The Pennsylvania Medical Society (PAMED) continues to lead state and national conversations about how to improve the Maintenance of Certification (MOC) process for all physicians and address physician concerns with its punitive nature and the administrative burden it causes.
PAMED leaders Scott Shapiro, MD (PAMED president) and Charles Cutler, MD (PAMED president-elect) convened the 4th open meeting on the continuing MOC issue. On Nov. 16, more than 60 physicians and key state and specialty society executives attended the forum at the American Medical Association (AMA) Interim House of Delegates meeting in Atlanta.
Physicians from across the country and from various medical specialties discussed ongoing concerns about transparency, effective methods for the assessment of clinical skills, and the appropriate process for career long learning. The group commended PAMED for its work in this area, and continued to support the principles outlined by both PAMED and AMA as they related to MOC working better for physicians.
PAMED’s delegation to the AMA submitted several resolutions, including one calling on the AMA to recognize only those specialty Boards that follow AMA’s principles of continuous professional education. On Nov. 16, delegates at the AMA meeting adopted Pennsylvania’s resolution with some modification, directing the AMA to oppose those MOC programs administered by the specialty boards of the American Board of Medical Specialties (ABMS), or of any other similar physician certifying organization, which do not appropriately adhere to the AMA principles on MOC.
It also adopted additional principles, bringing the total number of principles to 25, and tweaked language with some of the existing principles. The 25 principles include that:
- Changes in specialty-board certification requirements for MOC programs should be longitudinally stable in structure, although flexible in content.
- Implementation of changes in MOC must be reasonable and take into consideration the time needed to develop the proper MOC structures as well as to educate physician diplomates about the requirements for participation.
- Any changes to the MOC process for a given medical specialty board should occur no more frequently than the intervals used by that specialty board for MOC.
- Any changes in the MOC process should not result in significantly increased cost or burden to physician participants (such as systems that mandate continuous documentation or require annual milestones).
- MOC requirements should not reduce the capacity of the overall physician workforce. It is important to retain a structure of MOC programs that permits physicians to complete modules with temporal flexibility, compatible with their practice responsibilities.
- Patient satisfaction programs such as The Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient survey are neither appropriate nor effective survey tools to assess physician competence in many specialties.
- Careful consideration should be given to the importance of retaining flexibility in pathways for MOC for physicians with careers that combine clinical patient care with significant leadership, administrative, research, and teaching responsibilities.
- Legal ramifications must be examined, and conflicts resolved, prior to data collection and/or displaying any information collected in the process of MOC. Specifically, careful consideration must be given to the types and format of physician-specific data to be publicly released in conjunction with MOC participation.
- Our AMA affirms the current language regarding continuing medical education (CME): “Each Member Board will document that diplomates are meeting the CME and Self-Assessment requirements for MOC Part II. The content of CME and self-assessment programs receiving credit for MOC will be relevant to advances within the diplomate’s scope of practice, and free of commercial bias and direct support from pharmaceutical and device industries. Each diplomate will be required to complete CME credits (AMA PRA Category 1 Credit™, American Academy of Family Physicians Prescribed, American College of Obstetricians and Gynecologists, and/or American Osteopathic Association Category 1A).”
- In relation to MOC Part II, our AMA continues to support and promote the AMA Physician’s Recognition Award (PRA) Credit system as one of the three major credit systems that comprise the foundation for continuing medical education in the U.S., including the Performance Improvement CME (PICME) format; and continues to develop relationships and agreements that may lead to standards accepted by all U.S. licensing boards, specialty boards, hospital credentialing bodies and other entities requiring evidence of physician CME.
- MOC is but one component to promote patient safety and quality. Health care is a team effort, and changes to MOC should not create an unrealistic expectation that lapses in patient safety are primarily failures of individual physicians.
- MOC should be based on evidence and designed to identify performance gaps and unmet needs, providing direction and guidance for improvement in physician performance and delivery of care.
- The MOC process should be evaluated periodically to measure physician satisfaction, knowledge uptake and intent to maintain or change practice.
- MOC should be used as a tool for continuous improvement.
- The MOC program should not be a mandated requirement for licensure, credentialing, reimbursement, network participation, or employment.
- Actively practicing physicians should be well-represented on specialty boards developing MOC.
- Our AMA will include early career physicians when nominating individuals to the Board of Directors for ABMS member boards.
- MOC activities and measurement should be relevant to clinical practice.
- The MOC process should not be cost prohibitive or present barriers to patient care.
- Any assessment should be used to guide physicians’ self-directed study.
- Specific content-based feedback after any assessment tests should be provided to physicians in a timely manner.
- There should be multiple options for how an assessment could be structured to accommodate different learning styles.
- Physicians with lifetime board certification should not be required to seek recertification.
- No qualifiers or restrictions should be placed on diplomates with lifetime board certification recognized by the ABMS related to their participation in MOC.
- Members of our House of Delegates are encouraged to increase their awareness of and participation in the proposed changes to physician self-regulation through their specialty organizations and other professional membership groups.
Learn more about PAMED’s continuous efforts to improve MOC for Pennsylvania physicians at www.pamedsoc.org/MOC.