MOC is, for lack of a better term, a farce that does not improve upon the existing continuing medical education system. The cost and inconvenience is unjustified, and the secure exam format is demeaning and does not reflect the collaborative approach promoted by the health reformers, nor does it take advantage of technological developments. It could easily be replaced by specialty specific modules that are completed online in a rotating fashion so that every ten years, physicians cycle through their specialty's entire curriculum. Such an option would be inexpensive and effective. The main purpose of MOC appears to be the generation of fee revenue. To that end, it is undeniably effective!

If we continue to make this argument with passion and reason, more physicians and non-physicians will understand the

nonesense that MOC and its related sibling projects represent. We should spend our time becoming better clinicians and

educators and not waste time/money on such projects without proof they should exist---they simply serve to make the Presidents/Vice Presidents/Consultants to these issues richer and richer.

Do I smell a lawsuit? If so I'm in.

Need to strengthen the opposition trend. As I complete my MOC this year am just shocked at the time & expense. Much of the requirements are busy work-we have no time for that.

Fortunately I'm close enough to retirement that I can probably let my sub-specialty certification go. I feel sorry for you younger doctors who will have to put up with this nonsense for your whole careers.

More and more people are urging us to "say no" yet the Boards continue to blindly move along, aided by our member organizations, paying huge salaries, living royally, on the money they rake in each year from the physicians they're supposed to serve. The only way to stop this madness is to work with or set up a competing organization.

we are not alone in our opinions. I hope more doctors choose to revolt and resist and if it means giving up certification or recapturing medical staff committees and rewriting bylaws to eliminate the need for board certification as a condition of staff privileges so be it. Private doctors in the trenches of treating patients for a living are going to have to sacrifice a bit more of their precious time to represent themsleves better. Full time faculty or administrators often have a different agenda and we can no longer trust nor secede the control of our livelihoods to them. The condescending notion that board certification in todays real medical world is "voluntary" is so absurd. That only they carry the torch of excellence and without annual MOCs and fees the rest of us grunts would allow our knowledge to deteriorate into chaos is a call to action.

I think we rename MOC, "B&B" for "BURDENED BY THE BOARDS"

Reciting the Kreb's cycle may have had its place in the building blocks of a medical career, but is totally irrelevant to the average practicing physician ten years later.

If re-certification is so important, why do they allow anyone to be grandfathered?

Stop this nonsense (MOC) and prevent it from metastasizing to MOL (maintenance of licensure) - as that would entrap us all, and would cause of many physicians in their 50s and 60s to retire at a time when Obama Care needs all the dedicated physicians he can get to see the tens of millions of newly "Obama insured" patients.

everything in this country is about money. It is furthering patient care, why dont they give these millions of dollars back to the poor and needy who are without insurance and get a 90 percent paycut for their useless jobs. I never believed in organized medicine, ama, cma, this ma and that ma. They make me sick

my feeling is that if moc can't be abolished by mass noncompliance, then moc should be modified, reducing cost, including only the self-evaluation modules, which should count for all MOC, MOL and CME requirements. eliminate peer and patient reviews, the practice-improvement modules (PIM's) and the secure examination, none of which has any place in the life of a practicing physician as none has been proven to improve care or the health of our patients.

my main concern at this point is that they are trying to tie moc to mol or maintenance of licensure.

if they achieve this on the state level we won't have a choice but to comply as moc will become mandatory.

and short of mass moc noncompliance, our only option is legal action, like a class action law suit.

the real problem is the self serving mendacity of our leadership that considers itself above the rank and file proletariat they were chosen to represent. most come from academics and have no insight into the working physician and what's important to us. none of them has to meet a payroll or see 30 people in the office everyday or do 3 operations to stay afloat. none could care about reduced reimbursement. frankly, i'm all for the legal option, and further, i would encourage all physicians to drop out of professional societies because our dues just subsidize those who are deaf to our concerns

Thanks. Nice to know I am not alone in my opinion. I hope more doctors choose to revolt and resist and if it means giving up certification or recapturing medical staff bylaws to eliminate the need for board certification as a condition of staff privileges so be it. The condescending notion that board certification in todays real medical world is "voluntary" is so absurd.

As an obstetrician/gynecologist who finished my residency in 1985, I was required to take my boards and earned a 10 year certificate. If I would have graduated in 1984, I would have been boarded for life. The ABOG, requires a two part exam, the first written and the second a three hour oral examination, part of which is based on the first entire list of all the physician's hospitalized patients plus a significant number of representative outpatient visits. I passed both examinations the first time and was reboarded 10 years later. Since that time, my speciality board has changed the requirements to six years and now a yearly exam as well as the MOC. In Los Angeles where I practice, we have observed the erosion of younger physicians partaking in our local speciality meetings. The LA OB/Gyn Society is a skeleton of what it once was. The LA OB/GYN Annual Assembly, which was once world renown, with upwards of 700 participants attending, barely has 150 attendees, many of which are retirees. I hypothesize that the numerous hours and costs required to maintain our certification have added to the demise of these once impressive meetings and organizations. Another unfortunate outcome is the destruction of the collegial relationships developed by OB/GYNs in our region. I would scientifically study my theory, yet I am too busy preparing for yet another annual examination. Perhaps, the ABMS or any of the individual sub specialities can spend some of their resources on why comradery, collegiality and membership in local organized medicine has plummeted since the introduction of reboarding.

No question the current ABIM approach to maintaining privilege is costly in terms of time and money, is detrimental to the careers of physicians and is probably motivated by greed. Perhaps there should be an effort for physicians to go on strike for one year against this process. That will get everyone's attention.

