Is It Time to Replace Maintenance of Certification?

The American Board of Internal Medicine (ABIM) announced Feb. 3, 2015, that it is making substantial changes to its Maintenance of Certification (MOC) program and apologized for not doing a better job.

ABIM President and CEO Richard J. Baron, MD, reached out to diplomates via email and said ABIM “clearly got it wrong. We launched programs that weren’t ready and we didn’t deliver an MOC program that physicians found meaningful. We want to change that.”

These changes come as a growing movement is underway in the United States to set up alternative certification processes. Fed up with the lack of benefit from MOC, many clinicians have said it is time to dump the current MOC program and set up an alternative certification program. In particular, they are calling for a program that is more receptive to clinicians and to their needs. 

It remains uncertain if the changes now proposed by Dr. Baron will bring clinicians’ desire for a new MOC program to a halt.

Past Problems

The American Board of Medical Specialties (ABMS), which set up MOC, is the parent organization of 24 specialty boards, including ABIM. In endocrinology, diabetes and metabolism, MOC includes practice improvement modules and passing a secure closed-book exam. 

Nevertheless, despite its intended purpose, many endocrinologists complain that MOC is of little value, and they are not alone. New studies have found that many clinicians feel MOC is in need of significant change or should be replaced entirely. 

“We went through a process of trying to modify it in the summer and all the various specialty societies gave testimony in Philadelphia. Every subspecialty leader gave a litany of things that needed to be changed,” said American Association of Clinical Endocrinologists (AACE) President R. Mack Harrell, MD, who is a practicing endocrinologist in Ft. Lauderdale, Florida.

However, those efforts were fruitless, according to Dr. Harrell. He said those running the MOC had turned a deaf ear to attempts to improve or modify the product. 

“There is no proof that it improves care so what would be the point in keeping it? A lot of the modules are basically busy work and physicians are under a lot of duress now,” Dr. Harrell said in an interview with Endocrinology Advisor.

“Physicians have no choice and no input. I think it needs some competition and then it will be more responsive to doctors’ needs. We are looking for alternatives for other certification, and alternative pathways are being discussed by specialties.” 

Impact on Clinical Care, Patient Outcomes

Researchers in Wisconsin recently conducted a study with internists providing primary care at four VA medical centers. Results suggested little improvement in care with MOC.¹

“The data were never robust to support MOC and recertification, regardless of what ABIM states, and our publication offers no benefit for current recertification efforts on patient-care quality measures. The ABIM-sponsored study in the same issue of JAMA also offers no support for a physician recertification effect on patient care outcomes,” said lead study author John Hayes, MD, who is with the Clement J. Zablocki VA Medical Center in Milwaukee, Wisconsin.  

“ABIM and ABMS appear to be repeating talking points, hoping that the situation will quiet down. But I don’t see the physician outrage going away.”