It’s time to end MOC & MOL

We at Change Board Recertification ( were shocked by the one-sided October 25, 2012 “Viewpoint” article (“Maintenance of certification has value for physicians and their patients”) by Lois Margaret Nora, MD, JD, MBA, the President and CEO of the American Board of Medical Specialities (ABMS).

How could Medical Economics publish what amounts to a two page advertisement on MOC that disregards the economics of the issue ?

The twenty-four Boards’ 990 IRS documents are thoroughly revealing: Our investigation disclosed over $400 million in total reported assets—an amount compounded by the yearly certification and recertification of thousands of diplomates. Here’s just one example: $39,457,253 in revenue reported in the ABIM’s 2009 tax return for “examination fees and MOC.” Any financial gain by our Boards from advocacy of MOC, let alone such astonishing profits, represents a shameful conflict of interest.

MOC has evolved into a discriminatory and costly burden to physicians, patients and healthcare. The ABMS’ MOC program has become a profiteering juggernaut without any reasonable proof of benefit, efficacy or patient protection, and compliance is gradually being tied to the privilege of practicing medicine. Our Boards have also quietly inserted it into Obamacare and dubbed it the MOC Incentive Program, which reimburses compliant physicians at a 0.5% higher rate than non-participating physicians.

And despite Dr. Nora’s claims, our Boards are planning to tie MOC to the FSMB’s Maintenance of Licensure program (MOL), thereby linking MOC to licensure. Thanks to the efforts of a small group of dedicated physicians, this was stopped in the program’s pilot state of Ohio, the first of many states slated for this agenda.

Keeping up to date is essential to practicing medicine, but the existing MOC process neither qualifies physicians nor protects patients. MOC requirements have not been shown to be fair, accurate or predictive indicators of a physician’s skills or competency. All licensed professions have continuing- education requirements, but those imposed on physicians by MOC are simply egregious.

The Medical Economics interviewee and other referenced parties have transparent financial agendas and show no commitment to improving patient care or cultivating better physicians. Their plan to expand MOC to CMOC (Continuous MOC, an every-2-year cycle) and link it to MOL covertly increases related costs: Though the resulting fees would be collected in smaller amounts, the completion of more frequent MOC requirements would require physicians to spend even more time away from their practices. It is also clear that time-limited certification essentially makes MOC mandatory and thus increases the revenue of the boards, despite their mislabeling MOC as “voluntary.”

In light of the Boards’ unchecked power to regulate physicians, what we propose is fair and in the best interests of our patients and our profession. Our goals remain clear:

1. MOC should not be associated with hospital privileges.
2. MOC should not be associated with insurance reimbursements or network participation.
3. MOC should not be required for Maintenance of Licensure.
4. MOC should not be mandatory.
5. All Board certificates must be converted to lifetime status; only then will MOC be voluntary.

If this cannot be achieved, then mass MOC noncompliance is the only rational and logical means to reclaiming control of our practices.

During these changing times of health-care reform, our Boards sit on nearly a half-billion dollars in assets while hard-working physicians get less and less in reimbursements and many Americans remain without health-care coverage. Beyond restrictive rules for doctors and their own enormous salaries and fees, what do our “nonprofit” Boards actually provide? They do not represent us successfully in government matters, and certainly have no understanding of practicing physicians’ interests.

It’s time for all of us to get involved and for MOC to end.


Ron Benbassat MD
Beverly Hills, CA 90210

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