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    MOC: A view from the trenches

    One physician says the time to protest MOC mandates is now.

    This article's views do not necessarily reflect those of Contemporary Pediatrics. —The Editors


    I took my pediatric boards in 1984. Board certification back then consisted of both written and oral exams. While I was raising my young family, it wasn’t easy to allocate the funds needed to fly across the country to take my “oral” board exam. We somehow found the money and I completed my “orals” (after reading through the Nelson Textbook of Pediatrics a few times). I remember the sense of accomplishment I felt weeks later when I opened the letter indicating that I was “Board Certified” in Pediatrics, and I hung my framed certificate in my office with pride. To me, board certification marked the end of a long road beginning with premedical studies, medical school, residency, and medical practice. After more than a decade devoted to becoming a pediatrician, board certification meant that I had the skills and knowledge I needed to become a good pediatrician and do well by my patients.

    The rules change

    As you can imagine, I was disheartened to learn that at the turn of the millennium, the American Board of Medical Specialties (ABMS) was introducing a new Maintenance of Certification (MOC) program that did away with permanent certification. Although young pediatricians could become board certified, it was only a temporary designation and one that required “recertification” every 10 years.

    By changing the rules abruptly, the ABMS had denigrated my wonderful post-residency achievement by mandating participating in MOC in order to continue to demonstrate pediatric expertise. Because I was “grandfathered,” I had not intended to recertify, until I left private practice and my employer indicated participation in MOC was a condition of employment.

    Like many of my colleagues in clinical pediatric practice, I hold the MOC program in low esteem—even more so after managing to finish my Part 4 projects in the nick of time to complete my first 5-year cycle. After investigating the controversies surrounding MOC certification (see “The MOC controversy: Issues and answers“), I believe MOC is an unnecessary program, and one that only adds to our workload.

    Real world pediatrics

    As I have asserted time and again in my Peds v2.0 articles, there is a striking disconnect between real-world pediatric practice and the perception of pediatric practice by those who have sought to regulate and “improve” medical care. So many impediments have been placed in our path by extraneous bureaucracies that it is becoming very difficult to take care of patients these days. For these reasons, many pediatricians are retiring early or abandoning private practice. In my view, pediatricians, long considered the most timid of physicians (it’s in our nature that we must have a tolerant disposition to be a good pediatrician), should stop accepting these impositions and begin to rally to improve our working conditions. By doing so, we will improve our quality of life as well as the care we provide our patients.

    Two months ago, I suggested that we “just say no” to stage 2 meaningful use. Perhaps it’s also time to try to improve the MOC process and “just say no” to the current MOC program.

    A hot topic

    Today MOC is a very hot topic among my pediatrician colleagues. I honestly have not encountered a pediatrician in clinical practice who has anything good to say about the program, with most vigorously expressing that MOC does not improve the quality of care we provide patients. Many tell me that it takes time away from medical practice; it’s too expensive; and it adds to the office overhead of providing care. They also express that MOC Part 4 projects have little bearing on clinical practice and should be eliminated.

    Many who oppose MOC believe that the ABMS has reinvented itself and its relevance to medical practice primarily for financial purposes, claiming that the public needs to be reassured that American physicians continue to be well trained and educated. Many physicians feel betrayed by academic institutions, medical think tanks, medical societies, and the government, all of which have supported MOC without evidence that it is necessary or that it can even achieve its intended purposes.

    We suspect there may be dark forces at work because the ABMS and its member Boards were conceived as nonprofits but today have assets in the millions of dollars, and their executives are extremely well paid. In addition, continuing medical education (CME) organizations including the American Academy of Pediatrics (AAP) have generated lots of money providing self-assessment and quality assurance (QA) modules for MOC, so they have little reason to challenge the status quo.

    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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    • Anonymous
      I'm trying to find figures for how many pediatricians are choosing not to comply with MOC. Do you have any figures?
    • Dr. Scott Budd
      Dr. Schuman, Your final paragraph mentions the "American Association of Physicians and Surgeons". Did you mean the "Association of American Physicians and Surgeons"? I'm not a fan of the current MOC mandates, but I'm most definitely not a fan of the AAPS. Are you aware of what they stand for? I'd be curious to hear others views of this reactionary organization.


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