Why is MOC necessary?

Dr. Wes has written passionately against MOC: ABIM Pleads for Mercy.

But perhaps we should ask first: Why MOC at all?

Contrary to years of propaganda promoted through pseudo-science and journal article citations on the ABIM’s website, might MOC have really been created because the ABIM’s consolidated fund balance dropped 43.2% from $54,009,086 on June 30. 2001 to $30,691,329 by June 30, 2013 while the Standard and Poors 500 index increased 37.7% over the same period? Said another way, maybe MOC was created because the net assets of the ABIM diminished from negative $10,930,327 to negative $43,150,390 from 30 June 2003 to 30 June 2013 while their leadership and board members did little more than pad their resumes so they could apply to the next insurance company or National Quality Forum job opening.

Now I have followed Dr. Wes for many years. He is insightful and passionate. But MOC started in 1990.

Family medicine started MOC when their board started.

MOC, in my mind, is necessary because CME is generally a failure. We must look at CME requirements honestly. We have to accumulate a certain number of CME points. We can get those points in a variety of ways, and addressing any variety of topics. But we have no quality control and no checking to see if we are really keeping current.

Appropriate MOC should challenge us to really stay current.

For many years, I have had concerns about how we can help physicians stay current. Medicine changes, probably more rapidly than any other profession. The number of studies published each year means that I do not have a good method for picking out what new knowledge I should add.

We need help. We need a roadmap for staying current. We cannot have subspecialists picking our curriculum, but rather need our peers to evaluate suggestions from subspecialists and practicing physicians. We need prioritization.

The goal behind MOC is pure. We can argue about the evolution of the product.

I see that ABIM now understands their errors. They are not evil. They are honorable physicians trying to improve the profession. I have talked with their leaders, and I know that they want to do the right things for internal medicine.

When we worry too much about the money, we run the risk of falling prey to the affect heuristic. We get angry at ABIM, and therefore we disregard any good that they might do and highlight any bad that they might do.

The current leadership is really trying. If we had been criticizing MOC for 25 years, then we would have the right to continue. But the real problems are about how MOC changed and how the grandfathers and grandmothers were added.

I urge everyone to focus on how we can insure that we maintain our knowledge of advances in our field. If you want to investigate finances, please separate that from an honest appraisal of what MOC could become. After all, we are all patients eventually, and we want our colleagues to have the best knowledge base upon which they can help us.

I have personally urged the ABIM leadership to consider these goals for MOC. I believe that they are very open to constructive criticism. The CME enterprise could transform into what I envision for MOC, but I have no reason to expect the CME will become more relevant. We all need a roadmap for true improvement. I think MOC could provide that roadmap. If so, then MOC would be most valuable.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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