In a frank announcement, the American Board of Internal Medicine has apologized to doctors for a Maintenance of Certification program that “clearly got it wrong,” and pledged to make the program more consistent with internists’ practice and values.
Among the immediate changes: updates to its internal medicine exam; suspension of the practice assessment, patient voice, and patient safety requirements for at least 2 years; and MOC enrollment fees set at or below the 2014 levels through at least 2017.
Dr. David A. Fleming, president of the American College of Physicians (ACP), called the move monumental and historic.
“This turnaround has occurred in the face of mounting pressure and discontent expressed by a growing number of U.S. internists concerned about the MOC process,” Dr. Fleming said in an interview. “With the new changes in MOC, internists are still being held accountable and responsible for maintaining professional competence, but by removing the practice assessment and patient [safety] requirements that are not well supported by evidence, we go a long way in taking the pressure off very busy physicians who already feel burdened by many layers of regulatory and administrative reporting that many view as burdensome and a barrier to our first duty – caring for patients.”
Dr. Richard J. Baron
In a statement, ABIM President and CEO Dr. Richard J. Baron said it was clear that aspects of the program were not meeting physicians’ needs.
“We got it wrong and sincerely apologize,” Dr. Baron said in the statement. “We are sorry. ABIM is changing the way it does its work so that it is guided by, and integrated fully with, the medical community that created it. The goal is to co-create an MOC program that reflects the medical community’s shared values about the practice of medicine today and provides a professionally created and publicly recognizable framework for keeping up in our discipline.”
As part of the newly announced changes, ABIM will make its internal medicine exam more reflective of physician practice, with changes to be incorporated in fall 2015, according to the announcement. The decision to suspend the practice assessment, patient voice, and patient safety requirements means internists who have not completed activities in these areas will not have their certification status changed. Diplomates who are currently uncertified but who have satisfied all requirements for MOC except for the practice assessment requirement will be issued a new certificate this year. Within the next 6 months, ABIM will also change the language used to publicly report a diplomate’s MOC status on its website from “meeting MOC requirements” to “participating in MOC.”
By the end of 2015, ABIM said it will assure new and more flexible ways for internists to demonstrate self-assessment of medical knowledge by recognizing most forms of Accreditation Council for Continuing Medical Education–approved continuing medical education. An online FAQ provides more information on the changes.
ABIM initially revamped its certification policies beginning in January 2014, shortening the time physicians had to earn MOC points and publishing online whether doctors were meeting requirements. The actions meant every 2 years, physicians certified by ABIM had to earn at least some points by completing some of the educational activities approved for MOC credit, and at the 5-year mark, earn 100 points. Previously, physicians were given 10 years to earn 100 points. Physicians were also listed publicly as either “certified, meeting maintenance of certification requirements” or “certified, not meeting MOC requirements.”
The changes were met with almost immediate backlash. Doctors expressed frustration that the requirements were burdensome, expensive, and irrelevant. By January 2015, a Web-based petition against the program garnered more than 19,000 signatures and has drawn thousands of comments in protest of the new requirements. A second petition had nearly 6,000 signatures with doctors taking a “pledge of noncompliance” with the requirements.
A January perspective piece in the New England Journal of Medicine expressed that the MOC program is essentially a money-generating activity for the ABIM and that the organization has lost contact with the realities of day-to-day clinical practice.
In an interview, Dr. Baron said such feedback drove ABIM to make the changes. He acknowledged that it would take time to build back trust within the community.
“Part of why we’re taking the steps we’re taking is that it’s critical to have trust with the community,” Dr. Baron said. “Part of how you do that is if you got something wrong, you apologize for it, you acknowledge you got it wrong, and you commit to making changes and try to get it right.”