The Controversy Over Maintenance of Certification

To prevent the anti-MOC movement from progressing, Dr. Shapiro encourages physicians to testify in support of MOC to state legislatures—which she has done—or to colleagues. “Specialty societies, as well as individual diplomates, should stand up for MOC because it is a core foundation to our profession,” she said. “To allow state regulators, instead of hospitals, to decide proper qualifications for physicians would erode our professional self-regulation. MOC should be supported, not undermined, as a way to maintain public trust in physicians.”

Instead of having the government involved, Dr. Nussenbaum believes the controversy should be resolved within the house of medicine, by having specialty boards work with specialty societies and diplomates to continue to improve their processes and introduce new program innovations. “This is already happening within ABOto,” he said.

Controversy within Otolaryngology

Dr. Nussenbaum said there have been fewer critics of MOC within otolaryngology, and he thinks this is because the ABOto has been at the forefront of addressing any concerns. “When ABOto started its MOC program, its philosophy was to be practice focused, not to be costly, and not [to] be time consuming,” Dr. Nussenbaum said. “We have eight different practice focus areas in our MOC program in order to maintain relevance to the diplomates,” he said. “If a physician only practices pediatric otolaryngology, for example, he or she will not have to answer questions about head and neck cancer.”

“Annual dues are a flat $310 no matter what activities the diplomate has due that year; ABOto does not charge for every individual MOC activity,” Dr. Nussenbaum said. Diplomates can take the knowledge assessment test as early as the eighth year of their 10-year cycle. “The failure rate in otolaryngology is very low. In the rare instance that someone fails, the diplomate still has one or two more chances to pass it before their 10th year.”

The American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS) supports many of the principles behind MOC and recently signed a joint statement with the ABOto that promotes lifelong learning that is monitored by continuous assessment (see below). “Both groups feel that time spent on learning should fit within the normal flow of the physician’s practice at a reasonable expense,” said James C. Denneny III, MD, executive vice president and CEO of the AAO-HNS Foundation. “Both groups also feel that physician self-regulation is essential to the medical profession, and continuous certification is essential to both physicians and patients.”

ABOto’s Evolution

Each of the boards that comprise the ABMS has a unique concept of MOC; each one measures different parameters and employs different strategies for assessment, Dr. Denneny said. But certain boards have not been responsive to the legitimate concerns of their diplomates.