Recent changes to maintenance of certification policies have elicited a strong backlash from many in the medical community.
Last year, the American Board of Internal Medicine, which hosts the MOC program, changed its requirements and public listings. Physicians are no longer simply listed as "certified" on ABIM's public website or on the American Board of Medical Specialties' website. As of April 2014, physicians are listed as "certified, meeting MOC requirements" or "certified, not meeting MOC requirements." ABIM also moved to a shorter, continuous program cycle. Physicians must now complete MOC requirements in five years instead of 10, and must participate in education activities every two years at a minimum.
Paul Teirstein, MD, created an online petition in response to these changes, which has collected more than 19,000 anti-MOC signatures, according to his op-ed in The New England Journal of Medicine.
Many organizations have also publicly opposed the changes. The American Association of Clinical Endocrinologists formally asked ABIM to suspend the new requirements and the Association of American Physicians and Surgeons filed a lawsuit against ABIM's parent organization, the American Board of Medical Specialties, for restraining trade and reducing patient-physician access, according to the article.
Dr. Teirstein outlined the following arguments against MOC requirements in the NEJM.
1. ABIM studies supporting the value of MOC show mixed results. In an analysis of 33 ABIM studies, researchers found 14 did not document a significant association between certification status and positive clinical outcomes, and three studies documented a negative association, according to the article. The meta-analysis found 16 of the studies had a positive association.
2. Physicians only demonstrate interest in MOC because it is required. A majority of certified physicians have already signed up for MOC, according to ABIM. However, Dr. Teirstein argues, MOC is required for recently certified physicians and required for others for job security.
3. Completing requirements takes away from the time physicians can spend with patients. In a poll of 2,056 NEJM readers from 2010, 65 percent said they would not advise enrolling in the MOC program. In the comments section of the poll, many respondents said they "felt that the exercise [MOC] was only marginally relevant to their day-to-day practice and that it took their time away from patients and other learning activities."
4. MOC serves to generate funds for ABIM. ABIM, which is a private certifying organization, collected more than $55 million in certification fees from physicians in 2012, according to Dr. Teirstein. Physicians pay a range of $2,715 to $3,335 every 10 years to maintain requirements.
5. CME is a good alternative to MOC. Medical licensure requires physicians to complete about 25 hours of continuing medical education each year, according to the report. CME programs are regulated by the Accredation Council for Continuing Medical Education and no one program has a monopoly.
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