The MOC process is RIDICULOUS. In an era of Evidence Based Medicine, I want to see evidence for MOC. What other profession submits itself to such nonsense. The whole MOC process has an insulting "Guilty until proven Innocent” air, rephrased as "Incompetent until proven MOC worthy" by an UNPROVEN process. The vast majority of us are conscientious physicians providing excellent, caring, evidence based medicine to our patients. Just attend a plenary session at any of the meetings- packed with responsible fellow allergists who have gone out of their way to attend, paying attention, taking notes, not falling asleep and blowing it off! Even MOC won’t be able to weed out the few that are practicing “out of bounds”- and if you did and forced loss of certification, do you think those few people would actually care? Q 10yr board recertification process is adequate for the supposed “public mandate"... like the public mandate really exists- that’s why so many people pay cash for UNPROVEN "alternative medicine" quack practitioners- I don't think we want to be as UNPROVEN with MOC as the quacks! What about CONFLICT OF INTEREST with the ABMS or all the other members who are too busy with their burocratic rule-making for all of us busy taking care of patients- I would like to see UP FRONT their FINANCIAL interest is this whole system. WHEN ARE PHYSICIANS GOING TO STAND UP AND SAY ENOUGH IS ENOUGH? WHAT OTHER PROFESSION ALLOWS ITSELF TO GO THROUGH THIS GARBAGE!

i want patient and peer reviews eliminated

i want the secure exam eliminated

i want the practice improvement modules eliminated

none of those are relevant, practical or important to the practicing physician

the self evaluation modules should be ALL that is required for MOC, MOL and CME

Every serious profession: lawyers, architects, engineers, doctors, etc have continuing education requirements. So why do we have to do more? Money. It's all about money. It's a monopoly. It's unfair business practice and it shouldn't be tolerated.

I agree 100%. As an OB/GYN we were first promised recert every 10 years, then it became every 6 years...Now it is every year: Cha Ching, Cha Ching. I graduated medical school 30 years ago and I'm still taking exams, year after year...and paying through the nose for the privilege.

It might be too late for the OBs, but for the rest of you, stand up for sanity.

The Boards are fearful that we will stir things up enough that their very profitable enterprise will suffer financially. Let's stir...

it's a shame actually

i like being a doctor

i'm a good doctor

i have a great practice but if they tie moc to mol i just won't do it anymore

it has to stop before it becomes mandatory

i am not going to spend my life studying and taking exams

no way

I wonder what would happen if all of their Diplomates told these Boards to go blow off since they cannot seem to come up with a user-friendly system of doing something we’ve already sweat and bled and PAID for?

Gentlemen, like everything else this, is not about improving patient care, but money – and power.

It is amazing how this process emerged out of the clear blue sky in a very short time. Very few physicians were involved in its development and implementation. The mandate to develop the process is reputedly from "above," i.e the government, since it clearly did not come from within the medical profession or the medical community.

It is an invasion of our lives and livelihoods.

At this time the only way to effectively change it is to have a massive refusal by all doctors to participate in the process. Anything short of that will defeat our profession and further subjugate the profession to bureaucratic mandates that are irrational and unjustified.

No one in our profession will ever oppose any stimulus for self education - that is the culture of our profession. This is not the issue in MOC. The issue in MOC is that external forces are defining and mandating the standards with which our profession should conduct itself. We cannot allow that.

That is what the apathy among physicians brings--more misery and less money to them, and more money to the bean counters! That is so ironic since it is the money so many care so deeply about! So many sheep being led to run over the cliff! So sad! I thought these were educated folks!

I truly believe that when one studies for re certification, it detracts from patient care. Experience is the best teacher and not reading about esoterica in a study guide..Yes, as usual, when they say its not about$$ its always about $$$..keep up the great work..let us know if more funds are needed for your efforts.. It may pay off this time if we stand up for our convictions

The process is flawed to begin with. Any system that divides the members between "grandfathered vs. not grandfathered" is unfair and should be abolished. If the true concern is to maintain the integrity of the profession, every member should have to be recertified periodically. It mainly appears to be a money-making scheme for the people already "in power". Ridiculous.Not to mention that now the NP/PAs have no recertification process, that I am aware of. We are competing against them, and the board certification does not offer higher income, etc. for the most part.

between being busy seeing patients every day, having to keep up to date anyway and dealing with an understaffed office all week due to medical asst illness and also having my office manager of 4 years looking for another job closer to home because of family issues, just when the fuck am i supposed to do all of these board recert requirements? this is exactly why this moc shit is entirely impractical and especially not relevant to those of us in solo private practice. we have a business to run and patients to see. but why would a salaried politician "physician" that doesn't practice medicine care about that, right?

This is how change is made in the world

so long as those that choose to let their certifications lapse aren’t suffering any economic backlash, it seems to be “don’t ask don’t tell”. I think the boards have managed to intimidate anyone who might rock the boat.

THIS IS ONLY ANOTHER WAY FOR ABIM TO MAKE MORE MONEY AND PAY IT'S EXECUTVES.

I CAN NOT EVEN SPEND THE TIME TO READ THE GOD DAMN THING, 6 PM AND STILL GOT TO GO DO ROUNDS, MAYBE I WILL SEE MY KIDS TONIGHT, SEND THAT FOR PRACTICE IMPROVEMENT?

I don't see why most of the docs who must endure this draconian, irrelevant procedure wouldn't be fighting it along with you. Let's resist!

I am sure many have emailed you by now, but I could not agree with you more. NO other profession would let a bunch of old men allow re-credentialing without it including everyone. I also believe it is a total scam by the ABIM to make money as well.

It's about time we stood up to the establishment. Let's fight the machine.

If I am repeating something brought up earlier, please feel free to let me know. Awaiting IM MOC exam results from 8 weeks ago (excessively long). Then, I get to do it again for ID in 3 years. I reviewed all of the credentials of the ABIM board and was shocked at the number that are grandfathered and have not re-certified in IM voluntarily. This is UNBELIEVABLE (yes I am shouting) that they are dictating what we need to do to maintain certification, and collecting our dollars for it.

MOCA : Not a tool to learn. Simple journal clubs and updated review articles with CME credits foster peer review and interactive learning. As the practice of medicine evolves this would provide a better mechanism at far less time and cost .

Agree wholeheartedly with this mission.

MOC was, at its inception--as clear as mountain air, a power and money-grab. Physicians and state boards have long recognized--and met--their duties with respect to CME. Time to dump limited board certificates and MOC.

Also, who benefits directly from these cert/recert fees? Where do these costs go? Is this info available for general public and medical community?

ABIM is a private, money making business which has nothing to do with real patient care, but money.

I would like to express my Disapproval to the actions of board certification cartel in their attempts to restricting medical licenses to members of their group. I've been in practice for 25 yrs, with a stellar reputation and now some special interest cartel is attempting to pull my license to practice ? Besides restriction of trade, what business do these "boards" have in licensing physicians?Would this mean there is no need for licensing exams and they(boards) would control the whole profession? Absurd!!!

