Does maintenance of certification ensure physician competency?

Providers disagree on controversial ABMS-sponsored certification
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Since the maintenance of certification (MOC) launched in 2000, some providers have bemoaned how expensive and time-consuming the process is and questioned whether the recertification program accurately evaluates physician competency, according to an article in the New England Journal of Medicine.

Sponsored by the American Board of Medical Specialties (ABMS) and its 24 member boards, the program promotes lifelong professional development based on the core competencies from the Accreditation Council for Graduate Medical Education (ACGME) and The Joint Commission--medical knowledge, patient care and procedural skills, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice--according to the MOC website.

The MOC costs aren't cheap, according to some providers. For instance, the American Board of Plastic Surgery MOC fee is $4,820.

Although MOC participants typically seek recertification every 10 years, some younger physicians criticize the board for allowing other physicians before 1990 to be grandfathered in and evade recertification.

The goal of the program is to ensure physician specialists are keeping up with their discipline. However, only 1 percent of the 66,689 diplomats of the American Board of Internal Medicine (ABIM) who hold only time-unlimited certificates choose MOC.

But even with hefty costs and an alleged bias against younger physicians, MOC is winning support from some leading institutions.

The Mayo Clinic in 2010 became the first "MOC portfolio sponsor" with its pilot of quality-improvement projects that focus on practice performance assessment (Part 4 of MOC). The Multi-Specialty MOC Portfolio Approval Program included more than 550 Mayo physician participants in the first two years of the project.

Other organizations participating in Part 4 include the Medical University of South Carolina and the University of Michigan. With stronger institutional support, MOC may gain even more traction, the NEJM article noted.

ABIM board chairman Robert Wachter pointed out that physicians self-regulate their professional development. Wachter said, "If somehow MOC went away, it would be quickly replaced by more regulatory external bodies that ultimately would be more burdensome to physicians."

Hospitals already institute ongoing professional practice evaluation and focused professional practice evaluation. The MOC may prove to be another vehicle for ensuring physician competency.

For more information:
- read the NEJM article
- visit the MOC website

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