The Goliath of board certification: Does David stand a chance?

How should patients determine the quality of their doctor?

This is an interesting question that has now reached mainstream media status as evidenced by a Wall Street Journal article by Laura Landro, a very accomplished veteran health care reporter.

With the best and brightest going in to medicine, the requirement for more rigorous training than anywhere else in the world by (some might say) “exceptional, world class” medical educators and longstanding ongoing mandated continuing medical education to maintain competency and licensure, why is there suddenly such concern over the quality of doctors in America?  Most Americans have been very happy and trusting of the physician they knew and loved before — why the change?

Is it so that patients who must see new doctors in their new insurance plan can feel good that the new doctor (or nurse practitioner) is as good as the physician that has cared for them before?


Or perhaps it’s because the huge industrialized certification complex that foistied its Maintenance of Certification (MOC) requirement every two years beginning  January 1, 2014 upon America’s physicians is finding unprecedented pushback from their member-physicians so a direct-to-consumer PR campaign was  undertaken in an attempt to quell the unrest.


Or perhaps it’s because the American Board of Medical Specialties, along with its 24 subsidiary professional organizations, feels there is a need to justify the salaries of the multiple specialty board members that often exceeds that of their physician members and whose salaries are funded in large part by the fees from the MOC process.


Or perhaps there is a need to justify the difference and numbers of fees different types of doctors have to pay to maintain their certification.


Or perhaps the PR was required to justify the expansion of this certification process to include not only testing doctors, but to making them also perform unproven data collection exercises called “Practice Improvement Modules” that have absolutely no bearing on a patient outcomes or a doctor’s intellect and skill as a practicing physician, but typically take many months to complete.


Or perhaps the article was another effort to deflect attention from the fact that despite publishing a webpage of opinion pieces and articles claiming to substantiate the need for MOC, only 25% (at best) of board members of the various recertification bodies have bothered enough to maintain their own (sub)specialty certification.


How do patients really benefit with the MOC process now being foisted on America’s doctors every two years?  Do they get better access to their doctor?  No, for their doctors must take time away from their practices to study, take tests, and collect data for this.  Do they get to keep their doctor as long as they want if their doctor maintains their certification?  No, certification provides no guarantee that a patient can keep their doctor as patients are shunted to insurance company-controlled populations called accountable care organizations. Does maintaining certification guarantee that a doctor will practice better medicine?  No, at least not when the MOC process is compared head-to-head to the knowledge gained by years of close patient-care experience.

Ms. Landro seemed to be writing for the business interests in medicine in her role as a news reporter for the Wall Street Journal because she failed to mention these points and the impact the MOC process has had on hard-working, careful, and ethical clinical physicians in America.

While she does mention the suit filed against the American Board of Medical Specialties by an opposing organization called the American Association of Physicians and Surgeons, her article failed to mention the real reason this suit was filed: because a surgeon with over 30-years of patient care experience refused to “recertify” in his specialty and then had his privileges to practice medicine revoked by his hospital system as a result.

Years of experience and patient care — a measure most would agree is the most important determinant of a quality physician — lost because a doctor refused to perform these unproven MOC exercises.

It’s a classic David vs. Goliath story, really, since millions and millions of dollars annually are at stake for the certifying organizations.  And while the story continues to be played out in court, it is clear that the Davids are getting more upset — especially when Goliath’s unproven tests and “Practice Improvement Modules” (and who knows what else in the future) have the potential to affect David’s ability to practice medicine in the future.  Is this really what patients want?

Should a series of tests ever trump clinical experience in determining physician quality?  Should a series of tests be able to void a doctor’s lifelong commitment to patient care?

Not in my book.  And if patients think for one second this MOC process is just about having “quality physicians” at their disposal, they should think again.

Wes Fisher is a cardiologist who blogs at Dr. Wes.

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  • LeoHolmMD

    Great post. The ABMS and it’s ilk continue to struggle with legitimacy with an unconvinced profession and a public that could not care less. The only way they can keep the racket going is through intimidation and aligning themselves with hospitals who provide funding for these organizations through “slush” funds. You can get far more education using a program like UpToDate or even using the internet for that matter. You have to care about what you are doing for patients. There is no way to test for that. The MOC is more about the usual standardized testing foolishness: do you test well? Can you get around our tricky questions? There is plenty of evidence to suggest that slavishly following treatment guidelines and recent fads in medicine harm patients. They don’t call it “cutting edge” for nothing.

  • lord acton

    Just another reason to do direct primary care. No EMR, no need to pay the board certification mafia. Is there anything DPC can’t do??

  • Ron Smith

    Hi, Wes.

    I couldn’t agree more. Thirty years down and going strong as ever. Repeat certifications have added zilch to my abilities.

    Quality medical care ≠ MOC

    Warmest regards,

    Ron Smith MD
    www (adot) ronsmithmd (adot) com

  • guest

    I wish there was some medium by which we could get the message out that MOC and board certification is meaningless extortion. Anyone aware of a platform that reaches billions of people by which we can spread the word?

  • Deceased MD

    Seems to me the CEO’s of insurance companies should be tested. pharmaceutical employees, as well as hospital administrators to test their competency.

  • edwinleap

    Thanks for the great post. I recently took my second recertification. While I passed, I was amazed by both my treatment at the testing center. (‘Open your mouth…anything inside?’) and by the relative obscurity of many of the questions on the emergency medicine Concert exam. It might have made sense in the days when residencies were inconsistent, but they’re very standardized now. The most ridiculous of all seems to me the oral board exam, in which one plays a role regarding imaginary patients to demonstrate the knowledge that one’s residency director should easily be able to verify the physicians possesses.

  • T H

    MOC is very efficient… at harvesting money from MDs/DOs. The only reason to do it is because it will be difficult to find a job if there is a need to switch positions to a different hospital or obtain a license from a different state.

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