I applaud the excellent work being done to revoke the onerous recertification requirement. Anesthesiology board conveniently excludes those Anesthesiologists certified before 2000. While board certification has little relevance to clinical outcomes in Anesthesiology, board re-certification has clearly no benefits, as is the secure examination which bears no relevance to an individual's clinical practice.

I just took my recert Board yesterday. I fully agree with everything in your summary. The majority of the questions were irrelevant ( I practice primary care in private practice) The amount of time and money I spent on fee's and a review course as well as income loss due to 10 days off work is unfair and unacceptable.nI think it is important to keep up with knowledge, and your proposal is a very reasonable one. Doctors being grandfathered in is outrageous. What makes them different, than the rest of us? If anything,they should be the ones tested to demonstrate their updated knowledge.

MOC is, for lack of a better term, a farce that does not improve upon the existing continuing medical education system. The cost and inconvenience is unjustified, and the secure exam format is demeaning and does not reflect the collaborative approach promoted by the health reformers, nor does it take advantage of technological developments. It could easily be replaced by specialty specific modules that are completed online in a rotating fashion so that every ten years, physicians cycle through their specialty's entire curriculum. Such an option would be inexpensive and effective. The main purpose of MOC appears to be the generation of fee revenue. To that end, it is undeniably effective!

I am happy to assist with your efforts and will spread the word to my colleagues. In my specialty of plastic surgery, MOC involves membership in one of the approved specialty societies, as well as oral board-like case list submissions. In fact, I will be preoccupied with this over the next few months. My next MOC hurdle is due in December! And I'm not sure what I need to do for my general surgery boards. I believe just a re-exam is needed, for now.

I vigorously oppose the MOC as it currently stands, particularly the "Patient Feedback Forms" required for PIP. Harry Stack Sullivan explains the folly of this best: "...the psychiatrist must be keenly aware of this particular aspect of the expert's role...this taboo, as it were, on trafficking in the ordinary commodities of interpersonal relations...from using his expert knowledge to get himself personal satisfaction, or to obviously enhance his prestige or reputation at the expense of the patient. Only if he is keenly aware of this can the expert-client relationship in this field be consolidated rapidly and with reasonable ease."

I am currently board certified by ABFP through 2015, when I will be 62. I've had it. I used to be proud to be board certified, now I think it is meaningless. I look up information for my individual patients, but I don't participate in formal CME any more. I am scratching to survive financially in a private practice that I established 29 years ago. I can't afford the time or the money required by recertification. I'm thrilled to see that there is a group that is trying to change the process - Bravo!

I enjoyed perusing your site. I am going to explore it thoroughly and will likely post a favorable article on my blog and on those to which I contribute. I agree that the certification process has progressed beyond what is reasonable, and we now have sharply diminishing returns.

My thoughts are as follows: What other profession requires this? We have proved ourselves time and time again and now have people's lives in our hands on a daily basis. I believe we do not need further proof of our competence. If we cannot be trusted with keeping up on our skills (and therefore need a secured exam), then how can we be trused with patients behind closed doors?

Furthermore, what is the source of these test questions? When I recertified, there were questions that reflected either clinically irrelevant topics or data that was outdated.

The process should be clinically relevant, transparent, and not time consuming or expensive.

I am an AAPS member who was recently appointed to the Wisconsin Medical Examining Board. To my dismay, before my appointment began, the WI Board agreed to participate in a pilot MOL with FSMB. I need information in order to stop this program. Thank you.

Board re certification is a tedious process. It is time consuming specially the computerized sections. I do not even recall the information maze I went through. I do like the home component section on recent advances. The final clinical computerized version should also be changed to the open book home format because when we require assistance in difficult cases we go to our books and our colleagues. Do we check to see if they recertified? NO.

MOC modules are a waste of time, money.

The bottom line to Certification and MOC is how best to motivate physicians to pursue continual improvement AND how best to measure such. The present testing is ineffectual and not clinically relevant. When seeing a patient, the "answer" is open-book, open-internet, open colleague AND for office based practices,NOT immediately time-dependent.n2. Why aren't all professionals subject to the same testing as physicians (attorneys, accountants, mechanics, etc.)? The lack of competition with Cert/MOC in the marketplace is striking and problematic. The present system should be eliminated! If not, ALL physicians should be subjected to the present system! NO grandfathering.

I would support recertification if it was an easy to follow process. The MOC for neurology is a confusing jumble of regulations that the American Academy of Neurology itself seems not sure how to follow. In addition to humiliating self-assessment tests - insisting that we conform to "peer review guidelines" without delineating what those guidelines are supposed to be - and an unclear "performance in practice" measurement is no way to measure physician skills. As it stands, the MOC is a mess and it needs reform immediately.

There is something wrong with the whole concept of re-certification and even with the idea of CME. Though I chose "grandfathered", I am only half-grandfathered. I am grandfathered in my primary subspecialty but I have to keep recertifying in a subspecialty that I do not even practice very much any more. I took the recert boards for that in 2004 and passed easily. I could easily pass such a test again. But my current job does not even allow me access to this sub-specialty practice and I probably am not going to be able to fulfill the new requirements. One has to survey one's practice for two years prior to recertification now. So what if you get sick for six months? Does that mean you lose the certification that you have worked so hard for. Or in academic medicine, what if you get an opportunity to go overseas and study for a sabattical year? I guess you are out of luck. I understand the importance of maintaining competence, but--after all these years---there e is no proof that CME even helps with this. These MOC requirements are mainly of the "Mickey Mouse" kind in which one gets various colleagues to fill out various forms. None of this insures competence. Remember that the boards are private organizations with their own self serving agendas. They should not have influence on licensure and reimbursement. Physicians should be able to form additional groups which provide "certification" if they so choose. We should not be locked into one type of boards. Perhaps MOC is a good thing in that it will stimulate many doctors to form alternative organizations and break the tyrannical monopoly of the boards. I would be interested in exploring alternative approaches to certification with other physicians.

Very interested in this cause. I have recertified 3 times after being the first year "non-lifetime" certified in OBGYN in 1987. We just got our large hospital to change the rules and allow grandfathering status after being board-certified for 25 years.

