In the past few years there has been tremendous criticism of the American Board of Internal Medicine’s (ABIM’s) maintenance of certification (MOC) program. The MOC program was significantly expanded in 2014 and required doctors to get 100 MOC points every 5 years and do at least one MOC activity every 2 years. These requirements also came with increased fees for the MOC program and increased failure rates for the recertification exam. In the face of criticism, the ABIM changed the program earlier this year and removed activities like “practice assessment” and “patient voice” that many people felt were too arduous.
Much of the uproar around the MOC has been around the costs for MOC activities such as the fee to enroll in the MOC program, the cost of the recertification exam that doctors have to take every ten years, and the cost of retaking the test in light of increasing failure rates. But tied to these activities are not just the bills for these activities but also the cost of the time that it takes to do all these activities. And at a time when doctors feel as if they are expected to work more for less, measuring the costs of the time to do certification activities is tremendously important.
Recently, the Annals of Internal Medicine published a brilliant study that quantified the real cost to doctors for the MOC program — that is, both the direct cost of enrolling in the program and the recertification exam(s) plus the indirect cost of the time that is lost for each of these activities. The study estimated these costs for the newest version (2015) of the MOC.
The results are stunning. On average, direct cost of the MOC program is expected to be $2,349 per doctor over ten years. General internists and hospitalists can expect the lowest direct costs ($1,774 over ten years) while hepatologists can expect the highest direct costs ($3,802 over ten years).
But these costs pale in comparison to the time costs of doing the MOC activities. The researchers estimate that it will cost each doctor over $21,000 over ten years to do MOC activities. Cardiac electrophysiologists will be hit the hardest and should expect their time costs to be over $48,000 over ten years.
The team of researchers from UCSF concluded that the MOC program will costs doctors $5.7 billion over 10 years and most of that amount comes from the 33 million hours that they estimate doctors will spend on MOC activities.
It’s a stunning amount of time and money and much more than the few thousand dollars that the ABIM attributes to MOC costs. The question is: How should doctors respond?
I personally think there is value is ensuring that doctors maintain their knowledge and skills. We all know that medicine is changing and much of what we learned in medical school is no longer applicable in current practice. But at a time when reimbursement rates are dropping, practice costs are rising, and regulatory requirements by payers and others seem to be skyrocketing, the ABIM and others should ask whether the costs are worth it.
Tara F. Bishop is an internal medicine physician who blogs at her self-titled site, Tara Bishop MD.