As part of a general trend among all medical specialty boards, the American Board of Psychiatry and Neurology (ABPN) instituted a recertification process for all new general psychiatry certifications on October 1, 1994.1 In 2000, the individual specialties that constitute the American Board of Medical Specialties (ABMS) subsequently agreed to develop a comprehensive maintenance of certification (MOC) process to demonstrate ongoing learning and competency beyond what could be captured by a recertification examination alone.
All ABMS member boards now use a 4-part process for recertification. For ABPN, those 4 core components are listed in the Table.1,2
ABPN component 1 (maintaining an unrestricted medical license) and component 4 (passing the recertification examination) are straightforward; however, requirements for continuing medical education (CME), including the specific need to accrue ABPN-approved self-assessment (SA) CME hours, and the Improvement in Medical Practice (performance in practice, or PIP) module, have stoked significant commentary and confusion.
Based on feedback,3,4 ABPN in 2014:
• modified the SA and PIP requirements for physicians who certified or recertified between 2005 and 2011
• changed the specific requirement for the PIP feedback component.
These modifications only added to feelings of uncertainty about the MOC process among many psychiatrists.5
Given the professional and personal importance attached to maintaining one’s general and subspecialty certifications, the 2 parts of this article—here and in the January 2015 issue—have been constructed to highlight current ABPN MOC requirements and provide resources for understanding, tracking, and completing the SA and PIP portions.
In addition to this review, I urge all physicians who are subject to MOC to read the 20-page revised MOC Program bookleta (version 2.1, May 2014).5
aDownload the booklet at www.abpn.com/downloads/moc/ moc_web_doc.pdf.
Who must recertify?
As of October 1, 1994, all physicians who achieve ABPN certifications in general psychiatry are issued a 10-year, time-limited certificate that expires on December 31 of the 10th year.3 Note that the 10-year, time-limited certificate in child and adolescent psychiatry began in 1995 and expires 10 years later on December 31.
Certificates in the subspecialties (addiction psychiatry, forensic psychiatry, geriatric psychiatry, etc.), including those issued before October 1, 1994, are 10-year, time-limited certificates that expire on December 31.3 This expiration date often is overlooked by physicians who are exempt from the MOC process for their general psychiatry, or child and adolescent psychiatry certification. There is no exemption for any subspecialty certificate (aside from child and adolescent psychiatry before 1995), regardless of the date of issue.
Moreover, physicians who hold a certificate in a subspecialty also must maintain certification in their specialty (general psychiatry) to apply for recertification in their subspecialization. One exception: Diplomates in child and adolescent psychiatry do not need to maintain current certification in general psychiatry for their subspecialty certification to remain valid or to recertify in child and adolescent psychiatry.
The need to maintain multiple certifications can seem onerous, but note that CME, SA, and PIP activities that have been completed in one area of specialization or subspecialization accrue and count for multiple certifications for diplomates certified in 2 or more areas.5
Get started!
Tracking your progress is critical to keeping up with MOC requirements. You can do this with a personal spreadsheet or by using online resources. Although it is not required, ABPN has established a system that allows diplomates to create and maintain, at no cost, a physician folio on the ABPN server that facilitates documentation of CME hours, including specific SA hours, and PIP module completion.6 All diplomates are required to maintain records of SA activities, CME activities, and PIP units; the ABPN will audit approximately 5% of examination applications.5
Regardless of what documentation method you choose, you should establish an active profile on the ABPN site (www.abpn. com/folios), confirm your contact information, and, if you are not active clinically, update your clinical status. ABPN requires that diplomates self-report their clinical status every 24 months—information that is available to the public. Clinical status also identifies to ABPN those PIP modules that you must complete.
ABPN recognizes 3 categories of clinical status5:
1. Clinically active. Provided any amount of direct or consultative care, or both, in the preceding 24 months, including supervision of residents.
a) Engaged in direct or consultative care, or both, sufficient to complete Improvement in Medical Practice (PIP) units.
b) Engaged in direct or consultative care, or both, that is insufficient to complete PIP units.
2. Clinically inactive. Did not provide direct or consultative care in the preceding 24 months.
3. Status unknown. No information is available on clinical activity.
Based on these definitions, physicians in Category 1a are required to complete all components of the MOC program, including PIP units; physicians in Category 1b or Category 2 are required to complete all components of the MOC program except PIP units.