Have done 2 residencies in my life: Family Medicine and Dermatology. Also 10yrs as a Naval Medical Officer. At least in Family Medicine, EVERYONE had to recertify. No hypocrisy there. Am now preparing to recertify in Dermatology for the 2nd time in my life. At the AAD Meeting in Feb '11, an ABD Board member gave a talk stating unequivocally that as of Oct '10, EVERY STATE MEDICAL BOARD in the country had capitulated to the demand of linking MOC to MOL by 2020. Two States have initiated their link this year (2011). So it appears that the battle is NOW!

Board certification is useless by itself, not to mention the whole maintenance of certification process. We should advocate to abolish this entire board certification business, as does not make you a better doctor, and the questions on the exam are rarely clinically relevant.

I agree and wish to stay in contact. We should press the individual specialty societies to create our own boards without the ABMS, as the ABMS is NOTHING without the membership of each specialty-we gave the power and we MUST take it back!

If recertification is necessary and I am not convinced that it serves any of the stated purposes why can it not be simply and retaking of the exam every number of years.

If recertification is necessary and I am not convinced that it serves any of the stated purposes why can it not be simply and retaking of the exam every number of years. As this is considered sufficient for residents just completing their residency why would it not be sufficient for everyone?

Completely agree with simplifying the MOC process to help show the public we aim to stay current and proficient in our educational skills to continue to provide high quality medical care. I am due for recert in 2013 in Allergy (1993, 2003 board cert and recert) and hope you have method changes by then!

I just finished my recertification in cardiology final exam today, and I forgot how onerous the process can be. Many of the questions were clearly not relevant to clinical practice and required rote memorization. It is totally unreasonable to ask a board certified cardiologist to sit for a final exam every 10 years. Exams should clearly be open book with use of up to date or other resources that we use every day to manage our practice. I am 51 years old and have been in practice for over 20 years and am completely fed up with this whole process.

The new requirements for re-certification are ludicrous and unfair - not based at all in reality. But I had en-roll in MOC in order to keep my hospital-based job.

This whole system is a money-making project for ABIM and constructs a lot of resentment from the physicians towards ABIM based on my personal experience in discussing this matter with other physicians. It will not be long before smart college students start going away from medicine based on these unrealistic expectations placed upon physicians in the states. I am not far myself from leaving the country based on the above. I appreciate your efforts to help us fight these greedy members of ABIM. Thanks.

I have repeatedly re-certified in both my primary and secondary specialty, just because I enjoy reading around my specialty. The current MOC process is truly onerous. The process is more complex than CCHIT certification of an EMR ( and equally useless)!. The most ridiculous part is actually the "practice improvement" portion. It is an absolute waste of time and does nothing concrete to improve quality. It is almost similar to Press Ganey scores or unregulated patient feedback on websites!nI do the complete MKSAP evey few years. It isrobust review of the subject. I feel MKSAP represents value for money. If a physician has done MKSAP,, that should be used as continuing education for re-certification without payment of MOC fees to ABIM ( 180 credits of MKSAP is under $400). . nABIM used to be a respected body until it started this process of extortion. nAs the first step in regaining respectability, ABIM needs to remove all grandfathers and declare them as cu rrently un-certified. This will force all academic physicians, aging ABIM board members n to stay on their toes and stop making absurd rules for the community physicians like me. nMedscape like interactive courses really offer something of practical value to doctors who are too busy to attend 7 day drawn out medical meetings. The credits earned from these should be eligible for re-certification. Similarly attending specialty post graduate courses and completing post testing should qualify a doctor for CME without payment of extortion fees to ABIM. If ABIM wants to compete for physician dollars with high quality CME like MKSAP, let them compete in the open market by offering truly valuable courses. The problem then would be serious conflict of interest. nI see no sense in an examining body getting involved in the test prep. That is cheesy at the least and frank extortion from a legal anglenMy biggest fear is that if enough good doctors declare ABIM as a phony body with mone y-making as its principal unstated mission, it may spell di! saster f or all certifying bodies including ABIM. I am alarmed by the number of bodies who have declared themselves as alternative certifying bodies and even convinced hospitals to use these certifications in lieu of ABIM certification. nI hope ABIM will correct its course and make it worthwhile and affordable for qualified physicians to stay certified. For me it is also an affordability issue. I just do not have that kind of money to spend every 5 years. We do not want more mavericks like Rand Paul to erode the relevance of ABIM.n I hope we can get back the ABIM we used to respect.

I will be losing my job at the end of the month due to the MOC. I have written President Obama, major national news agencies but have not received any response. I am really getting close to the last resort (legal option). I can send a copy of the letter that I have sent if there is a "physical address". Also, is this a violation of Employment Act of 1967 ?

I find it expensive, especially when the reimbursement to Pediatricians are so low. I also find it extremely time consuming. In this era when we are constantly fighting to survive as physicians, I find this tedious process is only adding a lot more stress to our lives.

I seriously doubt the benefit and value of recertification. Almost feel it is made up for "some people to make money".

I found your website today and was very happy to see that someone is trying to do something about this ridiculous MOC process. For the past 10 years, my practice has been focused solely on providing care only to poor/indigent HIV patients. I have not seen a transplant or oncology patient for over 10 years, and I will never see one ever again. I don't do travel medicine b/c my patients don't travel. Since board certification is a requirement to practice these days (the community health center where I work requires it), will somebody please tell me how my ability to answer transplant and travel ID questions on the board exam impacts my ability to care for the patients in my practice? Yes this ABIM exam/and prep cost thousands of dollars and countless hours. But what really angers me is that the ABIM board exam has the potential to be an OBSTACLE to my ability to care for my patients. I'm curious to learn about the strategy of your group for how you will get the change that you (and many of us) would like to see, thanks.

I'm writing here since there was no process to do such in the MOC website. Just took the ID subspecialty recertification exam...and in the mist of the MOC. Im an acedemic physician with significant clinical experience. Overall the process has not in any way helped my practice, which is too bad since a properly designed MOC could be of value. We dont want to waste our time. I hate the monopoly that's been created,,,, the business of board review classes, and the lack of financial transparency. I think we should get an idea of the money being made.n3. Using of certification for promotion, payment and privileges is a very very big issue. As such the MOC must be completely reworked to a useful and meaningful process. A yearly CME module created by our subspecialty societies to update us in our fields, with even a yearly timed home internet based test would be a great improvement, a lot more efficient, cost effective... but then this would kill the business of MOC.

