From the desk of the EMD: Can Maintenance of Certification (MOC) be saved?

February 5, 2018

Most of you received a “present” from the ABAI in your inbox to start the new year. The Continuous Assessment Program (CAP) has begun. Will this be the savior of MOC? Will the practicing allergist embrace this format of continuous learning or will it lead to the fall of the ABAI? Already, 21 states have passed or considered legislation to protect physicians who choose not to fulfill American Board of Medical Specialties requirements for MOC. My state of Georgia passed the following in March 2017: “maintenance of certification shall not be required as a condition of licensure to practice medicine, staff privileges, employment in certain facilities, reimbursement, or malpractice insurance coverage…”

From talking to allergists around the country, I have seen that there is no doubt that one of the top stresses in the practice of allergy is MOC. In the Medscape Lifestyle Report 2017, which examined the main causes of burnout in all physician specialties, maintenance of certification requirements were rated a 4.0 where, 1 equals "Does not contribute at all" and 7 equals "Significantly contributes”. The highest cause was “Too many bureaucratic tasks” at a 5.0. So, you can see that MOC rates as a major factor in physician burnout.

Will replacing the every 10 year proctored exam with CAP reduce the anxiety of the allergist? The ABAI states that this new program will more closely align with the rapidly changing environment of physician practice. CAP will leverage advances in technology to assess medical knowledge and clinical judgment through a more flexible, continuous, and dynamic model that also incorporates learning into the assessment process.

"Will CAP lead to more angst for the allergist than the once every 10-year proctored examination?"

I can see some positives to this new approach. No doubt this is a more flexible program allowing selection of articles from the recent allergy literature and core questions that are geared for the practicing allergist. On the face of it, this program appears more relevant to learning. The allergist receives 6 hours of CME every 6 months for doing CAP. It is open-book and can be done off and on throughout the 6-month period. Both the College and the Academy will conduct journal clubs covering the articles at their annual meetings. The January/February issue of AllergyWatch covers the articles in the January through June cycle. An upcoming issue will cover the articles in the July through December cycle. This should help in achieving the 80% correct answer rate required for a passing score. 

But will CAP lead to more angst for the allergist than the once every 10-year proctored examination? Will having to undergo testing on a regular basis be more stressful for the allergist? Will it take more time away from practice and family to fulfill this requirement? Will the core questions truly be relevant for the practicing allergist? When you are taking the test, you get immediate feedback on whether you get the question right or wrong. That could lead to a problem if you believe the question was not clear and/or the answer not correct. When I was on the ABAI writing questions, even when the questions were vetted numerous times, many were discarded after the examination as they were determined to be confusing or could have more than one correct answer. Will the ABAI make sure all questions are clear and straightforward with no chance of ambiguity? And if there is some question, will they be responsive to the physician’s concern. The bottom line is that we still don’t know if CAP, or for that matter any of MOC, makes us better allergists.

Nevertheless, I believe we need to give CAP a chance. The ABAI is trying to improve the MOC process. There is no doubt we don’t want the government to step in and mandate it. Will the allergy community find that CAP is a great way to learn and keep up with the literature, or is this just another burden that can increase the risk of burnout? Let’s see what happens in 2018. It will be important for all of us to give honest feedback to the ABAI about our experience with CAP. It is our specialty, it is our Board, and our voices need to be heard by the ABAI.

Michael Blaiss, MD, FACAAI, Executive Medical Director