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Q&A: Paul Teirstein—The Doc Behind the Mutiny Against the MOC

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   April 09, 2015

Why he started a rival organization for recertification, what's wrong with the current approach, and what the MOC argument is really about.

Frustrated while filling in blue boxes on a monitor to satisfy new requirements for his board recertification, Paul Teirstein, MD, chief of cardiology for Scripps Clinic in San Diego, got a little perturbed with having to comply with maintenance of certification (MOC) requirements.

More than a little, actually.


Paul Teirstein, MD

So the renowned interventionalist, who has stented kings and Mother Teresa and does not shy from the limelight, is fighting back on a national scale.

He has organized the National Board of Physicians and Surgeons, which he says is a rational alternative to the MOC, the new two-year maintenance of certification (MOC) requirements that the American Board of Medical Specialties and 24 specialty boards, including the American Board of Internal Medicine, require doctors to complete to show their knowledge is up to date.

Teirstein says his effort is powered by 23,000 physicians who signed supporting petitions in the belief that the MOC's requirements are costly busywork that serve only to enrich certification board executives.

During an hour-long interview and e-mail follow-ups, Teirstein explains his rationale. This Q&A was edited for clarity and brevity.

HLM: What's wrong with requiring doctors to show they're up to date every two years instead of with an exam every decade? Medicine is rapidly changing today.

Teirstein: It's just a laborious waste of time. I'm not happy that the organization [ABIM] is making this a requirement so they can bring in more money and pay themselves more money; that's very clear to me. But my major objection is that it's wasting my time.

HLM: What's the issue with these two-year modules and tests? Can you give an example of why this is a waste?

Teirstein: I see a barrage of questions I don't need to learn. But I have to take a course to answer them because the [required] answer is a way I would never treat my patients. A lot of the questions are based on outdated material. One example, from a fellow who took the test in June, asked about anti-platelet 2B3 inhibitors, which we hardly use anymore; they don't have the benefit doctors thought they did 10 years ago.

Another example is what to do with a patient who has a [cardio] SYNTAX score above 22. I have to answer that I would refer that patient to bypass surgery, but in practice you don't do that because it depends on your individual patient. Most of the patients coming to me need to be kept away from bypass surgery because they have other problems. But that would not be the right answer for the test.

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