The process is flawed to begin with. Any system that divides the members between "grandfathered vs. not grandfathered" is unfair and should be abolished. nnIf the true concern is to maintain the integrity of the profession, every member should have to be recertified periodically. It mainly appears to be a money-making scheme for the people already "in power". Ridiculous.nnNot to mention that now the NP/PAs have no recertification process, that I am aware of. We are competing against them, and the board certification does not offer higher income, etc. for the most part.

MOC is either everyone or no one and the cost needs to be reduced to a nominal fee if it stands. How can you excuse the physicians the farthest out from their training from recertification? And what about a re-recertification? Isn't this all excessive bureaucracy? Where do patients benefit? Where do doctors benefit? More costs with little or no increase in quality of care.

Please help us to stop the madness of the actual recertification process.nWe are also a victim of the money making process between the board review courses and the ABIM. Who regulates that?

Recertification has become a business run by bureaucrats and power-mongers who feign to be acting in the public interest, but who really are out for themselves. It is another example of the tyranny of the leadership, whereby academicians burden clinicians who are in the trenches doing all the heavy lifting . The recertification boards are on the dole provided by the exorbitant fees which they charge. They are conspirators with the hospitals and health care payors whose joint goal is to control all physicians.nNot on my watch!nAs Thomas Jefferson wrote, " When the people fear the government, that is tyranny. When the government fear the people, that is FREEDOM."nIt is time that hard working physicians take charge and retool the recertification mess.

I AM SO EXCITED to have found a group of physicians who are concerned about the waste of board certification/recertification/MOC. I believe the system needs a competitor. The system needs a logical, practical, clinical, and reasonable alternative organization that can offer certification/recertification/MOC based on sound clinical practice, with publishing of the sources of information that have been used for the test questions, all at a reasonable cost. It is time to start another board certification process that is reasonable!

I just read the letters to the editor in NEJM, 6/24/2010 and reviewed the two articles pro or con for MOC in 3/11/2010 NEJM. Are you aware that several hundred endocrinologists and hemotologists have not been able to pass MOC? Texas will not grant a license to such a person and BCBS of PA will not pay him/her unless another MD who is Board Certified is in the practice. The published 94% pass rate of MOC does not include these two groups of doctors! In the 6/9\10 Wall St Journal the story is reported that the ABIM sued docs for discussing the exam. We should sue the ABIM!

I wholeheartedly agree with this mission. The cobbled together present recert process has no bearing to reality of what I, as an allergist-immunologist in an urban/suburban setting, do in clinical practice. Kudos!

I support a re-evaluation of the recertification process, It is complex, expensive and of dubious value in terms of maintaining quality of patient care.

Amazing, we need to get rid of this entire "shenanigans" calling themselves ABEM..... I have been disgusted with them for years, never realizing what a money machine they are.

I was in the first group of (grandfathered) ER physicians to ever take the ABEM exam. Then I rectified in 1990 for another 10 more years, and re-re-certified a THIRD time in 2000. My certification expired on Dec 31, 2009 (10 years after the last exam) and at an age of 64, now semi-retired, I have no desire to take the exam a fourth time. I believe a life time certification should be awarded after taking and successfully completing the ABEM certification exam on 3 occasions over 30 years. Therefore, I have decided to stop practicing EM, and now attend 95% of all the resident educational grand rounds at the Lehigh Valley Hospital Network EM residency program in Allentown, PA. This is just for intellectual curiosity and to keep in the loop of advancing EM. I am an Emeritus member of ACEP and one of the first members of AAEM when this organization was formed. I still maintain membership in both, and maintain my Medical license. I hope you succeed in your venture to revamp the rules of board certification. I would be willing to put my knowledge and expertise, especially bedside DX, against any of the graduating residents in today's environment.

If they had a more reasonable process, it would encourage recertification and some reasonable re-education would occur. Now, it's a deterrent to do anything.

Instead of incentivizing me to keep informed, the high barrier and the busy work of MOC entirely defeats the purpose of the process. Ridiculous...

I’m a 54 year old internist/geriatrician at Cedars Sinai Medical Center in Los Angeles. I have busy practice and also serve as the Medical Director for Cedars Sinai Health Associates. I’m married and have a ten year old daughter with special needs. My internal medicine certification is “immortal” but my Geriatric certification is not. I’d like to maintain certification in Geriatrics. But, each time I review the requirements, I am astonished at the amount of time and effort it would take and the bureaucratic nature of the process. That time that would be difficult to carve out of my schedule and, viewing the process, it would not be worthwhile. So, I don’t bother. And, neither do any of the other geriatricians I know in this community.

The benefits of recertification have to be commensurate with the time commitment. As a physician with an MPH and an MBA in addition to my geriatric certification and Fellowship status in the American College of Physicians, I have rarely hesitated to go the extra mile in the pursuit of personal or professional achievement. But, the ABIM’s re-certification process was just too much for me.

It serves no one’s interest to let geriatricians like myself abandon re-certification. A more straightforward, less time consuming process, that updated physician’s knowledge base in a more efficient, less bureaucratic fashion would serve the interests of both patient care and advance the goals of the ABIM.

As an obstetrician/gynecologist who finished my residency in 1985, I was required to take my boards and earned a 10 year certificate. If I would have graduated in 1984, I would have been boarded for life. The ABOG, requires a two part exam, the first written and the second a three hour oral examination, part of which is based on the first entire list of all the physician's hospitalized patients plus a significant number of representative outpatient visits. I passed both examinations the first time and was reboarded 10 years later. Since that time, my speciality board has changed the requirements to six years and now a yearly exam as well as the MOC. In Los Angeles where I practice, we have observed the erosion of younger physicians partaking in our local speciality meetings. The LA OB/Gyn Society is a skeleton of what it once was. The LA OB/GYN Annual Assembly, which was once world renown, with upwards of 700 participants attending, barely has 150 attendees, many of which are retirees. I hypothesize that the numerous hours and costs required to maintain our certification have added to the demise of these once impressive meetings and organizations. Another unfortunate outcome is the destruction of the collegial relationships developed by OB/GYNs in our region. I would scientifically study my theory, yet I am too busy preparing for yet another annual examination. Perhaps, the ABMS or any of the individual sub specialities can spend some of their resources on why comradery, collegiality and membership in local organized medicine has plummeted since the introduction of reboarding.

