sociation-driven so your education is going to improve the health care of patients you take care of, not just your test- taking skills,” he said. “The freedom to choose is something we gain at the state level through legislation, rather than being held hostage to one single entity.”
BOARDS IN THE SPOTLIGHT Boards, while not backing down, are taking notice. Dr. Nora says board certification, including MOC, re-
mains voluntary, and ABMS policy maintains the process should not be the sole credential to determine physician competency. “That being said, we believe it is a very important cre- dential. We would not be doing our public responsibility if we did not insist board certification was an ongoing pro- cess. It shouldn’t mean what your doctor did 40 years ago is what they are doing now,” she said. “We have not made it mandatory, but hospitals, health systems, and others recognize that board certification and MOC are associated with enhanced quality.” Taking away that prerogative, she said, would be “detrimental to patients and detrimental to physicians.” Dr. Nora acknowledges, however, that boards, too, must continuously improve, pointing to recent innovations. A neurologist, Dr. Nora says she understands, for in-
stance, the stress and burden created by a high-stakes exam every 10 years. She says many boards are piloting remote proctoring and access to materials, while tailoring exams and quality improvement activities more closely to actual physician practice. ABMS also set up what she calls an
“MOC directory” where doctors can find approved learn- ing opportunities outside those created by the boards — at medical schools or medical societies, for example — and expanded the number of sponsoring institutions in the portfolio program. ABMS is attentive to reducing fees where possible, and
Dr. Nora anticipates some of these changes will help mod- erate costs. She says fees tend to balance out to a few hun- dred dollars a year, and physicians would be doing many activities, like completing CME or attending specialty meetings, anyway. Because costs translate to value, howev- er, “as physicians find this more and more relevant to their specific practices, they are less concerned.” Testimony at the AMA’s House of Delegates meeting in
June also highlighted improvements. Several boards, for instance, are looking to replicate the Board of Anesthesiol- ogy’s “MOCA Minute,” which replaces lengthy exams with periodic, interactive quizzes. Other changes would make simulation activities optional. (MOCA stands for MOC- Anesthesiology.) In the face of vehement criticism, ABIM suspended its
quality improvement and patient safety requirements in February 2015 until more meaningful standards are defined, while overhauling other MOC components, including:
32 TEXAS MEDICINE September 2016
• No longer requiring underlying certifications for MOC in some disciplines. A physician boarded and subspe- cializing in interventional cardiology, for instance, no longer has to recertify in general cardiology.
• Creating a new partnership with the Accreditation Council for Continuing Medical Education to accept more forms of CME for MOC credit.
• Providing an alternative for diplomates in good stand- ing to take assessments at home or in the office versus traveling to testing centers.
A big shift underlying those changes was altering
ABIM’s governance structure to better communicate with physicians and incorporate doctors’ feedback into program redesign, says ABIM President and Chief Executive Offi- cer Richard J. Baron, MD. In updating exams, for instance, ABIM asks practicing physicians to rate blueprints for rel- evance and importance. Drs. Baron and Nora both disagree that CME by itself is
adequate. ABMS publically rebuked the new AMA policy opposing exams (tma.tips/ABMSRecertificationStatement). While a crucial component of lifelong learning, “CME is
an entirely passive standard,” Dr. Baron said. “Adult learn- ing theory says assessment drives learning, but a part of what makes you retain knowledge is testing on it. CME is enough for licensure. But 81 percent of licensed doctors in the country are board-certified and always felt they met a higher standard. “I get that physicians are feeling frustrated and pushed
around and overly regulated,” he said. “When you think about how much medical knowledge has changed since I finished my training 32 years ago, our program can provide reassurance to doctors themselves, to colleagues they work with, and reassurance to the public and health care institu- tions that they meet a defined standard and are practicing today’s medicine.” Dr. Monday sees the MOC tide shifting in the right di-
rection. “Physicians value lifelong learning; we are just requesting reasonable requirements and more meaningful standards.” n
Amy Lynn Sorrel is associate editor of Texas Medicine. You can reach her by phone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370- 1629; or by email at
amy.sorrel@
texmed.org.
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