In a frank announcement, the American Board of Internal Medicine has apologized to doctors for a Maintenance of Certification program that “clearly got it wrong,” and pledged to make the program more consistent with internists’ practice and values.
Among the immediate changes: updates to its internal medicine exam; suspension of the practice assessment, patient voice, and patient safety requirements for at least 2 years; and MOC enrollment fees set at or below the 2014 levels through at least 2017.
Dr. John I. Allen, AGAF, president of the American Gastroenterological Association, said the move by ABIM to implement the changes shows the organization heard the tremendous negative feedback by physicians about the burdensome process and rightly responded.
“We all believe that lifelong learning is important and that retesting in some form is needed throughout the career of a physician,” Dr. Allen said in an interview. “The process of MOC and the reporting burdens on physicians, however, was much too high and with little evidence for positive effect. I applaud the ABIM for admitting their mistake and apologizing. We, at the AGA, look forward to helping shape a meaningful and ongoing program to maintain specialty certification.”
Dr. Richard J. Baron
In a statement, ABIM President and CEO Richard J. Baron said it was clear that aspects of the program were not meeting physicians’ needs.
“We got it wrong and sincerely apologize,” Dr. Baron said in the statement. “We are sorry. ABIM is changing the way it does its work so that it is guided by, and integrated fully with, the medical community that created it. The goal is to co-create a MOC program that reflects the medical community’s shared values about the practice of medicine today and provides a professionally created and publicly recognizable framework for keeping up in our discipline.”
AGA is uniquely positioned to contribute to ABIM’s collaborative process with a newly convened task force to identify the ideal pathway to recertification and assessment of physician competency.
As part of the newly announced changes, ABIM will make its internal medicine exam more reflective of physician practice, with changes to be incorporated in fall 2015, according to the announcement. The decision to suspend the practice assessment, patient voice, and patient safety requirements means internists who have not completed activities in these areas will not have their certification status changed. Diplomates who are currently uncertified but who have satisfied all requirements for MOC except for the practice assessment requirement will be issued a new certificate this year. Within the next 6 months, ABIM will also change the language used to publicly report a diplomate’s MOC status on its website from “meeting MOC requirements” to “participating in MOC.”
Dr. Allen, who is clinical chief of digestive diseases at Yale University in New Haven, Conn., noted that suspension of the MOC’s Practice Improvement, Patient Voice and Practice Assessment component will reduce the most onerous part of the process and give physicians time to rework the portion or eliminate it.
“We still will need to work with ABIM to make the recertification test reflective of our practices and style of knowledge acquisition,” he said. “I believe we all can pause long enough to reshape MOC.”
By the end of 2015, ABIM said it will ensure new and more flexible ways for internists to demonstrate self-assessment of medical knowledge by recognizing most forms of Accreditation Council for Continuing Medical Education–approved continuing medical education. An online FAQ provides more information on the changes.
ABIM initially revamped its certification policies beginning in January 2014, shortening the time physicians had to earn MOC points and publishing online whether doctors were meeting requirements. The actions meant that every 2 years physicians certified by ABIM had to earn at least some points by completing some of the educational activities approved for MOC credit, and at the 5-year mark, earn 100 points. Previously, physicians were given 10 years to earn 100 points. Physicians were also listed publicly as either “certified, meeting maintenance of certification requirements” or “certified, not meeting MOC requirements.”
The changes were met with almost immediate backlash. Doctors expressed frustration that the requirements were burdensome, expensive, and irrelevant. By January 2015, a Web-based petition against the program garnered more than 19,000 signatures and has drawn thousands of comments in protest of the new requirements. A second petition had nearly 6,000 signatures with doctors taking a “pledge of noncompliance” with the requirements.
A January perspective piece in the New England Journal of Medicine expressed that the MOC program is essentially a money-generating activity for the ABIM and that the organization has lost contact with the realities of day-to-day clinical practice.
