The American Board of Internal Medicine is making several changes to its maintenance of certification requirements, but, so far, it is not enough to quell the still-growing tide of anger and resentment against the process.
The ABIM announced the changes just ahead of a July 15 "summit" with 26 specialty societies that receive certification through the organization, and outlined them in a detailed letter that was sent to internal medicine diplomates on July 28. That correspondence also responded in detail to a May 7 letter sent by the American College of Physicians (ACP) on behalf of 14 medical societies, enumerating their concerns about the process.
Dr. Patrick T. O’Gara
The Endocrine Society, which attended the July 15 meeting, said that it left with many of the concerns it came in with. In a statement issued shortly thereafter, the Society called on the ABIM to suspend the maintenance of certification (MOC) requirements until it conducted "a formal analysis of all possible unintended consequences of the new MOC requirements."
Among the unintended consequences it says might result: If endocrinologists have to spend more time on MOC, they might spend less time with patients or on research, or they may even leave the field all together. That will put a dent in access to care when there is an increasing need, according to a letter from the Society to the ABIM in early June.
The American Association of Clinical Endocrinologists (AACE) also warned ABIM that by "monopolizing physician time," MOC could end up harming patient care. The group also said that many endocrinologists who previously did not have to recertify (so-called "grandfathers") might leave practice rather than go through the current process. In a letter to ABIM in late June, AACE also called on the Board to suspend the new requirements until there was a better understanding of how it might affect the endocrinology workforce. The ABIM should also "refrain from publicly reporting that a physician does not meet the MOC requirements," said Dr. R. Mack Harrell, AACE’s president, in that letter.
Meanwhile, 3,000 or so physicians have signed on to a "Pledge of Non-Compliance" with the ABIM’s requirements. The pledge was organized by Dr. Paul Teirstein, chief of cardiology and director of interventional cardiology at the Scripps Clinic, La Jolla, Calif., and his colleagues who have formed Physicians for Certification Change, an anti-MOC organization. Dr. Teirstein also launched a petition drive in March to overhaul the MOC process. That petition had about 18,000 signees at press time.
There are several other organizations hoping to derail or significantly change the ABIM’s requirements, including the Association of American Physicians and Surgeons, Change Board Recertification, and Docs4PatientCare.
In addition, many of the 26 professional societies whose members are certified by the ABIM have also been very organized in presenting their discontent.
Dr. Richard Baron
The ABIM understands the frustration, said Dr. Richard Baron, ABIM president and CEO, in an interview. "One of the things that people have said is that we’re not listening," he said. That is one reason why the ABIM decided to hold what he called a "listening session" on July 15. "We’re a learning organization," he added, noting that the ABIM will "continue to evolve the program," based on the feedback it receives from individuals and from professional societies, among others.
Dr. Baron also acknowledges that by presenting an entirely new MOC process this year, "our timing was not propitious," given the many challenges physicians now face. The ABIM outlined those pressures in the July 28 letter, counting among them "dealing with the Affordable Care Act," fulfilling meaningful use requirements, and responding to changes in payment and practice models, including team-based care.