AMA Challenges Certification Programs

We recently wrote about complaints from orthopedic surgeons over Maintenance of Certification (MOC) programs and a lawsuit brought by the Association of American Physicians and Surgeons against the American Board of Medical Specialties (ABMS), seeking to stop the MOC program. (Certification: Scam or Public Safety: OTW 5/7/2013).

Now the American Medical Association (AMA) has weighted in by issuing a resolution challenging the American Board of Medical Specialties and approving a study to evaluate the impact of MOC and licensing requirements on physicians.

MedPageTODAY reported on June 18, 2013 that the anti-MOC resolutions adopted by the AMA House of Delegates include:

• Opposition to mandatory specialty board recertification programs and discrimination by hospitals and other entities against physicians who don’t recertify
• Support of lifelong continuing medical education and lifelong specialty board certification
• A call for increased transparency by the ABMS and its component specialty boards through published reports on revenue, expenses, and compensation of board members and senior staff
• A request that the AMA work with ABMS and component boards to integrate existing data-reporting programs with certain recertification programs

Recertification Program Effectiveness

The ABMS works with 24 specialty boards to develop recertification programs and promote continuous professional development. The MOC program, which started in 2000, requires most certified specialists to seek recertification—typically every 10 years—by successfully completing a four-part assessment.

Surgeons complain that such recertification programs are burdensome, costly, and have little known positive impact on patient outcomes.

MedPage reported that opposition to recertification programs boiled over at this AMA meeting as the Federation of State Medical Boards has expressed support for developing an additional type of recertification—a Maintenance of Licensure (MOL) program—that would require physicians to demonstrate knowledge in order to renew their state licenses.

But apparently the changes in AMA policy by the House of Delegates didn’t go far enough. New York delegation chair Robert Goldberg, D.O., offered an amendment to the Council on the Medical Education report regarding MOCs and MOLs that would have the AMA commission a study to evaluate the recertification program’s impact on physicians. The amendment would require an examination of the impact on physician workforce, practice costs, patient outcomes, patient safety, and patient access.

The amendment, according to the report, passed with the support of roughly 60% of the delegates. The complete report is due to the House of Delegates at the 2015 annual meeting. The New York delegation chair said there is little evidence to show MOC programs improve patient outcomes, safety, or access. “Where is the evidence? Show us, ” Goldberg said to MedPage.

“Our members are really upset about these exams and while we’re sitting and talking about it, the board is coming up with more subspecialty exams to give, ” Connecticut delegate John Foley, M.D., reportedly said. “I think it’s about time we take some action.”

ABMS Responds

The ABMS defended its MOC program in an eight-page “myths and facts” document posted March 20, 2013 on its Web site. The program is “anchored in evidence-based guidelines, national clinical and quality standards, and specialty best practices, ” the group says.

More than 450, 000 physicians participate in the MOC program, which ABMS says is designed to help assure a doctor has successfully completed a rigorous evaluation process, and to ensure competency. The pool grows by roughly 50, 000 physicians a year.