I agree completely and have always felt this way.

Agree 100%. Waste of time and money. No value or relevance.

I've been able to speak w/a couple of people who write the board questions. They basically tell me that every so often (few months) they get to travel to a nice city, stay in nice hotels, go to nice restaurants, etc. They do spend some time going over questions and arguing the merits of each question, but the people I've spoken with pretty much stress the nice little "vacation" they get on the Board's nickel.

Probably not a major revelation, but interesting nonetheless. Not about money? Bullshit

I support the cause against MOC highly.

Specifically, many readers felt that the cost of MOC far outweighed the educational benefit and that the MOC program was essentially a money-generating activity for the ABIM. Others, many of whom reported previous enrollment in MOC, felt that the exercise was only marginally relevant to their day-to-day practice and that it took their time away from patients and other learning activities

So true, but do you think anything will change? It seems that the ABIM has the ongoing ability to do nothing in the face of discontent amongst its [forced] membership.

I will support the cause for change.

I get sick to my stomach thinking about recertifying in 4 different specialties....

As one with 5 board certifications, it is absolutely an incredible expense and time for questionable return.

I completely agree. Down with MOC.

I applaud you! What ever petition needs to be signed, just let me know.

I am also board certified and re-certified..i believe the exam is very minimally representative of things we encounter in everyday practice..so it is not a basic competence exam at all.

The cost they impose on us for this recertification and the amount of work necessary I agree is outrageous.

If those that make up these parameters are not required to recertify themselves..then I agree that that is the most outrageous.

I will join the fight.

I know my quality of life would improve dramatically if I didn't have to worry about recertification exams.

CME alone would be great!

I am on board, where do I sign up to sign a petition?

Now that is what I certainly agree with. We should just have to maintain CMEs.

I am absolutely fed up w/all of this "hoop jumping" demanded by those who exempted themselves.

Thanks for opening our eyes. Please let us know more details on how we can get involved.

I’m in- tell me what you need me to do.

Bravo.

I am board certified in internal medicine, gastroenterology and transplant hepatology and I have paid thousands of dollars and taken weeks of my time to "recertify".

Look to me for support.

We are all faced with rising costs of running our medical practices, diminishing reimbursements from the insurance companies, looming health care reform and now more and more board recertification with increasing requirements, demands and costs. Worse yet, the physicians making the rules for us and implementing these mandates are themselves exempt from recertification. The question of whether board recertification is necessary, relevant and/or fair is even more pronounced in these tumultuous times for health care in general. I feel that it is not only unfair, but that it is outrageous.

Enough is enough.

As physicians board certified after 1990, we should not stand for this any longer. We should actively take back control of our careers and future. It's time for us physicians to get our collective heads out of the sand and stand up for our rights.

I encourage and challenge you all to get involved. It's time to make a stand together and be heard with one unanimous and definitive voice.

Say NO to board recertification.

Younger members of the American Medical Association have expressed their opposition to the MOC process in a resolution. The resolution states that the MOC process is burdensome for physicians in terms of costs, inconvenience, and time away from their practice. Given the rising costs of running our practices, diminishing insurance reimbursements, and looming burdens under health care legislation, the current approach to MOC does not meet the intellectual or fiscal needs of practicing physicians, and it is largely irrelevant to maintaining quality patient care and core competence.

Hospitals and insurance companies have taken it on themselves to impose MOC requirements, going so far as to base privileges and reimbursement decisions on recertification — in effect, attempting to regulate who practices medicine.

I successfully completed my first 10-year recertification cycle in the MOC program. I found the process to be time-consuming, expensive, and stressful. Therefore, I was not surprised to learn in the essay by Levinson and King that less than 1% of time-unlimited ABIM diplomates voluntarily choose to recertify. One way to increase voluntary recertification rates would be for employers of physicians, payers (i.e., Medicare and health insurance plans), and malpractice insurance providers to provide monetary incentives. If recertification results in better care, then it should be rewarded in a meaningful way.

It is just a money making scheme

there are good physicians and bad ones

good ones keep up regardless and passing a recert exam won't turn a bad doc into a good one

it is a scam to give those in academic medicine and on the boards something else to do

The MOC "performance improvement" module I'm working on now is one of the biggest wastes of time I've ever experienced.

If there ever is a head to head study done on MOC I'd be happy to volunteer for the placebo arm!

I am just curious what others think. I think they are all making millions on us. The President of the ABAI is making over 100,000 dollars on 2 hours a week of work. Nice.

I do think you need to do the CME requirements. I thought all state licensure authorities required annual CME. So why now also MOC?

Having a lifetime cert I would not bother with MOC even though the ABAI has been pressuring me to get it. >$100K for 2 hours a week works out to >$1000 per hour (if he does not take vacation). Where can I send my application for this job or is this only available for those in the inner circle?

MOC is short for mockery.

The MOC is a great way for your specialty board to make money. That's about all it does.

MOC:

1. Too much money.

2. ABAI has no desire to release a full accounting of the money

3. ABAI threatens a negative report for non-participating docs.

but....

4. ABAI will not stand up for us board certified allergists against docs of all kinds practcing allergy.

Let's see the balance sheets for the ABAI before contributing any more to their 401Ks.

Anyone conserned about MOC needs to look at:

http://www.fsmb.org/pdf/BD_RPT_1103_%20MOL.pdf

THis is the progress on MOL (maintenance of license). Here you will see a very strong push by the "stakeholders" to implement a whole new set of HOOPs just to keep your license (particualrly interesting is that 20 State boards were involved in a (Twenty state boards participated in the call, as well as members of the MOL Implementation Group.) :

"The draft report of the MOL Implementation Group was distributed via email in November 2010 to the state medical and osteopathic boards, followed by a first round of external stakeholders – e.g., American Medical Association (AMA), the American Osteopathic Association (AOA), American Osteopathic Association-Bureau of Osteopathic Specialists (AOA-BOS), American Board of Medical Specialties (ABMS), American Medical Colleges (AAMC), Accreditation Council for Continuing Medical Education (ACCME), Accreditation Council for Graduate Medical Education (ACGME), Council of Medical Specialty Societies (CMSS) and the public.

