Maintenance of Credibility
Two years after changing its MOC requirements, the ABIM is
still working to address concerns about the program.
The American Board of Internal Medicine’s (ABIM)
Maintenance of Certification (MOC) program was
back in the news this fall when it released the final
report of its Assessment 2020 Task Force, “A Vision
for Certification in Internal Medicine in 2020.”1
The report evaluated ABIM’s current MOC
program and provided a list of recommendations for
future iterations of the certification and recertification
processes, including a list of competencies physicians
should possess and the best way to assess them.
The task force responsible for the report was
convened in 2013 and comprises ABIM leadership
and experts in assessment, education, health care, and
consumer advocacy. Their goal, as stated in the report, was to “develop a vision for the future of assessment in internal medicine and associated subspecialties,” making several key recommendations designed
to increase the value of MOC to physicians while
decreasing the burden on their time and resources.1
Notably, before the most recent controversy
about ABIM’s updates to its MOC program started,
the organization had already assembled its Assessment 2020 Task Force as part of an ongoing
effort by ABIM to find ways to evolve and improve,
according to Harlan Krumholz, MD, chair of
the Assessment 2020 Task Force and professor of
medicine at Yale School of Medicine in New Haven,
Connecticut. “An important facet of the development was the effort to include many voices and
perspectives. We had a public website, sought public input, studied public comments,” Dr. Krumholz
said. “We also were committed to learning as much
as possible about the evolving science of assessment
– and determining what was working best in many
other fields that are engaged in these activities.”
However, this newest announcement has only further complicated the matter, exacerbating the sense of
uncertainty and frustration many hematologists have
with the MOC program, according to Marc J. Kahn,
MD, MBA, Peterman-Prosser professor of medicine
in the Section of Hematology/Medical Oncology at
Tulane University School of Medicine in New Orleans, Louisiana, and chair of the ASH Maintenance
of Certification Working Group, whose comments in
the article reflect his own views.
“People are confused about which requirements
remain and which do not,” Dr. Kahn said.
ASH Clinical News recently spoke with Dr.
Kahn, Dr. Krumholz, and other physicians involved
with ABIM about the results of the Assessment
2020 Task Force, the current status of MOC, and
what the future may hold.
A History of Change
The first big change to ABIM’s certification program
came 25 years ago when it did away with its “board-
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certified for life” status, which allowed physicians
certified in or before 1990 to maintain certification
without completing any additional requirements
over their career.
“In 1990, the ABIM decided that lifetime certifications didn’t make sense,” Dr. Kahn explained,
given the evolving nature of medicine and the pace
of new scientific discovery. “They had an obligation
to make sure people were keeping up.”
After 1990, diplomates wanting to maintain
their certification had to complete a three-part
program: maintain licensure (Part 1), complete
knowledge-based self-assessments (Part 2), and sit
for secure exams every 10 years (Part 3).
More recently, the ABIM announced that, as
of January 1, 2014, all of its diplomates, including
those considered “grandfathered-in” were required
to actively participate in MOC activities to be listed
as “ABIM certified, meeting MOC requirements” on
the publicly available directory of physicians on the
ABIM website.
With the revised program, ABIM ramped up
certification requirements: Diplomates had to
complete at least one MOC activity every two years,
earn 100 MOC points – including 20 in medical
knowledge – every five years, and pass the MOC
exam for certification every 10 years. The 2014
changes also expanded Part 4 of its exam, requiring diplomates to earn MOC points in the areas of
Patient Voice and Patient Safety, in addition to the
Practice Assessment component.
“The announcement about Part 4 requirements
is when the medical community went berserk,”
Dr. Kahn said. “Physicians were being asked to do
things that they already do every day at their own
institutions. Many saw this as nothing more than
busy work.”
In the wake of these announcements, several
online petitions were launched calling for ABIM
to recall its new MOC requirements, with tens
of thousands of physicians signing in agreement.
Many large professional medical societies, includin