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 JK, Baron 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.]

The Digital Divide

Electronic health records. Each individual provider is unique. Much of it is related to generational changes in technology, (but not always)

The Office of the National Coordinator for Health Information Technology offers a Curriiculum Development Center.  Implementation of a new EHR is one of the  largest challenges during a transformation. The largest barriers are 'keyboarding skills".  They vary greatly and those who used computers in high school, college or medical school have the best skill-set (but not always). 

Younger MDs expect automation such as the airline industry, the retail industry and their personal devices. Some older MDs do not know how to use email efficiently. The training ground has a wide variety of learners.

The reaction to technology may be surprising, it may depend upon where  physicians are coming from.  The younger generation sees it as a separate thing, to use. The older generation is efficient at what they already do, and will resist being told 'you will be able to take better care of your patients with HIT or EMR."

It's hard to re-train a brain. Early adopters working elbow-to-elbow can transfer brain-muscle memory.  Find the balance, understand motivations, balance, take into account different expectations, and don't stereotype by age.

The Digital Divide

Now, for better or worse,,it is what it is. It will continue to change for change is inevitable. What will evolve tomorrow is quite unpredictable, for we have not yet adapted to what we have now. The rapidity of change is becoming self-defeating.

Medical Software Developers: TMC Biodesign Fellowship--Paid Stipend

TMC Biodesign Fellowship Deadline August 2

From Problem To Solution TMC Biodesign is a paid, one-year innovation fellowship that brings together highly accomplished innovators fromengineering, software, technology, medicine, business, and design and provides them unprecedented clinical access to The Texas Medical Center to create novel digital health and device solutions for healthcare’s greatest unmet needs. Digital Health and Device Focus By applying established biodesign principles to the development of cutting-edge solutions, TMC Biodesign will enable and train two teams of four innovators to create new technologies and effective business models that will reinvent the future of healthcare: Medical Device Innovation Fellowship Team: The TMC Biodesign Medical Devices Team will have the opportunity to shadow healthcare professionals in a specific clinical focus area and create novel point-of-care, minimally invasive devices or implants, clinical or surgical tools, and other innovative medical device solutions. Digital Health Innovation Fellowship Team: TMC Biodesign’s Digital Health Team will be the first of its kind to focus exclusively on building digital health solutions. Our Fellows will build transformative solutions in mobile, web, cloud, data analytics, remote monitoring, sensors and wearables, population health management, EMR solutions, and telemedicine. Apply Today! Our deadline is August 2nd, 2015. First round interviews are granted on a rolling basis, so please apply soon if you would like an expedited decision. Fellows will be required to relocate to Houston for the duration of the one-year fellowship and will receive a stipend of $90,000 as well as health benefits. Learn more at tmcinnovation.org/tmc-biodesign/ and apply today! Digital Health Space provides this information, independently and has no financial interest in this offering.

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With an impressive speaker list on a variety of subjects, Digital Health Space offers this announcement.

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