The Pennsylvania Medical Society (PAMED) is taking action on an area of increasing physician concern – the American Board of Medical Specialties (ABMS) Maintenance of Certification (MOC).
MOC has become controversial, with many physicians labeling it confusing, costly, time-consuming, and a poor method of demonstrating continued proficiency in one’s specialty. While objections have been raised to all four parts of the MOC process, most of the opposition centers around Part III (the examination) and Part IV (the practice performance assessment).
Physicians have expressed concern that the Part III examination may not provide an accurate measure of cognitive expertise. Further, the examinations are expensive, and failure to pass can have severe consequences, including loss of hospital privileges, exclusion from insurer networks, and preclusion from teaching at medical schools. Additional penalties are forthcoming in 2015, when Medicare penalties are on the way for not participating in the Physician Quality Reporting System (PQRS). MOC is included in PQRS.
However, physician irritation seems to focus even more strongly on Part IV, the Practice Performance Assessment. Requirements of the various specialty boards vary widely, even among similar specialties. For example, there are significant differences between the Part IV requirements established by the American Board of Family Medicine and the American Board of Internal Medicine.
At PAMED’s House of Delegates meeting last month, a board task force brought recommendations for potential action back to the full board and also the delegates. The task force presented a recommended “Statement of Principles” governing what MOC should be, which were adopted by both the PAMED Board and the House of Delegates.
|The Statement of Principles is as follows:
In early November, PAMED’s delegation carried the Statement of Principles to the AMA Interim Meeting, where delegates largely adopted them as AMA policy. You can read more about the AMA action here.
Meanwhile, PAMED efforts to address concerns with MOC continue, with a statewide survey under way to further identify strengths and weaknesses in the recertification process. Additional actions are being discussed, and PAMED will keep members informed as those actions unfold.
The ABMS is a non-profit organization of approved medical boards, officially referred to as the “Member Boards,” which represent 24 broad areas of specialty medicine. In 2000, the 24 member boards of the ABMS agreed to evolve their recertification programs to one of continuous professional development –MOC.
ABMS MOC is intended to assure that physicians are committed to lifelong learning and competency in a specialty and/or subspecialty by requiring ongoing measurement of six core competencies adopted by ABMS and the Accreditation Council for Graduate Medical Education (ACGME) in 1999.
Those six core competencies are:
- Professionalism—Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diverse patient populations.
- Patient Care and Procedural Skills—Provide care that is compassionate, appropriate, and effective treatment for health problems and to promote health.
- Medical Knowledge—Demonstrate knowledge about established and evolving biomedical, clinical, and cognate sciences and their application in patient care.
- Practice-based Learning and Improvement—Able to investigate and evaluate their patient care practices, appraise, and assimilate scientific evidence and improve their practice of medicine.
- Interpersonal and Communication Skills—Demonstrate skills that result in effective information exchange and teaming with patients, their families, and professional associates (e.g. fostering a therapeutic relationship that is ethically sound, uses effective listening skills with non-verbal and verbal communication; working as both a team member and at times as a leader).
- Systems-based Practice—Demonstrate awareness of and responsibility to larger context and systems of health care. Be able to call on system resources to provide optimal care (e.g. coordinating care across sites or serving as the primary case manager when care involves multiple specialties, professions or sites).
The 24 ABMS member boards set the criteria and curriculum for each specialty. The four-part MOC process includes:
Part I —Licensure and Professional Standing
Medical specialists must hold a valid, unrestricted medical license in at least one state or jurisdiction in the U.S., its territories, or Canada.
Part II—Lifelong Learning and Self-Assessment
Physicians participate in educational and self-assessment programs that meet specialty-specific standards that are set by their member board.
Part III—Cognitive Expertise
They demonstrate, through formalized examination, that they have the fundamental, practice-related and practice environment-related knowledge to provide quality care in their specialty.
Part IV—Practice Performance Assessment
They are evaluated in their clinical practice according to specialty-specific standards for patient care. They are asked to demonstrate that they can assess the quality of care they provide compared to peers and national benchmarks and then apply the best evidence or consensus recommendations to improve that care using follow-up assessments.
In 2006, all member boards received approval of their ABMS MOC program plans, which are now in the process of implementation.