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PRESIDENT’S
MESSAGE
The Future of Maintenance
of Certification (MOC)
By Dr. Jayesh Shah, 2016 BCMS President
When it was time to prepare for my board recertification exam • Examining the activities that medical specialty organizations have
again, these thoughts came into my mind — Was the vigorous underway to review alternative pathways for board recertification.
training in medical school, internship, residency and fellowship not
enough? Continuing education hours are needed for medical li- • Determining whether there is a need to establish criteria and con-
cense renewal. Isn’t it sufficient if physicians kept abreast of the struct a tool to evaluate whether alternative methods for board
changes and updates in their respective specialties by visiting up- recertification are equivalent to established pathways.
todate.com, or by attending specialty related conferences, grand
rounds, and annual meetings? Which physician would not want to • Asking the American Board of Medical Specialties to encourage
practice medicine at its best and provide the best treatments for pa- its member boards to review their MOC policies regarding the
tients? Is the threat of a malpractice lawsuit not enough to keep requirements for maintaining underlying primary or initial spe-
them current in what they practice? If I already hold a medical li- cialty board certification in addition to subspecialty board certi-
cense to practice in a state, is additional board certification, board fication allowing physicians the option to focus on the MOC
recertification or maintenance of certification necessary? activities most relevant to their practices.
I was glad I passed my board recertification exam after many In summary, many agree that initial certification of a specialty is
painful hours of hard core studying and what seemed unnecessary necessary, but is the maintenance of certification to keep our physi-
mental and financial stress. Many physicians have complained cians up to date in the ever changing field of medicine necessary in
about maintenance of certification (MOC) being time consuming, its present format? We need MOC pathways that will allow physi-
expensive and irrelevant to their specialty of practice. Some physi- cians to efficiently utilize their time so physicians can spend more
cians like me who are specialists, have not one but two board re- time with patients than in activities that have not been proven to
certifications. Every physician finds their own way of continued improve outcome or quality.
learning in a better way than what the MOC has to offer. The time
has come to revamp the maintenance of certification for all medical Some believe that the recertification process should be more fre-
specialties. quent — maybe annual or biennial, specialty specific, and open
book. Some believe that the CME requirement every year should
The Journal of the American Medical Association was the first be considered as documentation of ongoing learning. Is board cer-
to study the role of MOC in quality of care and costs. The study tification, board recertification, or maintenance of certification re-
showed that patients’ medical outcomes were no better with the quired? For those who decide to not get recertified, will there be
MOC and overall costs were only marginally lower in the recerti- unknown consequences such as affecting their insurance network
fying group (2.5 percent). Physicians are now challenged with participation or their hospital privileges? What do you think? The
added responsibilities of submitting quality metrics to CMS to ac- Texas Medical Association opposes the use of board certification as
celerate the shift to value-based payment. a requirement for reimbursement or licensure.
A new report from the AMA Council on Medical Education More importantly, I feel that more regulations are being laid
examines the current state of MOC and osteopathic continuous upon physicians and our profession is increasingly being controlled
certification (OCC), noting physician concerns around such el- by people not directly involved in patient care, i.e. non-physicians
ements as cost effectiveness and relevance to practice as well as who have no idea of the realities of day-to-day clinical practice. It
the professional imperative to ensure that the patients are receiv- is about time that we, as practicing physicians, take back the lead-
ing high-quality care. ership of medicine. With the help of our respective professional or-
ganizations, we, the physicians, can and should address our
In the annual meeting of the AMA in June 2016, delegates concerns collectively.
adopted policy to further efforts to improve the MOC process,
including:
8 San Antonio Medicine • August 2016
