Is the End of Recertification Exams Near? ABIM Announces At-Home Assessment Option

Slowly but surely, the American Board of Internal Medicine (ABIM) seems to be acquiescing to its members wishes with regard to Maintenance of Certification (MOC) reform.

Two years ago, the certifying organization for all internal medicine physicians and specialists announced changes to the MOC program that inspired significant backlash. In addition to taking a recertification test every 10 years, diplomates—as they are called—would also be responsible for completing time-consuming point-earning activities and burdensome patient safety and survey modules, all which cost the physicians substantial sums of money to complete.

Over the past year, the ABIM has apologized for not promoting a program that physicians found meaningful. They began announcing changes to the program and even suspended certain MOC modules. But still some physicians said they wouldn’t be happy until the 10-year recertification exam was nixed—rather, they propose that completing rigorous CME programs is enough.

Yesterday, the ABIM seemed to almost give them what they want. In a press release, the organization announced that while physicians can still take recertification exams every 10 years, as of January 2018, they will have another option to instead complete shorter assessments on their own computers “more frequently than every 10 years but no more than annually.”

“At a time when online credentials with no standards behind them are proliferating in many disciplines, doctors have told us they want us to continue to provide an MOC credential that says to their peers and to the public, in a credible and substantial way, that they are maintaining the knowledge they need to practice medicine,” said ABIM President and CEO Richard. J. Baron, MD, in the press release. “By offering shorter assessments that they could take at home or at the office, we hope to lower the stress and burden that many physicians have told us the current 10-year exam generates.”

Critics React

Responding to the ABIM’s announcement, American College of Cardiology (ACC) President Richard Chazal, MD, seemed cautiously optimistic. “MOC continues to rank among the top concerns of our internal medicine members, with the 10-year examination being the largest obstacle,” he said in a statement. “We applaud the ABIM’s move in the direction of more flexibility in MOC requirements; however, we will need more details to see how it aligns with the ACC’s proposal.”

In an email, Paul Teirstein, MD, (Scripps Clinic, La Jolla, CA)—the unofficial leader of the MOC reform movement who founded an ABIM-alternative organization called the National Board of Physicians and Surgeons last year—told TCTMD that “moving away from the required 10-year secure recertification exam is a major change. It is a definite improvement.”

He worries, however, about what exactly the replacement assessments will entail and whether they will actually improve patient care. Teirstein also commented on the cost. “By charging $200-$300 per diplomate annually for required MOC, ABIM collects $40-60 million each year,” he reported. “Many physicians believe this is excessive and creates a conflict of interest for the ABIM. The ABIM is, indeed, transforming MOC. But, by requiring annual activities to fulfill MOC, ABIM is able to preserve its large revenue stream after its transformation.”

Acknowledging the urgency for change felt by many ACC members who will be due for recertification before January 2018, Chazal said “the need to get this right” is more important than a rapid solution.

He plans to continue working with the ABIM to pass along feedback and implement change. Specifically, the statement said the ACC requested the following:

• Focused assessments or reevaluations of cognitive skills, similar to the “SAP” model, with the 2016 ACC Lifelong Learning Clinical Competencies as the basis of this assessment
• An open-book format for those members choosing to take the 10-year exam
• Research within the internal medicine community to test the outcome of MOC activities on the actual improvement in patient care and outcomes

Before any changes are finalized, the ABIM is allowing for a public comment period and expects to announce a final plan by the end of 2016.

“ABIM is grateful for all of the suggestions and guidance that we have received from physicians over the past year,” Baron said in the statement. “Already more than 9,000 ABIM Board Certified physicians have shared their opinions with us through a survey, and hundreds more are helping ABIM by participating in our MOC blueprint review and open book study. As we move forward with the new proposed assessment pathway, we will seek additional input from physicians, the public, and other stakeholders. Together, we will build an assessment program that better reflects how physicians practice medicine today while preserving a credential in which the profession can take pride and the public can place trust.”

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• Physician Dissatisfaction With MOC Goes Mainstream, Inspires Activism