Physicians Rail at Recertification Requirements

Cheryl Clark, 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.

Doctors are additionally concerned about new transparency policies that reveal to the public which doctors meet interval requirements, and which ones don't. "There's an insinuation that good doctors pass their boards, and bad doctors don't," Fleming says.

'Huge Stakes'

General guidelines for the new certification are now required by the American Board of Medical Specialties for all 24 boards, each of which tailors specific certification requirements for its group of specialty practitioners.

For internists, the largest group, board certification comes from the American Board of Internal Medicine, which certifies 200,000 internists or one in four physicians in the United States.

But it is the way the ABIM has interpreted its mandate from the ABMS, and tailored its own rules, that has internists fired up. "The ABIM's requirements are as rigorous or more rigorous than many other certification boards," Fleming says.

For example, the new rules require doctors to survey patients' charts, to assure that certain services have been provided, such as foot exams for all patients with diabetes. The effort may involve hiring more staff.

"We're not saying they shouldn't have to do this, but the problem is the way it's being rolled out, with very tight expectations that are burdensome for many practices. We don't think it should be part of the recertification process," Fleming says.

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