Wednesday, January 30, 2013
Maintenance of Certification and quality: There are two sides
I had written a previous post on this subject earlier, but with two articles out this week in premier journals (the New England Journal of Medicine and JAMA), I am seeing some interesting chatter on Twitter from well-respected physicians describing the downsides of Maintenance of Certification, or MOC.
Here are two previously written blogs (#1 and #2) outlining these "downsides." It is clear to me how these physicians feel about the MOC process.
There could be many ways to discuss the issue of MOC in this blog. I will try to focus on simplicity: "for" and "against," along with literature that highlights each of these arguments.
Arguments challenging the current process of MOC
1. It takes physician's time away from direct patient care.
2. It is a "scam," due to the fact that it is very costly, with the beneficiaries of monies being the leadership of the Boards comprising the ABMS (American Board of Medical Specialties). [Interesting that this article is not referenced in PubMed, but can be found through standard non-medical search engines.]
3. It is out of touch with the current practice of medicine.
4. It has not been shown to benefit patients or patient care.
Arguments in favor of the MOC process
1. If not the current ABMS MOC process, then there exists the possibility that other regulatory agencies (such as OSHA) could dictate how physicians should practice (see quote in article by Dr. Robert Wachter).
2. There exists a correlation between higher scores on MOC examinations and quality of care. (Article 1 and Article 2).
3. Physicians who spend the majority of their time in practice, not just "academic types," validate the content of MOC examinations.
4. The farther out a physician is from training, the lower is the quality of care provided. While this seems to be a pretty harsh statement against the "there is no substitute for experience"-argument, the current literature does support this position.
I am sure that there are many other arguments for and against MOC. This blog is not intended to be a mathematical "weight comparison" of articles on the topic. My own opinion on this is simple: physicians need to engage in lifelong learning (Article #1 here and Article #2 here), under the "Practice-Based Learning and Improvement" competency.
Whatever the ideal process should be for this, I cannot say with certainty, but I would much rather have those within my own specialty, who also understand educational methodologies, regulate ongoing physician certification, rather than others that are removed from the day-to-day challenges of the current practice of medicine. The current leaders in my specialties, who dictate the regulations as they currently stand, are the ABIM and the ABP. This was summarized in my Annals of Internal Medicine letter to the editor earlier in 2012.
So what do you think about the process of MOC as a way for the ABMS to hold physicians to a standard acceptable to the public? Is it working well? If not, what could be improved?
In full disclosure, I am not employed by the ABIM or any of the ABMS boards. I personally know one member of the ABIM, from his days as a former program director. I have not written examination questions for the ABIM or the ABP. I get no royalties from the ABIM, the ABP or the ABMS, and have no stock in these companies or any of their subsidiaries. 
Alexander M. Djuricich, MD, FACP, is Associate Dean for Continuing Medical Education and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis. This post originally appeared at Mired in MedEd, where he blogs about medical education.
Labels: Alex Djuricich, guest post, maintenance of certification, medical education, Mired in MedEd
posted by Alexander M. Djuricich, MD, FACP at
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Albert Fuchs,
MD
Albert Fuchs, MD, FACP, graduated from the
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also did his internal medicine training. Certified by the American
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full-time faculty member at UCLA School of Medicine before opening
his private practice in Beverly Hills in 2000.
And Thus, It Begins
Amanda Xi, ACP Medical
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of Medicine, charter class of 2015, in Rochester, Mich., from which
she which chronicles her journey through medical training from day
1 of medical school.
Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and
general internist in the Division of General Internal Medicine at
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Controversies in Hospital
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Run by three ACP
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and control, inside and outside the hospital. Daniel J Diekema, MD,
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db's Medical Rants
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DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about
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Matthew Mintz, MD, FACP, has practiced internal medicine for more
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Everything
Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science,
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FutureDocs
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Ryan Madanick, MD, ACP Member, is a gastroenterologist at the
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David L. Katz, MD, MPH, FACP, is an internationally renowned
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Richard Just, MD, ACP Member, has 36 years in clinical practice of
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KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites
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MD
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Michael Kirsch, MD, FACP, addresses the joys and challenges of
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Elaine Schattner, MD, FACP, shares her ideas on education, ethics
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Mired in MedEd
Alexander M.
Djuricich, MD, FACP, is the Associate Dean for Continuing Medical
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the Indiana University School of Medicine in Indianapolis, where he
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More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice
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Kimberly Manning, MD, FACP, reflects on the personal side of being
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The Blog of Paul Sufka
Paul Sufka,
MD, ACP Member, is a board certified rheumatologist in St. Paul,
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Neil Mehta, MBBS, MS, FACP, is interested in use of technology in
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Peter A. Lipson,
MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and
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Janice
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World's Best Site
Daniel Ginsberg, MD,
FACP, is an internal medicine physician who has avidly applied
computers to medicine since 1986, when he first wrote medically
oriented computer programs. He is in practice in Tacoma,
Washington.
Other blogs of note:
American Journal of
Medicine
Also known as the Green Journal, the American Journal of Medicine
publishes original clinical articles of interest to physicians in
internal medicine and its subspecialities, both in academia and
community-based practice.
Clinical
Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP
Member, associate program director at New York University Medical
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Interact MD
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PLoS Blog
The Public Library of Science's open access materials include a
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White Coat
Rants
One of the most popular anonymous blogs written by an emergency
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