A 2014 physician survey conducted by the Pennsylvania Medical Society (PAMED) revealed what many suspected – widespread dissatisfaction with Maintenance of Certification (MOC). In responding to that dissatisfaction, the American Board of Internal Medicine’s February 2015 announcement that it would amend parts of its MOC program marked a major milestone for those who have long advocated for change.
But it didn’t mark the end of the process.
PAMED hosted an MOC Summit on Friday, March 6, in snowy Philadelphia to discuss next steps. The summit included representatives from 15 other state and local medical societies, as well as the American Medical Association (AMA), the American College of Physicians (ACP), the American Board of Medical Specialties (ABMS), and the American Board of Internal Medicine (ABIM).
The summit reinforced that physicians in other states feel the same way as the Pennsylvania physicians surveyed by PAMED.
“I think a multi-state dialogue is critically important to improving what the American Board of Internal Medicine and the ABMS does in terms of certifying the best physicians,” said Larry Downs, Esq., CEO of the Medical Society of New Jersey. “Certainly, one state or two states can have an impact. But if you have 15, 16 states together all talking and expressing their interest in improving the system, it’s certainly a great start.”
These organizations will continue refining next steps over the coming months. Below are some themes and action items that came out of the March 6 meeting:
- Define the role of state medical societies in this discussion, for example being able to link to all physicians in a state and get feedback or help direct learning projects on health issues that are important statewide
- Define the appropriate role of the AMA; AMA should protect physicians and assure that the processes and business practices of the Boards are above board and “by the book”
- Bring voice of physicians in each state to their Board; identify local/regional issues and corresponding best practices to take to boards
- Future listening session with ABIM
- MOC changes should include physicians who are working in clinical practice; certain percentage should be practicing physicians
- MOC process should be relevant to actual clinical practice
- Modules – why is there a 10 year cycle if learning is continuous? Targeted daily improvement and evaluation is better
- Education should be on modules that are available online and low cost
- Reduce the overall cost of the program, including time out of the office, etc.
- Stress this is about lifelong learning and not just MOC
- Get specific feedback on exams from physicians – and share results (what we got wrong and why)
- Replace the exam with a lifelong learning process
- Exam should be educational; remove punitive consequences
- Exams should be open book, reflecting practicing physicians’ ability to access materials when treating patients
- What makes good connection between the Board and their physician groups?
- Change the name of MOC to something that more accurately reflects what we want the process to be
- Work to bring other states on board with our efforts
- Expand use of the MOC Portfolio Approval Program
- Task force across the states to give feedback on process/exams
- Do a needs assessment on how physicians learn and tailor exam/learning methods to that
- Identify co-projects between Boards and state societies