Maintenance of certification (MOC) for something as significant as the practice of medicine seems like a harmless enough idea. But for physicians across the country who dedicate thousands of hours to study, earn licensure, achieve board certification, and practice medicine, MOC is not only unnecessary but also a resource-consuming mandate that does nothing to improve patient outcomes and quality of care.
According to the American Board of Medical Specialty’s (ABMS’) own website: “Board certification is a voluntary process, and one that is very different from medical licensure … Board certification demonstrates a physician’s exceptional expertise in a particular specialty and/or subspecialty of medical practice.” In other words, physicians who pursue board certification self-identify as professionals committed to ongoing learning and subject-matter mastery. The vast majority of Texas physicians willingly pursue and obtain their initial certification for just that reason.
ABMS introduced MOC in the past 20 years, granting a lifetime certification to physicians board certified at the time of its creation. The rationale for the arbitrary “grandfathering” date is murky and ambiguous at best.
In the past 12 months, several states have passed laws specifically disallowing reliance on MOC for credentialing, payment, and contracting. More are considering legislation this year. Serendipitously, Oklahoma had success with Senate Bill 1148 — the same bill number for legislation courageously authored by Texas State Sen. Dawn Buckingham, MD, a physician in the Austin area. Texas’ SB 1148 prohibits the state from using MOC as a requirement for state licensure or renewal. It prohibits hospitals and insurance companies from relying on MOC for credentialing or contracting. That bill is working its way through the Texas Legislature this week.
The Medical Credentialing System in 2014 reported revenues of more than $2.5 billion — $1 billion of which is attributed to ABMS entities alone. The American Board of Internal Medicine (ABIM) is the largest of ABMS’ credentialing agencies and is responsible for credentialing one-quarter of all physicians.
Drilling down further into those numbers is eye-opening. ABIM reports $58 million in revenue for 2015, nearly $27 million of which came from MOC fees. With $30 million spent on salaries and benefits that year and only $6.3 million on actually administering the MOC, one could easily draw the conclusion that the push for MOC is nothing more than self-serving largesse. Well, that and the luxury three-bedroom condominium purchased in downtown Philadelphia in December 2007. The money these boards collect and spend — on expenses like first-class, cross-country airfare for their staff — just adds to physicians’ ire over MOC mandates.
In fact, some specialty boards have emerged as a direct result of the revenue-generating opportunities MOC offers. Forty-two medical specialty boards now exist to conduct MOC courses. Forty-two. Providing employment for test proctors does nothing to improve patient care and outcomes. “Do no harm” is not just an oath to be sworn by physicians. It is also a standard to which MOC should be held. If it truly is voluntary, as ABMS asserts, stop punishing physicians who elect not to pursue it.
From the extraordinary dedication physicians demonstrate by initially achieving board certification, to meeting and exceeding continuing medical education requirements, to continuously putting patient care first and foremost, mandating MOC to practice medicine is an appalling overstep of nonexistent authority. Not only that, it is driving experienced, caring physicians from practice.
Texas physicians are determined to end this over-testing tyranny and ensure Texas remains a “right to care” state.
Carlos J. Cardenas is president, Texas Medical Association.
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