From the desk of the EMD: MOC is at a crossroads

As you may know, the American Board of Allergy and Immunology is overseen by a parent organization, the American Board of Medical Specialties (ABMS). Presently there are 24 boards under this organization. Their mission is to serve the public and the medical profession by improving the quality of health care by setting professional standards for lifelong certification in partnership with member boards. Recently, the ABMS published a draft document to address the issues associated with Maintenance of Certification (MOC) for physicians in the U.S., Continuing Board Certification, Vision for the Future. You might be asking, “Was this document needed in the first place?”

I don’t have to tell you that there has been a great deal of angst related to changes in MOC, with the additional burdens – both time-consuming and financial – placed on allergists mandated by the standards set by ABMS. Last December, a group of internists sued the American Board of Internal Medicine (ABIM) over its MOC process, alleging that the board is monopolizing the market. The lawsuit, filed in Pennsylvania district court, claims that ABIM is charging inflated prices for maintaining certification, that the organization is forcing physicians to purchase MOC and that ABIM is inducing employers and others to require ABIM certification.

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There is massive unrest among physicians in many specialties over the MOC process. The College has heard from many of you. Something needed to be done, so the ABMS put together a commission of physicians and others with a stake in physician continuing education and drafted recommendations for change related to MOC. Importantly, allergy had a representative to this group, Michael Nelson, MD, FACAAI, the new executive director of the ABAI. To get the widest range of opinions possible, this commission held two open public sessions, one in Washington D.C. and the other in Denver, during 2018. They came away with 15 recommendations related to MOC. The final document is 35 pages long with numerous appendices. 

Here are my thoughts on the draft document:

1. In their recommendations, the commission advocates that professionalism, assessment, lifelong learning and practice improvement must be part of the continuing certification programs. However, the commission does NOT believe the elements should be siloed in a four-part framework, but rather should be multi-sourced and based on the skills and competencies required for optimal patient care in each specialty. This statement is important in that it opens the door to removal of many components of MOC if not felt to be truly helpful in assessing physician competence. For example, do we really need the Practice Assessment/Quality Improvement Modules or is there really a need for us to query our favorite patients as to whether we are a “good communicator”? There is no data indicating their completion makes us better allergists. I hope this leads the way to removal of this “busy work” by the ABAI.
2. The commission wants the ABMS boards to have clearly-defined remediation pathways to enable diplomates to meet assessment, learning and practice improvement standards in advance of any loss of certification. The purpose of MOC is not to revoke your license to practice allergy. There must be a clear route to work with any allergist that fails to meet the ABAI standard.  
3. The commission made it clear that MOC should not be the only criterion that is used granting credentials and privileges by hospitals, health systems, payers and other health care organizations. In fact, they state that these should not be denied to a physician solely on the basis of certification status. MOC should not be the only criterion for hiring or denying credentials. This is a good move by the commission.
4. Very important is the makeup of the boards. The commission recommends diverse diplomat representation for leadership positions and governance membership and require that a supermajority (more than 67%) of voting board members be clinically active. ABMS boards should also include at least one public member as already done by the ABAI.  These are important steps for the practicing allergist. The ABAI has done a fine job in getting more clinicians on the board but more than 2/3 is definitely needed. 
5. Transparency is important, and this was recognized by the commission. ABMS boards must regularly communicate with their diplomates about the standards for the specialty and to foster feedback about the program. It is our Board and we need to have routine communication from them.

Take a look at this document yourself. Many of the recommendations are already being done by the ABAI. The recent transition from a ten-year secure exam to the current Continuing Assessment Program module, where we get to review articles at home and answer questions at our convenience, was the correct move by ABAI. Only time will tell if the ABAI embraces more of the recommendations for continued improvement of the MOC process, which should make it more user friendly and relevant for the practicing allergist.

Michael Blaiss, MD, FACAAI, Executive Medical Director