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    MOC: A view from the trenches

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


    We are lifelong learners

    One of the joys of pediatrics is that I learn at least 1 new thing every day. Pediatricians put up with complicated electronic health records, meaningful use, and insurance company requests for medication authorizations—all because we enjoy taking care of patients. We are used to participating in CME, and most states and hospitals require CME each year in order to maintain our medical licenses. Few physicians would disagree because most feel that CME of our own choosing can be enormously beneficial. State medical boards and hospitals have mechanisms in place for identifying problem physicians and also have numerous remedies for rehabilitation. Even without MOC, current processes already identify the very few physicians who do not provide quality care.

    Medical care is not just about “knowing stuff” but also providing good patient care. It means knowing how to communicate with patients and provide options; how to educate and reassure; and how to be honest and forthright when we face diagnostic dilemmas. We do not practice in a vacuum and it is more than appropriate to discuss cases with colleagues or specialists or to provide referrals when indicated. Although we can try to teach how to provide quality care, this often comes via experience, and more often than not our patients turn out to be the best teachers of all.

    How to fix MOC

    At a time when we are becoming more focused on evidence-based medical care, it is time that we challenge ABMS mandates as having no scientific merit and start to discuss developing evidence-based guidelines regarding how to practice medicine. This would mean suspending current MOC practices with the exception of the 10-year exam, and retaining the yearly CME requirement of state medical boards.

    I would like to receive credit for the self-education I do every day, be it looking up topics via UpToDate or Medscape, communicating with specialists, or reviewing a case with colleagues. This is the kind of real-world education that truly improves the quality of care we provide patients. I’d also like to receive credit for projects involving analyzing the accuracy of new devices I integrate into medical practice.

    I recently performed an in-office study regarding the sensitivity of a rapid strep test, determining that because we had few false negatives compared with culture, we could stop doing backup cultures. When submitted to the American Board of Pediatrics for MOC Part 4 credit, the study was rejected because it did not adhere to QA project requirements. Nonetheless, the project is now saving our clinic and patients money, and expediting patient care.

    It is long past due that we join with those colleagues who have signed petitions protesting MOC mandates. We should also encourage our AAP chapter representative to request that the AAP investigate the MOC process.

    I am hopeful that eventually someone begins listening to those of us practicing in the trenches of medical care. While I bide my time, I am joining the American Association of Physicians and Surgeons, which has the stones to sue the ABMS in an attempt to overturn the MOC process.



    By completing my MOC, I can pay the American Medical Association $75 to get 60 CME category-1 credits. This satisfies 1 year of CME requirement in my home state of New Hampshire and most other states. —Andrew J Schuman, MD, FAAP

    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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