As physicians continue to push back against maintenance of certification (MOC) requirements that many regard as onerous, the American Board of Internal Medicine (ABIM) has announced an agreement with three medical societies to explore alternatives to the current process. The American College of Cardiology (ACC), the American College of Physicians (ACP), and the American Society of Clinical Oncology (ASCO) have agreed to work with ABIM to explore “collaborative maintenance pathways” through which physicians can maintain board certification.
According to a news release, each organization will consider creating a MOC process for their specialty that offers board-certified physicians flexibility in how they can demonstrate that they meet standards and are keeping their medical knowledge current. In these collaborations, ABIM will continue to set the performance standards and to issue MOC certifications.
ABIM has already made some concessions to physicians who are unhappy about its MOC procedure, which includes a high-stakes, all-day board recertification exam once very 10 years. For example, starting in 2018, ABIM will allow general internists and nephrologists to undergo “knowledge check-in” assessments every 2 years that are shorter than the 10-year exam and can be substituted for it. (The same approach will be rolled out to other internal-medicine subspecialties in 2019 and 2020.)
Richard Baron, MD, president and CEO of ABIM, told Medscape Medical News that if ABIM’s collaboration with the three specialty societies is successful it will give physicians three choices: do the ABIM knowledge-check-in biannually, do the same using the collaborative pathway developed with their specialty society, or take the 10-year “high-stakes” exam. According to ABIM research, Dr Baron added, about 20% of general internists and internal medicine subspecialists prefer the latter option.
Mary Norine Walsh, MD, president of the ACC, and Bruce Johnson, MD, president of ASCO, told Medscape Medical News that they welcomed ABIM’s offer to collaborate and were pleased with the progress made to date. However, they said, more remains to be worked out, and success is by no means guaranteed.
“Consequences”
The key sticking point is the nature of the assessments that physicians would be subject to every 2 years. Dr Baron said that the assessments must be as rigorous as those ABIM currently does, and must have “consequences.” That means there must be a possibility of decertification, or at least the requirement to take the 10-year exam if a doctor declines to participate in the biannual check-ins, he said.
The participating societies don’t believe there should be no consequences, but they’d prefer to build on their current lifelong learning programs in developing the MOC assessments. Jack Ende, MD, president of the ACP, said in the news release, “ACP’s society alternative pathway will be based on our Medical Knowledge Self-Assessment Program (MKSAP), which has helped physicians update and assess their knowledge in internal medicine since 1967.”
In her interview with Medscape Medical news, Dr Walsh was less prescriptive, but indicated that the ACC has a different view than ABIM does on the value of self-assessment modules. “Whether we reach agreement on what is a summative evaluation [of physician knowledge] remains to be seen. This is not a done deal,” she said.
She also noted that cardiologists still have problems with any examination or assessment that could lead to their board decertification. That’s true even if it’s a shorter exam that they must take once every 2 years.
“The high-stakes nature of the exams is what is disruptive to practices and to patients,” Dr Walsh said. “So the concept of doing ongoing work for which you get credit and can maintain your certification is what we’re after.”
Dr Johnson said that ASCO is committed to lifelong learning. Most of the oncology drugs now in use, he noted, were not available in 1985, when he completed his training, so there’s clearly a need to ensure that physicians are current with medical knowledge. Therefore, he said, “Some sort of certification is appropriate for our members and the medical community in general.”
Test by Subfields
But most oncologists don’t like having to take the high-stakes MOC exam every 10 years, he noted. Not only does it open them to the real possibility of decertification, which can lead to a loss of hospital privileges, but the exams also don’t differentiate among the various oncological subfields. If a physician in a large practice sees mostly breast cancer patients, he said, an exam that asks him or her about the latest prostate cancer treatments “may not be pertinent to their educational needs.”
For that reason, Dr Johnson said, ASCO is exploring the possibility of multiple MOC assessments for oncological subfields. Similarly, Dr Walsh said that the ACC is interested in having exams targeted at various cardiology subspecialties, such as interventional cardiology, electrophysiology, advanced heart failure cardiology, transplant surgery, and adult congenital heart disease.
Dr Baron said that ABIM is open to that idea, and admits that the board “hasn’t done a good job in the past of matching our assessments over the course of a career to that aspect of physician practice.”
However, he cautioned, ABIM can’t subdivide its assessments into too many categories with too few doctors in each. Instead, he said, the board might work with the medical societies to pick three or four major subfields in each subspecialty and build assessments by tapping their societies’ knowledge of those domains.
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