Maintenance of Certification: Good or Bad?

Dear Colleagues,

​A short history lesson: For years, physicians, upon completing a residency or fellowship, went through a challenging written, and for some, oral certification test, which, if they passed, rendered them certified for life. Like the Bar for lawyers, or a college or graduate school degree, no retesting was needed to maintain the certification. Physicians, by their very nature and the nature of their profession, remained up to date with medical knowledge by time honored methods, including obtaining a minimum number of CME credits each year (through journals, conferences, and the like), participating in Grand Rounds, M & M rounds, Peer Review conferences and similar peer gatherings, interaction with colleagues, and, of course, the most important opportunity for ongoing learning, daily contact with patients.

In the 1990s, it was decided that certification for physicians should no longer be lifelong and recertification, every 10 years, came into existence. Later to be known as Maintenance of Certification (MOC), this process was imposed on younger physicians by an older generation of grandfathered doctors who conveniently exempted themselves from the need to undergo MOC in order to maintain their certification.

​The ostensible logic for MOC was to ensure “quality of care” and maximize the public safety by holding physicians to a “higher standard”. The only problem is, to this day, there is not a single scientifically rigorous study that shows that doctors completing MOC provide any better care that those who have not done MOC. The few studies done fail to meet compelling scientist standards, and worse, are often co-authored by physicians who work for the very entities that create and administer MOC, an obvious conflict of interest that is never addressed.

​Every few years, MOC becomes more onerous, more complex and more costly. Currently, for internal medicine, the process includes, or will soon include the following:

1) Open book home tests modules, much of whose content is irrelevant to what we do on a daily basis
2) Practice Improvement Modules (PIM), a tedious, time consuming, busy-work process of no proven value
3) The requirement to submit patient answered surveys about you
4) The requirement to submit colleague answered surveys about you
5) A secure exam whose content is largely obscure and irrelevant to what we do on a daily basis, and whose secure nature is so insulting that we cannot even have a handkerchief in our back pockets or wear a watch during the exam.
Currently, we are told by our boards that MOC is “voluntary”, but this is just an illusion. As more and more hospitals are manipulated into believing that a MOC doctor is better than a non-MOC doctor, MOC is becoming a requirement for hospital privileges. Similarly, payers are being convinced of the same thing, and are requiring doctors on their panels to be current with MOC, thus linking MOC to reimbursement. So much for being voluntary. But now comes the final step, the effort to link MOC to Maintenance of Licensure (MOL). Pilot programs for such a linkage are already being proposed in 12 states. Such a linkage would utterly end any illusion of MOC being voluntary and would, in fact, force even the remaining grandfathered doctors to do MOC as well, if they still wanted a valid license. The other part of this, easy to overlook at first, is that MOL occurs every two years, and, if linked to MOC, then MOC, in some form, would need to be done every two years. In fact, the latest proposed acronym to come out of the ABIM, and similar boards, is CMOC, or Continuous MOC, with the implications that MOC would essentially be a never ending ongoing process for which, again, no data has ever shown it to be of value to patient care.

​So why are ever stronger efforts being made to force us to participate in a dubious process? For the always obvious reason, money. The test creating and administering industry (and make no mistake, it is an industry) and the test preparation industry have made, and continue to make tens of millions of dollars from MOC, and similar recertification processes. These are your hard earned dollars going to pay lavish salaries to board members who no longer even practice medicine but who feel utterly comfortable imposing on you these costly, onerous, time consuming and unvalidated recertification requirements.

​So what to do? Accept yet more abuse from the “system”? Passively bow to our fate? No! Enough is enough. It is an outrage and it is time for doctors to band together, take a stand and put a stop to MOC. Already, significant groups of physicians have in fact banded together and are employing a variety of strategies to achieve the goal of ensuring that MOC becomes truly voluntary, with no linkage to reimbursement, license or hospital privileges. If you want to know more about what is going on, who is involved in fighting this and what you can do to help, please look at the information found at these web links:

​Thank your for you consideration and support.

Jonathan Weiss, MD