Changes to ABIM MOC Requirements Stir Debate

In January 2014, several new requirements for Maintenance of Certification (MOC) set forth by the American Board of Internal Medicine (ABIM) went into effect. At the highest level, the changes affect two credentials: whether a physician is board certified and whether they are meeting MOC requirements.

As of 2014, all diplomates — including “grandparents” who were certified before 1990 and not given time-limited certificates — must start actively participating in MOC activities or risk being listed as “not meeting MOC requirements” on the ABIM website.

The news was met with concern by some physicians, particularly in the interventional cardiology community. A petition started in March by Paul Teirstein, MD, of Scripps Clinic in La Jolla, Calif., has now gathered more than 18,000 signatures asking for changes to the new requirements.

“The MOC have not been shown to improve outcomes for patients, and while physicians — especially interventional cardiologists — are committed to lifelong learning, given the demands of the specialty, we must devote our time to worthwhile activities,” said TCT Course Director Gregg W. Stone, MD, of Columbia University Medical Center in New York. “The additional requirements and expense that the current MOC entail, with doubtful clinical utility, must be reconsidered.”

Adding on obligations

Physicians who wished to meet the new MOC requirements had to register on ABIM’s website by May 1. Moving forward, they must participate in an MOC activity every 2 years; earn 100 MOC points every 5 years, including 20 in practice assessment and 20 in medical knowledge; and must pass a secure exam every 10 years for each specialty credential.

In addition, interventional cardiologists must submit a Form Attesting Interventional Cardiology Practice every 5 years, verifying performance as primary operator, co-operator or supervisor of 150 PCI cases in the prior 2 years. If the volume requirement cannot be fulfilled, the physician must provide a procedural log of 25 consecutive cases in which he or she served as primary operator during the same time period.

A call for change

The increase in effort and cost has caused some physicians to question the value of the new requirements.

“While making sure physicians are up-to-date and knowledgeable is critical, MOC is certainly not the only way physicians can stay educated,” said Ajay J. Kirtane, MD, SM, also of Columbia University Medical Center. “Many physicians attend CME events, do preparatory work for presentations or lectures, or complete online forms of education but do not receive credit for them in the current system.”

The petition started by Teirstein claims the new MOC requirements “add significant time and expense to board certification.” Physicians who sign the petition attest that:

1) ABIM has made unreasonable changes in MOC, requiring more frequent participation and higher fees.

2) Scientific data indicating MOC provides benefit is lacking.

3) MOC activities are complex, have questionable value, and detract from more worthwhile pursuits, including patient care and other educational activities, like CME.

4) A test administered every 10 years for recertification is a sufficient metric for MOC.

“Therefore, we call on ABIM to recall the changes in MOC and institute a simple pathway consisting of a recertification test every 10 years,” the petition states.

ABIM responds

In a statement about the issue released in April 2014, Richard J. Baron, MD, president and CEO of the ABIM commented: “As medical knowledge and practices continue to change, a continuous MOC program tells the community that a physician is staying up-to-date, has met a knowledge standard established by his or her physician peers, and is engaged in ongoing assessment of his or her practice.”

He acknowledged the frustrations expressed and addressed many of the petitioners’ concerns.

“Please know that we take very seriously the feedback we hear about our products and programs. MOC is a continuously evolving program in which we focus on improving the value and relevance of the credential, and we continue to welcome constructive diplomate feedback on how to enhance our assessments,” Baron said.

ABIM points to its establishment of the Assessment 2020 Task Force, which is gathering input from the medical community on ways to evolve and improve the MOC process.

In July, ABIM also announced that nearly 150,000 physicians had enrolled in its MOC program as of May 1. Among those physicians with at least one time-limited certification, 77% had enrolled in MOC, including 84% of accredited cardiologists. Twenty-five percent of the so-called grandfathers had also enrolled in the MOC program, including 45% of grandfathered cardiologists.