Monday, July 27, 2015

Why Maintenance of Certification is Bad for Physicians and Patients

Is MOC Necessary ?

























Dr Tierstein a fellowship trained cardiologist, renders his opinion regarding maintenance of certification. Dr Tierstein works at the Scripps Institute in the Department of Cardiology. He is board certified by the ABIM and in cardiology by the specialty section of the ABIM (like all sub specialties of Internal Medicine).

The ABIM web site serves as a 'cookbook' or guide of "How to become Board Certfied in Internal Medicine and/or one of it's sub specialty groups, and how to complete MOC (Maintenance of Certification)

There has been much controversy about the effectiveness or benefit of MOC . It has evolved in a manner whereby stakeholders and  insurers use it to rate provider physicians. While they do not categorically state that not having an MOC will disqualify you from continuing to be a provider, the veiled threat is apparent.

At one time initial board certification was not required to join a hospital medical staff,  As time evolved the 'voluntary' nature of board certification evolved into a mandatory requirement. 

This form of 'certification creep' is occurring again in the area of MOC. MOC developed as many specialty groups became aware that if they did not set a standard for their membership, someone else would. Another veiled threat, that a state, or federal regulatory agency would impose rules upon physicians.  The AAGME reflexively established MOC programs in all specialties.

This action caused a large increase in administrative expenses and spawned an entire new medical-education industry. It also evolved into a large revenue source for the organizations.

It has taken 10-20 years for physicians to cycle through the process. Now most have gone through at least one MOC cycle.

Many MOC physicians who have re-certified state it was a waste of time, money and detracted from their professional status and work-life.

References:

Tulgan H. The Challenges of Providing Continuing Medical Education at a Non-Teaching Community Hospital. WebmedCentral MEDICAL EDUCATION 2011;2(7):WMC002005
doi: 10.9754/journal.wmc.2011.002005


Lockyer, J., Horsley, T., Zeiter, J. and Campbell, C. (2015), Role for Assessment in Maintenance of Certification: Physician Perceptions of Assessment. J. Contin. Educ. Health Prof., 35: 11–17. doi: 10.1002/chp.21265

(2012), AANEM news and comments. Muscle Nerve, 46: 615–619. doi: 10.1002/mus.23653

Brennan, Troyen A., et al. "The role of physician specialty board certification status in the quality movement." JAMA 292.9 (2004): 1038-1043.

Holmboe, Eric S., et al. "Association between maintenance of certification examination scores and quality of care for Medicare beneficiaries." Archives of Internal Medicine 168.13 (2008): 1396-1403.

Iglehart, John K., and Robert B. Baron. "Ensuring physicians' competence—is maintenance of certification the answer?." New England Journal of Medicine367.26 (2012): 2543-2549.

Levinson, Wendy, et al. "American Board of Internal Medicine maintenance of certification program." N Engl J Med 362.10 (2010): 948-52.

Drazen , Jeffrey M. Weinstein , Debra F. . (2010) Considering Recertification. New England Journal of Medicine 362:10, 946-947

Kevin C.Chung, Philip J.Clapham, Donald H.Lalonde. (2011) Maintenance of Certification, Maintenance of Public Trust. Plastic and Reconstructive Surgery 127, 967-973

Thomas H.Gallagher, Carolyn D.Prouty, Douglas M.Brock, Joshua M.Liao, ArleneWeissman, Eric S.Holmboe. (2014) Internists’ Attitudes About Assessing and Maintaining Clinical Competence. Journal of General Internal Medicine 29, 608-614

Paul M.Kempen. (2013) Maintenance of Certification – important and to whom?. Journal of Community Hospital Internal Medicine Perspectives 3

Iglehart JKBaron RB. Ensuring physicians' competence -- is maintenance of certification the answer? N Engl J Med 2012;367:2543-2549[Erratum, N Engl J Med 2013;368:781.]

No comments:

Post a Comment