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Physicians Rail at Recertification Requirements

Cheryl Clark, for HealthLeaders Media, June 19, 2014

Medical doctors are facing revamped board recertification requirements that are "expensive, burdensome, and detract from the care of the patient," says David Fleming, president of the American College of Physicians.

A physicians association representing some 120,000 practicing internists is up in arms over groundshaking new rules for board certification, known as maintenance of certification or "MOC."

Many of the new recertification requirements, which took effect Jan. 1, "are not evidence-based, but are expensive, burdensome, and detract from the care of the patient," says David Fleming, president of the American College of Physicians.

The new rules are so "logistically and emotionally burdensome," he says, that they "may drive smaller practices out of business."

The traditional recertification exam, a "secure" set of 200 multiple choice questions doctors must pass once every 10 years, now has a failure rate of 22% for those who take it the first time. For those who took it for the first time five years ago, only 9% failed, Fleming says.

Not only are many of the questions on the exam irrelevant, Fleming contends, but "the core general medicine questions that we were used to having in the past are no longer there. Instead, there's a lot of esoteric information you were expected to memorize, like knowledge of clinical situations and diseases that you never see."

The rules are perceived to be so onerous, that 10,000 internists have signed a petition calling for many of the new criteria to be killed.

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7 comments on "Physicians Rail at Recertification Requirements"

Paul Kempen, MD, PhD (7/7/2014 at 12:36 PM)
Ms Clark has actively supported the positions of the ABIM, which is a private corporation recently having invented MOC for their own corporate profits, certification already costing currently $400 million a year in gross receipts and paying their CEO salaries as high as $1.2 million in 2009. They have not been able to demonstrate Certification improves care, yet alone that MOC impacts care in outcome based study. They have even authored and published in 2002 an attempt at meta-analysis to prove Certification matters-but found this was impossible due to the poor quality of all prior studies, describing the "proof" as a "missing link" in the title (Sharp LK, Bashook PG, Lipsky MS, Horowitz SD, Miller SH. Specialty board certification and clinical outcomes: the missing link. Acad Med 2002;77:534–42). The assumption that doctors are not "up to date" is further unfounded, as life long learning is essential to continue in practice and obtain state licenses. The fact that numerous state and national oversight mechanisms exist is ignored, as Ms Clark choses to support the ABMS to be her particular brand of reassurance-as unfounded as that is. I pointed repeatedly to ABMS written articles confirming there is a lack of evidence to support certification and their MOC program, while studying and publishing comprehensive reports to the contrary (Kempen PM. Maintenance of certification and licensure: regulatory capture of medicine. Anesth Analg. 2014 Jun;118(6):1378-86. ) as have others. As for practice improvement modules: These include changing patient care without patients being informed of any risks, costs or dangers-while the sole purpose is for a doctor to personally profit=MOC re-certification. Research for personal benefit and without informed consent was internationally outlawed after WWII by the Nuremberg laws and subsequently validated among all civilized societies by the Helsinki declarations. Society DEMANDS that informed consent be required and that safety and review be assured for every patient in any experiemental setting. Validation of physician competence IS already being verified by multiple agencies including hospital and state medical boards who DO have practice authority, which the ABMS does not have. We do not provide free license to anyone to experiment with human life. This is exactly what the ABMS is forcing, while actually doing nothing to insure physician quality. Next time you go to your doctor ask him if he is MOC compliant and including you in his personal profiting MOC experiment. Be sure to ask what YOUR risks and costs will be to assure the ABMS that he is practicing medicine in YOUR and not the ABMS's best interest!

John Bakos (6/25/2014 at 10:45 PM)
In almost 20 years of clinical internal medicine practice, I have never been asked by any patient if I was boarded or if I re-certified. Another money making scheme by administrators to separate rubes (us) from our increasingly limited resources.

Jonathan Weiss (6/24/2014 at 12:15 AM)
I am a veteran of MOC, having done MOC x 3 in the 1990s (IM, pulmonary and CC). 2 years ago, I started the process again and completed MOC in IM, at which point the nagging concerns I had in the 1990s doubting the benefit of MOC to me or my patients crystalized into an epiphany. MOC is a money making scam for the Boards and yet another method of subjugating doctors that is becoming increasingly more onerous, time consuming and costly while also becoming more irrelevant and a distraction from more applicable self-directed CMEs. Time to wake up docs, and fight this, or we will be in chains forever. Strongly suggest you take a look here: