Stop MOC: An open letter to the American Board of Pediatrics

Dear American Board of Pediatrics:

On December 17 2015, at 3:01 in the middle of my busy day seeing patients, I voluntarily gave up my American Board of Pediatrics certification. I thought I should write this letter, hopefully preempting any more threatening emails warning me that I must pay up or lose my certification. This was not mere oversight on my part. This was purposeful.

The reason I am no longer ABP certified has nothing to do with my education or skill. Indeed, I’ve easily passed my board examination twice. Like a compliant pediatrician, I enrolled in MOC in 2010, paid my $1,000 and completed all my educational requirements.  I participated and completed all my MOC requirements again in 2013 and 2015.

I have disrupted my office flow to ask patients to rate me on my hand washing and I’ve sent that data to the ABP.  Twice.  I have disrupted my office flow to ask patients to rate me on my ability to give them flu shots and I’ve sent that data to the ABP.  I have dutifully completed your proprietary CME modules. I have submitted to and passed two secure examinations where I was treated as a near-criminal. Up until December 17 at 3:00, I did everything you asked.

But when I was threatened with loss of certification if I didn’t give another $1300, I finally had enough. The fact that the ABP can completely strip qualified and competent pediatricians of board certification for not paying more money is further evidence that MOC is all about the money.

A quick glance at your tax records makes it abundantly clear that this IS all about the money.  It’s about the president earning $1.3 million, but not doing MOC himself. It’s about first class airfare for board members and their spouses and $1.2 million spent on board meetings and conferences. It’s about $102 million in total assets in 2013, skyrocketing up from $65 million just four years earlier. It’s about an elite group living lavishly while front-line pediatricians slave away complying with never-ending hoops and ever-increasing fees.

And that’s why I didn’t pay.  I can’t continue to fund this type of coercion.  Those funds are used to change MOC rules on a whim and to threaten pediatricians into compliance.  While the ABP board was enjoying holiday preparations with their families, thousands of pediatricians were scrambling desperately to complete their MOC by Dec. 17.  Social media groups and message boards were full of physician moms and grandmothers looking for support as ABM MOC was pulling them away from family events to take tests, run reports on patient charts, and then cough up $1,300 out of fear. This breaks my heart. The ABP should be ashamed of themselves and what they’re doing to our colleagues. The ABP board should be ashamed of what they’ve done to the reputation of the ABP.

On one hand, I am sad about giving up my ABP certification. I remember the elation I felt when I passed my boards after residency. I really felt like I had accomplished something and that my certificate represented my professional  educational commitment to pediatric medicine. Now, after seeing the monster that board certification has ballooned into, I’m very happy to be off the MOC hamster wheel and no longer supporting a corrupt system that punishes very good doctors and pushes our most experienced pediatricians into early retirement.

As it stands, something with American Board of Pediatrics MOC must change. As pediatricians, we’ve joined the rest of our physician colleagues across all specialties pleading for MOC to end. It must return to a one-time examination after residency, maintained by holding an unrestricted state medical license and completing CME hours of our choosing. Ongoing secure examinations must end, limitation to ABP and AAP proprietary CME must end, the outrageous fees must end, and the time-consuming busywork of “Part 4 Practice Improvement Modules” must end. MOC must be egalitarian for all pediatricians, without exemptions or lowered fees for favored groups.

These are not just my isolated musings, this is what 4000 of my pediatric colleagues have requested in petition at This is what 23,000 physicians have signed under Dr. Paul Tierstein’s petition.

If past behavior of the ABP is any indication, I’m sure there will be more board meetings, workgroups, and pilot programs to tinker with MOC, to make it more “integrated” with our practices. Dr. David Nichols will write another blog post letting us know you are listening and have tinkered some more.

It’s all this flailing around and tinkering that makes me realize you don’t get it. We aren’t asking you to tinker and integrate MOC; we’re asking you to stop. The ABP keeps arbitrarily changing rules, and will continue to control us with these never-ending changes.

I really don’t think the ABP will be able to end MOC until we are allowed to stop participating. In order for us to stop participating, we have to conquer the one thing that keeps us in compliance: fear.

So in 2016, while the ABP meets and tinkers, I will focus on ending the fear. I will focus on freeing pediatricians from MOC requirements for hospital privileges and insurance credentialing, so MOC is truly voluntary. I will focus on educating my colleagues about alternative board certification options that treat us fairly and professionally like the National Board of Physicians and Surgeons, so there is choice.

In the end, I truly hope the ABP regains some measure of credibility and respect among practicing pediatricians. That will only come by respecting us as the professionals and colleagues we are, and not siding with the many other forces that are piling never-ending requirements, regulations, fees, and abuses upon us in the pursuit of power and financial gain.


Megan M. Edison MD

Meg Edison is a pediatrician and can be reached on Twitter @megedison.  This article originally appeared in Rebel.MD.

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