The report was also distributed to a subsequent second-round of external stakeholders – e.g., ABMS/AOA-BOS member boards and state medical and osteopathic associations. The deadline for submitting feedback was December 31, 2010."

SO take note-MOL is coming and the AMA is out there pushing for it!:

From AMAmmednews.com

Medical Education (Committee C)

Delegates ask AMA to monitor new licensure requirements

Updated June 21, 2011: Implementation of new maintenance-of-licensure requirements is raising alarms among physicians concerned that it will place an undue burden on their pocketbooks and take valuable time away from patients, delegates said June 21 during the Annual Meeting.

Existing maintenance-of-certification requirements already are time-consuming and costly, and physicians want to ensure that new licensure rules from state medical boards don't require doctors to duplicate those efforts, said Steven Chen, MD, a delegate for the Young Physicians Section.

"We don't feel these are complex or controversial requests," said Dr. Chen, a surgical oncologist from Sacramento, Calif., of physicians' calls for relief from duplication of effort.

The growing number of mandates comes at a high price for physicians, said Gregory Threatte, MD, an alternate delegate for the Medical Society of the State of New York and an anatomic/clinical pathologist from Syracuse. He spoke during reference committee testimony June 19.

"It is a critical issue for a lot of physicians. They are starting to chew up more and more expense," he said.

Delegates adopted five policies dealing with maintenance-of-licensure and maintenance-of-certification requirements.

They include calling for the AMA to encourage medical boards to accept participation in maintenance of certification and Osteopathic Continuous Certification as meeting maintenance-of-licensure requirements. At the same time, active medical licenses shouldn't be revoked on the basis of certification requirements, the policy says.

The AMA also will study the effectiveness of proposed continued licensing requirements and recommend to the American Board of Medical Specialties that physicians be required to take only one specialty exam every 10 years.

In other action Delegates adopted a policy aimed at ensuring due process in medical licensure. Physicians being investigated should have at least 30 days to respond to state board inquiries, have the right to prompt board decisions in pending matters and have their quality of care be evaluated by a physician of the same specialty.

How the heck do we fight this. We are all reeling from the stupid EMR and CPOE stuff and MOC is a pain in the ass and now this MOL. No wonder I see a lot of depressed friends.

Call/write your specialty board and complain, Talk to your society leadership if they will listen. Start getting your state politicians involved and tell them you will retire/quit or "quite taking Medicare". Get your rural hospital administration uptight about losing physician coverage, especially if they buy in to this certification requirements!

Get ready to retire!

No doubt the individuals on the specialty boards are likely in bed with the MOC/MOL people. MOC in particular is a pot of gold for the docs working there.

Well I think there is indeed a great deal of "Collusion" between the specialty societies and the Boards. The difference is in that the societies are elected and boards are appointed. If enough people start "questioning" this business, and becoming politically active at national, state society and general political levels, this is where you have a VOICE. The Boards are 12-14 people in a room. The Federation of State Medical Boards is a COMPANY (i.e.= INC) that has a 95 year history of lobbying the government to "make doctors pay for quality" and EDUCATE only lawyers and administrators. This is like the JCAOH for hospitals now for doctors, and WE are the "rich bas--ds that are paying to get fleeced! We need to act or follow like sheep and continue to be fleeced!

A 2009 survey of AAPS members, http://www.jpands.org/vol14no1/orient.pdf, showed that only 30 percent thought the process of recertification had improved their performance as physicians, and only 22 percent would voluntarily do it again.

“Recertification has become a cottage industry of bureaucrats and testing agencies, dragging with them a few university physicians,” she writes, in the summer 2011 issue of the Journal of American Physicians and Surgeons. http://www.jpands.org/vol16no2/hieb.pdf

In the same issue of the Journal, Martin Dubravec, M.D., calls board certification/recertification/maintenance of certification “a malignant growth.” http://www.jpands.org/vol16no2/dubravec.pdf

http://www.annfammed.org/cgi/eletters/9/3/203#2...

Benbassat R. and Dubravec M., "Maintenance of Certification: In response to Xierli et al and Miles [e-letter]". http://www.annfammed.org/cgi/eletters/9/3/203#2..., 23 May 2011.

The Federation of State Medical Boards (FSMB) is working at the State level to link MOC to Maintenance of Licensure, or MOL. If this is achieved, the process will no longer be voluntary and will become compulsory for maintaining one's license to practice medicine. This would be a dramatic change in licensure and would apply to all physicians and not just those grandfathered. (Documentation for this can be checked here: http://www.fsmb.org/pdf/mol-board-report-1003.pdf and here http://www.fsmb.org/m_mol_reports.html).

How did we let this happen to us. I spoke up at meetings, I even got the board to come to our local allergy society meeting. They could give a rats ass. Really. I spoke to the University guys agreeing to write questions and make money from this and they said that I am a dinosaur and get outta the way. Well hey guys on university salary, we have to make a living, we dont just get a salary and do in at 10 AM for rounds and out at 3pm for "research.

My biggest gripe is that there is not a shred of evidence that any of these measures (certification, MOC, MOL, etc) make any impact on quality or safety. So I question their motives (which is the appropriate thing to do in an era of evidence based medicine, correct?).

I think that getting onto state medical boards to oppose these measures and to level the playing field would be key:

-Ideally, certification, MOC, MOL should not be allowed to be a job requirement by any hospital or required by insurance for reimbursement. Willing to reconsider if it can be proven to make a difference.

-If stuck with certification, MOC, MOL, it should not be legal to discriminate among certification entities, IE an unaccountable organization like the ABMS should not be allowed to run a monopoly, set fees, schedules, requirements, and be protected from any recourse.

-Burdens such as this on physicians should be steadfastly opposed, and if their motivation is the "public good" they should be paid for as such

-Strong efforts should be made to turn the tables and push for rules and regulations that would compel others to actually do something useful for us such as:

-single federal license valid in entire US. process would keep the truly bad doctors from hiding out in refuge jurisdictions and could greatly simplify credentialling

-require pharmacists to distribute info on side effects that the patient must sign for, and is returned to prescribers office as acknowledgement that they take responsibility for side effects. potentially eliminate a bunch of frivolous lawsuits based on occurrence of known side effects

-require EMRs to output data in a common electronic format that could be read by all other EMR's. would allow much easier interchange of medical records.

