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Doctors rebel against a re-certification test that costs $23,600 per doctor

June 27, 2016

Tags: MOC, maintenance of certification, medical specialty boards, revolt


written and posted by Pat McNees
"Over the last few months, we have seen a great increase in the number of doctors ... speaking up against the current MOC (maintenance of certification) that is now in place," wrote Dr. Linda Girgis in Are Medical Specialty Boards Extorting Physicians? Dr. Girgis explained why doctors do not want to comply with current MOC requirements:
1. The majority of doctors believe it is not relevant to the everyday practice of medicine.
2. It is costly. (More than $20,000 over the course of a career.)
3. It is time consuming.
4. There are no studies proving that the MOC improves patient care or clinical outcomes.
5. Many doctors feel that the requirements are being developed by academic doctors and not those actively practicing medicine.
6. "The boards claim that patients want these requirements and trust the board certification. No, my patients want me to listen to their concerns and spend more time with them."
7. "The leaders of the specialty medical boards are making exuberant salaries, 3-4 times what a physician in clinical practice is making. Clearly, they have a financial conflict of interest in keeping the MOC going." (MedCity News, 6-23-14)

In a 'poll of physicians on Sermo (a physicians only community of 270,000), only 4% agreed that the MOC should stand as it currently is."

In Why MOC is broken and how to fix it (you can watch the talk, and visuals, on YouTube), Dr. Wes Fisher took the case against MOC to the American Medical Association's House of Delegates in June 2016 (Kevin MD, 6-22-16). At one point in U.S. history, physicians who practiced internal medicine had to pass stringent examinations to be board certified--at which point they were board certified for life. In 1990, that changed: board certification was no longer for life, and every ten years they faced examinations that required hours of study and memorization--exams many doctors criticize as being academically oriented and unrelated to the everyday practice of medicine.

Dr. Fisher argued that the purpose of the recertification exams was financial, not medical -- that studying for the exams every ten years took time away from the patients' bedside and cost doctors $23,607 out of pocket (and if you fail, you have to pay ABIM again if you want to study and retake the exams). Not that doctors shouldn't participate in continuing education to stay up on medical developments, but there was no evidence -- nor even an attempt to research -- whether the MOC examinations improved patient care or medical outcomes. You can read Dr. Wes's Recap of his talk to the AMA House of Delegates MOC (Recap, 6-14-16) There is a link in his article at which to download his PowerPoint presentation.

"The roots of the uprising trace to January 2014, when ABIM attempted to expand its program for recertifying doctors, adding boatloads of requirements and fees to be paid by physicians." reported Kurt Eichenwald in A Certified Medical Controversy (Newsweek, 4-7-15). "As a result, the prominent group of doctors formed a competing certification organization, while condemning ABIM’s recertification program as an expensive waste of time that hasn’t been shown to improve medical knowledge or the quality of health care." Indeed, it imposed unnecessary testing requirements to "fatten the board's bloated coffers."

"ABIM and the ABIM Foundation lost $39.8 million on program services in the five years ending in 2013—a nonprofit indeed. Yet during that same time, the organizations paid $125.7 million to its senior officers and staff," he reported. Rather than improve physician performance, ABIM was turning doctors into a cash machine.

Eichenwald has covered this story from early on. In To the Barricades! The Doctors' Revolt Against ABIM is Succeeding! (9-15-15), he reported that the American Board of Internal Medicine attempted to expand its recertification process only to be met with revolt. The ABIM "abuses its monopoly power to force doctors to do whatever it decrees, while ignoring the many doctors who have demanded for years that independent researchers conduct comprehensive studies to determine if ABIM’s requirements do anything to improve patient care. This medical protection racket has made millionaires of ABIM top officers, financed a ritzy condominium, limousines and first-class travel, all while sucking huge sums of cash out of the health care system." Rheumatologists, who must fulfill ABIM’s requirements for maintenance of certification, or MOC, recently slapped down the process—and hard, demanding that “If independent evaluation does not identify a substantial benefit to patient care, there must be a commitment to revise the program so that it achieves its ultimate goal of improving patient outcomes.”

The initial Newsweek story put the spotlight on Dr Paul Teirstein, "a nationally prominent physician who is chief of cardiology at Scripps Clinic and who is now leading the doctor revolt." Teirstein organized the National Board of Physicians and Surgeons, an alternative to the MOC. He states: “We don’t want to do meaningless work and we don’t want to pay fees that are unreasonable and we don’t want to line the pockets of administrators." MOC Controversy Continues, As Newsweek Unveils ABIM’s Troubled Financials (Policy and Medicine, 4-17-15)

What's it all about? Q&A: Paul Teirstein—The Doc Behind the Mutiny Against the MOC (HealthLeaders Media, 4-9-15). "Teirstein says his effort is powered by 23,000 physicians who signed supporting petitions in the belief that the MOC's requirements are costly busywork that serve only to enrich certification board executives."

"He has organized the National Board of Physicians and Surgeons, which he says is a rational alternative to the MOC, the new two-year maintenance of certification (MOC) requirements that the American Board of Medical Specialties and 24 specialty boards, including the American Board of Internal Medicine, require doctors to complete to show their knowledge is up to date." Not that doctors shouldn't be required to keep up to date on their field and current practices, but the ABIM tests were both inadequate and vastly overpriced. Read more here.

The Pennsylvania Medical Society hosted a panel discussion to address physician concerns on Maintenance of Certification (MOC) at the AMA's 2016 Annual Meeting in Chicago on June 13, 2016. Presenting in Part 1 is PAMED President Scott Shapiro, MD, and financial and accounting consultant Charles P. Kroll, CPA. You can hear what they said here: ABIM and the Finances of MOC: The Slow Motion Financial Death Spiral of ABIM and the MOC Bailout Scheme (Charles P. Kroll, CPA, Healthcare Forensic Accountant, presentation 6-13-16) Slides here. See video of presentation here..