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MOC Update: Physicians Championing Change Press Onward

Analysis  |  By Debra Shute  
   July 14, 2016

The founder of an alternative to MOC "would love to disband it" if boards come up with a new plan to make MOC meaningful and cost-effective.

The debate around maintenance of certification (MOC) has been raging for more than two years, during which some physicians have effectively changed the conversation around what it means to stay current in their profession.

This week, I spoke with two of them: Paul Teirstein, MD, is chief of cardiology for Scripps Clinic in San Diego, and creator of an alternative certifying body, the National Board of Physicians and Surgeons (NBPAS).

Scott E. Shapiro, MD, FACC, FCPP, is a cardiologist at Abington (PA) Medical Specialists, president of the Pennsylvania Medical Society, and member of the American Medical Association (AMA) House of Delegates.

They spoke about their respective thoughts on the state of MOC, ongoing advocacy efforts, and what this work means to practicing physicians. The transcript below has been lightly edited.

Related: Paul Teirstein: The Doc Behind the Mutiny Against the MOC

HLM: Dr. Teirstein, how do you feel about what you've achieved so far with the NBPAS?

Teirstein: We've had great success. We have over 4,000 diplomats and over 40 hospitals have accepted the National Board. It continues to grow. We get a handful of doctors that apply every day.

I would love to disband it if the American Board of Member Specialties (ABMS) member boards would come up with a plan that is meaningful and was the right price and not despised by doctors.

Related: Physicians Rail at Recertification Requirements

They've made changes in the right direction, but we have a long way to go until we have less onerous, less costly, meaningful ways of demonstrating that we're keeping up with changes in medicine.

The changes have been too slow. And they're being replaced with take-home tests, which give us doubts about whether they'll be any real learning going on. Finally, we've not heard a thing about reducing costs.

HLM: Dr. Shapiro, how have attitudes within the culture of medicine shifted regarding board certification in recent years?

Shapiro: I think the AMA is a very good litmus test of the current environment.

The AMA doesn't [traditionally] make decisions like we did in June to really condemn those boards that still have these high-stakes, punitive computer exams. And in debate, many really applauded those that focused on continuing education and not maintaining profits.

HLM: Dr. Teirstein, you must have put a lot of uncompensated time into NBPAS by now. How have you juggled it with the rest of your career?

Teirstein: I probably spend 20% of my time now, and it was a lot more in the beginning.

The time I spend [on NBPAS], which has been maybe a thousand times more than it would have been if I'd just done my MOC, I think is meaningful work because we've made positive changes. I think we've really helped physicians and therefore I'm happy to spend my time doing it.

HLM: What is your advice to individual physicians who want to effect change in their professional environments?

Shapiro: Continuing professional education is the cornerstone of our profession, and I think making sure that we're all participating in activities that are meaningful to our practice—and not merely jumping through hoops that don't help our patients or our profession—is important.

Teirstein: It's not that hard to do something [to address problems] and it feels good. And the Internet resources that we have available to make changes these days are pretty powerful.

When I started this, I was told by innumerable physicians that I shouldn't waste my time. I have emails that say the horse is out of the barn, it's a done deal. But it turns out that it wasn't a done deal and that we can undo things that aren't right.

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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