The Controversy Over Maintenance of Certification

The movement opposing the American Board of Medical Specialties (ABMS) Maintenance of Certification (MOC) program is gaining momentum. Physicians who oppose mandatory MOC requirements by hospitals and insurers have been influential in proposing legislation in 17 states so far to ban the requirements.

“Some state medical societies have asked their state governments to legislate what MOC can and can’t be used for,” said Brian Nussenbaum, MD, executive director of the American Board of Otolaryngology (ABOto) and a member of ENTtoday’s editorial advisory board. The ABOto, which started requiring MOC in 2002, is one of 24 member boards that comprise the ABMS. To date, bills restricting the use of MOC for privileging, reimbursement and/or licensure have been introduced in 26 states and passed in seven (Georgia, Maryland, Missouri, North Carolina, Oklahoma, Tennessee, and Texas).

The legislation opposing mandatory MOC has been driven by some diplomates who say that certification processes are not relevant to their practices, are too time consuming and costly, and don’t accurately reflect what’s necessary to maintain the public trust in continuing certification. In addition, high-stakes exams that need to be taken at least every 10 years cause a great deal of anxiety.

Physicians in the anti-MOC movement support initial board certification but say that MOC has evolved into a money-making scheme that forces them to pay testing fees that are too costly and are required too often.

Among groups that oppose MOC are the National Board of Physicians and Surgeons, the Association of American Physicians and Surgeons, Practicing Physicians of America, and the Association of Independent Doctors. Individual physicians are also contacting their state medical societies and legislators to ban mandatory MOC requirements by hospitals and insurers.

The ABMS, which sets the standards for physician certification, says MOC is necessary for quality of care and patient safety. Dr. Nussenbaum also stands behind the rationale for MOC—he said that initially becoming a board-certified physician immediately after completing residency and an ABOto diplomate is not enough to ensure that the physician will continue to maintain that competency throughout his or her entire career. “Our philosophy is that initial certification is not equal to lifelong certification,” he added. “Certification, rather, is a lifelong process that starts with initial certification and is ongoing throughout an individual’s career.”

Additionally, according to ABMS, there is evidence that board certification and MOC are associated with higher standards, better quality care, and improved patient outcomes. Certified physicians are also significantly less likely to be disciplined by state medical boards. There is also evidence that physicians participating in MOC provide care at a lower cost, mostly by ordering fewer tests and demonstrating more efficient patient management.