Maintenance of Certification

Maintenance of Certification (MOC) is the process of allegedly keeping physician certification up-to-date through one of the 24 approved medical specialty boards of the American Board of Medical Specialties (ABMS) as well as some of the medical specialty boards of the American Osteopathic Association (AOA).^[1] Some studies, funded and performed by highly conflicted employees of the member boards, have shown that board certified physicians deliver may higher quality care than their non-certified colleagues and that board certification is correlated with:

• Higher performance on a broad range of quality measures^[2][3][4]
• Implantations by a nonelectrophysiologist were associated with a higher risk of procedural complications and lower likelihood of receiving a CRT-D device when indicated compared with patients whose ICD was implanted by an electrophysiologist.^[5]
• Better outcomes and more reliable care^[6]
• Higher quality of care for acute myocardial infarction(AMI)^[7]
• 15% lower mortality in myocardial infarction^{[8] [9]}
• Higher rates of some preventative services^[10]

Additional studies can be found in the ABMS Evidence Library. No high quality data exists to demonstrate that physicians who participate in maintenance of certification or their patients have better outcomes than those who do not participate. Most articles in the evidence library are funded and performed by member boards and employees of member boards, and therefore should be interpreted cautiously.

The Maintenance of Certification program provides an expensive, onerous process that is designed to help physicians keep abreast of advances in their fields, develop better practice systems, and demonstrate a commitment to lifelong learning. Physicians need to have - and maintain - the clinical judgment and skills upon which high quality care depends. ^{[citation needed]} The member boards of the ABMS are highly conflicted in their promotion of maintenance of certification, since mandating this process generates a large amount of annual revenue for the member boards.

Maintenance of Certification and the medical community

Many major medical organizations have expressed support for the Maintenance of Certification program as a potential means of facilitating physicians' continuous professional development and measuring physicians' continued competency, including the following:

• The American Board of Medical Specialties (ABMS)
• The American Osteopathic Association (AOA)
• The American Medical Association
• The American Hospital Association (AHA)
• The National Board of Medical Examiners (NBME)
• The Federation of State Medical Boards (FSMB)
• The Council of Medical Specialty Societies (CMSS)
• The Accreditation Council for Graduate Medical Education (ACGME)
• The Association of American Medical Colleges (AAMC)
• The Educational Commission for Foreign Medical Graduates (ECFMG)

Maintenance of Certification competencies

The Maintenance of Certification program supposedly assesses the six general competencies identified through the ACGME Outcome Project and subsequently required in medical residency program evaluations:

• patient care and procedural skills
• medical knowledge
• practice-based learning and improvement
• interpersonal and communications skills
• professionalism
• systems-based practice

It is clear that Maintenance of Certification cannot assess many important qualities that patients seek in a physician including, but not limited to, compassion, empathy, ability to relate to patients, and willingness to relate to patients. Maintenance of Certification does assess a physician's ability to take multiple choice tests and remember trivial facts, skills of relatively low importance in high quality performance of medicine

Maintenance of Certification components

Maintenance of Certification incorporates the ACGME competencies through four program elements:

• Professional Standing: Physicians must have a valid, unrestricted license to practice medicine and confirmation of good standing in their local practice community.
• Lifelong Learning and Self-Assessment: Through examinations and other assessment methods developed by ABMS member Boards, medical societies, and others, physicians assess their clinical and practical knowledge. This component stimulates learning, requires that physicians document their learning, and ensures that physicians keep up with the rapidly evolving medical knowledge essential to quality patient care.
• Cognitive Expertise: Physicians are required to pass a closed-book, proctored examination in their specialty area that assesses critical aspects of clinical knowledge and judgment in scenarios like those encountered in physician practice. This examination evaluates not only what physicians know, but how they use what they know to promote health, diagnose and treat illness effectively and efficiently.
• Practice Performance Assessment: Physicians use tools to self-assess their performance in medical practice, with an emphasis on patient care quality, measurement, and documented quality improvement. These assessment tools include various Practice Improvement Modules (PIMs) that evaluate physicians' performance in a clinical area relevant to their practice, compare their performance to clinical guidelines, help them to develop a plan to improve important aspects of their practice, and assess the impact of that improvement plan.

Maintenance of Certification and other stakeholders

Some health plans are implementing programs that recognize and reward physicians who are actively participating in Maintenance of Certification activities.^[11] ABMS member boards are actively working with other health care organizations to advance quality initiatives and reduce measurement redundancy through recognition of physicians' Maintenance of Certification program participation. A few hospitals and health systems are beginning to use Maintenance of Certification components to engage physicians in quality improvement. Many physicians feel participating in the maintenance of certification program is not worth the cost or time.

Studies suggest that board-certified physicians provide improved quality of patient care and better clinical outcomes than those physicians without board certification,^[5] including a 15% reduction in mortality rate among heart attack patients treated by board-certified physicians.^[7] Considering a recent meta-analysis that shows a decline in physician performance associated with the time elapsed since the physician's initial training,^[12] it is essential for physicians to participate in programs such as Maintenance of Certification in order to keep current with medicine's expanding knowledge base and technical advances, and to apply this knowledge to quality improvement in their medical practice. There are no studies showing Maintenance of Certification improves outcomes among older or younger participating physicians compared to those who pursue self-directed education. Maintenance of Certification supposedly helps physicians and other health care stakeholders address the critical need to enhance patient safety and patient care quality.^[13] It remains uncertain whether Maintenance of Certification accomplishes this or any other goal.

See also

• American Board of Medical Specialties (ABMS)
• American Osteopathic Association Bureau of Osteopathic Specialists (AOABOS)

External links

• Official ABMS Maintenance of Certification Website
• http://www.changeboardrecert.com

References