Are Maintenance of Certification Requirements Getting Out of Control?

Maintaining your clinical certifications is mandatory, but is it worth the time and expense? Robert Lowes of Medscape reports that, “For almost 2 years, many internists and internal medicine (IM) subspecialists have bitterly complained that recent changes to their maintenance of certification (MOC) program cost them more time and money but do not make them better physicians.”

Prior to 2014, physicians were required to recertify every 10 years, which required them to pass an exam and complete a variety of training modules. In 2013, this meant that doctors had to earn 100 module points every 10 years but could do them all in the year before taking their exam.

This changed in 2014 when the American Board of Internal Medicine (ABIM) changed requirements making MOC more of a continuous process wherein physicians are required to earn 100 module points every 5 years. They also added new patient safety and patient voice modules to the program and the costs of the modules and exams increased from between 16 and 39%. Many physicians have argued that this change is having a negative impact on them.

A recent study entitled A Cost Analysis of the American Board of Internal Medicine’s Maintenance-of-Certification Program took a critical eye to the change. The results of the study, which were published in the Annals of Internal Medicine, show that there has been a 35% increase in fees and a 26% increase in the hours a physician has to put in to meet the requirements over a course of 10 years.

The study’s authors quantified this by calculating the value of time spent in terms of hourly wages and added the MOC fees. They found that the change in requirements translated to an average cost of $23,607 for recertification. For specialists, the costs are even higher. Hematologist-oncologists, for example, are facing costs of as much as $40,495 for recertification. It should be noted that physician time (which comes to approximately 180 hours per physician) accounts for 90% of the total costs.

Using this method of calculation, the study’s authors showed that the increased requirements will cost physicians in the U.S. an additional $1.2 billion over 10 years. One of the study’s co-authors, Dhruv Kazi, MD, assistant professor at the University of California, states that a rigorous evaluation of the ABIM’s MOC program and its effect on patient care is needed to show that this increased expense is justified. In an interview with Medscape, Dr. Kazi stated, “Such a large investment should be driven by evidence. We don’t see the evidence.”

Richard Baron, MD is the President and CEO of ABIM. He argues that the study is flawed and that even before the increased requirements were issued, most physicians already spent a considerable amount of time keeping up with changes in their fields. He states that the ABIM’s program provides a structure to this activity and does not actually result in extra work for the doctors.

At any rate, more than 23,000 doctors have signed a petition in protest and the ABIM responded by making concessions. It agreed to suspect practice assessment, patient voice and patient safety modules for 2 years and to accept most forms of continuing medical education (so long as they are approved by the Accreditation Council for Continuing Medical Education) as credit toward their required training points. The ABIM also announced that physicians who are certified in nine internal medicine subspecialties will no longer have to maintain underlying board certifications. These nine subspecialties are:

• Advanced heart failure and transplant cardiology
• Clinical cardiac electrophysiology
• Interventional cardiology
• Adult congenital disease
• Transplant hepatology
• Adolescent medicine
• Hospice and palliative medicine
• Sleep medicine
• Sports medicine

You can learn more about this topic and the debate it has inspired by reading Medscape’s very comprehensive article here and by checking out the full data compiled by the study.