present/past Presidents - telling them my story (it took, I think, a considerable amount of courage to do that). I might as well have tossed the letter into a black hole. . . I've read about the new protocol - and I still think it's too much. I certainly recognize the need to stay current, and after passing the original exam, I am perfectly fine with regular CME and/or some form of low-pressure/open-book testing to be done at MY CONVENIENCE, but I am NOT FINE with the proctored test, or the practically useless/time-consuming "Part 4" activities (seriously, how many times can you do a "hand-washing" or "breast-feeding" module and not want to kill yourself?), or with answering the timed e-mails that the ABP now wants to hurl at me once a week (NO PRESSURE! and as if I don't have enough to do). It's just for the birds. . . I have decided that if the ABP continues down this road, as an older-but-not-quite-old-enough-to-be-grandfathered-in Pediatrician who has suffered mightily because of her ADD (only diagnosed as an adult/after training), I will be seriously considering legal action based on discrimination law (for instance, when I inquired about accommodations for my ADD during the last test, the ABP offered only extra time - completely MISSING the crux of the problem - which, to me is pretty sad given that Pediatrics is the medical specialty that is supposed to understand more than others that not all brains work/process/learn/TEST the same way). . . It's never been fair or right . . . OBTW, when I inquired about participating in the recent feedback sessions - the ABP's "schedule" could not accommodate the response. . . And/so enough is enough. The ABP needs come down out from its rarefied academic towers in Chapel Hill and start LISTENING to its diplomates on-the-ground and in-the-trenches . . . and give credence to voices that they have long/determindedly ignored. . . In point-of-fact, over the years, my Board certification in Pediatrics has meant absolutely NOTHING to a series of smug, self-important, way-over-paid hospital executives and/or lawyers (who do not have to re-pass their bar exams every ten years) who regard Pediatricians as "a dime a dozen" - lowly pawns on their chessboards of power and greed. . . they've done whatever they wanted with no checks or balances and the ABP looking the other way. It's WAY past the time that changed.
    • Dr. Vic Strasburger
      I agree with Mary and feel bad that she's not being treated fairly. Sure, the ABP is making changes -- under pressure -- and the changes they're making are INSUFFICIENT! MOC should be fun, educational, online, and CHEAP! The testing component could be a short quiz at the end of (an educational) module just to show you didn't click through it all at once. The idea that somehow the public and Congress DEMANDS MOC is ludicrous -- in 35 years, I've never been asked if I'm Board-certified (and only been asked once where I went to medical school -- Harvard, BTW). Time for the ABP to make substantive changes, not just window-dressing.

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