-require all controlled substances to be prescribed through a monitored system similar to iPledge. Make it require a patient contract, require a primary MD

to be listed who can set limits electronically for how much an ED could give out in pill form (obviously needs workaround/way out for trauma), has windows for dispensing, and should make it much more challenging for patients to get 100 oxycontin from every ED and pharmacy across a 4 county area

-Require insurance companies to pay providers for filling out their paperwork (med appeals). Fees set by a committee, but no less than $10-20 per form.

-Create a set of billing codes to permit billing for telephone conversations with patients that insurers would be required to pay for. Has to be optimized to encourage truly short telephone calls to take the place of f/u visits and save insurance money and pay us better on a time adjusted basis, but to also let us do phone counseling at a rate that also makes sense. Since I try to get melanoma patients from dx to definitive treatment in under 2 weeks (same week usually), I often give melanoma diagnoses by phone and will have 15-30 minute conference calls with patient and their family if desired to develop treatment plan because its logistically easier than trying to squeeze that in as a f/up.

The whole Cert/MOC/MOL is a great example of the collusion of powers with their own interests at heart that are aligned against us. Not only are their others, but if we had a greater voice in some of these legislative/regulation issues we might be able to eliminate a lot of structures and requirements that just divert money from health care toward special interests and replace them with systems that improve health care and delivery.

An unaccountable organization like the ABMS should not be allowed to run a monopoly, set fees, schedules, requirements, and be protected from any recourse." = While I definitely agree with you on this point, are individual specialty boards truly "unaccountable" since its members are selected by their professional organizations? Seems to me we are shooting ourselves in the foot if we don't like what our Board is doing yet keep appointing the wrong people to it.

While I am in favor of having initial board certification and for maintaining one's license in good standing to practice medicine, I am wholeheartedly against MOC and linking it to MOL. Not only are these processes discriminatory (grand-fathering), costly, time consuming, clinically irrelevant and totally unproven for providing benefit for either physician or patient -- they have absolutely no place in the lives of practicing physicians.

Physicians must unite.

This is from the recent AMA meeting in Chicago:

"Delegates ask AMA to monitor new licensure requirements

Updated June 21, 2011: Implementation of new maintenance-of-licensure requirements is raising alarms among physicians concerned that it will place an undue burden on their pocketbooks and take valuable time away from patients, delegates said June 21 during the Annual Meeting.

Existing maintenance-of-certification requirements already are time-consuming and costly, and physicians want to ensure that new licensure rules from state medical boards don't require doctors to duplicate those efforts, said Steven Chen, MD, a delegate for the Young Physicians Section.

"We don't feel these are complex or controversial requests," said Dr. Chen, a surgical oncologist from Sacramento, Calif., of physicians' calls for relief from duplication of effort.

The growing number of mandates comes at a high price for physicians, said Gregory Threaten, MD, an alternate delegate for the Medical Society of the State of New York and an anatomic/clinical pathologist from Syracuse. He spoke during reference committee testimony June 19.

"It is a critical issue for a lot of physicians. They are starting to chew up more and more expense," he said.

Delegates adopted five policies dealing with maintenance-of-licensure and maintenance-of-certification requirements.

They include calling for the AMA to encourage medical boards to accept participation in maintenance of certification and Osteopathic Continuous Certification as meeting maintenance-of-licensure requirements. At the same time, active medical licenses shouldn't be revoked on the basis of certification requirements, the policy says.

The AMA also will study the effectiveness of proposed continued licensing requirements and recommend to the American Board of Medical Specialties that physicians be required to take only one specialty exam every 10 years."

Also see this recent article in the Annals of Family Medicine :

Benbassat R. and Dubravec M., "Maintenance of Certification: In response to Xierli et al and Miles [e-letter]". http://www.annfammed.org/cgi/eletters/9/3/203#2..., 23 May 2011.

And these 2 published in the July issue of Clinical Pediatrics: Ain't Misbehavin': Is It Possible to Criticize MOC? by Strasburger MD and Maintenance of Certification by Steele MD It's going to take all of us to get involved to implement changes.

Board certification is taking $1000+ of my hard-earned money every so many years. Its a racket. I would hope that completing med school and residency and fellowship is enough, esp given the "rules" for completing these. But it is not, and hence we need to spend money unnecessarily.

I doubt many patients know your board certification status, or care.

I don't think anyone is arguing against the initial board certification after you complete your training. What is however discriminatory, costly, time consuming and utterly clinically irrelevant to the practicing physician is the board REcertification / MOC process that is now in place and becoming increasingly burdensome.

Who the heck DOESNT do CME? And given the availability of online CME, there is really no excuse not to.....I have to provide CME evidence at every hospital I am credentialed, AND to the PA AOA for re-licensing...that, after initial certification SHOULD be enough....but what the heck, at $1000+ per person, that is a LOT of cash to make.

MOC: it's a racket

MOC: BS/Scam.

The time has come for all good men to refuse to recertify.

The ONLY way out of this medicratic nonsense is organized collective civil disobedience.

Our professional societies have failed us in that respect. Instead of organizing us to oppose this nonsense, they have decided to participate in the profits derived from this nonsense.

They are assisting us in fulfilling the requirements of recertification. Basically, they are grooming us like cattle, to be sold for the slaughter house.

It's such a doggone shame that the professional associations have all helped with the process rather than obstruct it.

Our professional associations, starting with the AMA and going on to all the specialty associations, are all profiting quite handsomely from this process. Incredibly, these associations are not led by bureaucrats, but by members of our own species - PHYSICIANS. The processes by which these associations make policy decisions is NOT democratic. They do not consider the members a constituency to which the societies must respond, but a whole bunch of gullible and exploitable professionals who are willing to pay MUCHOS DOLARES.

"Recertification" needs an entirely different name and interpretation.

Certification takes a tremendous effort and set of accomplishments to meet eligibility criteria in the first place, never mind the test. It is absolutely huge.

"Recertification" is mostly a matter of having kept your nose reasonably clean, knowing your field of practice, doing a lot of paperwork, and taking another test. It is a bit of fancy frosting on the cake, and has very little to do with your true capabilities, either way.

Doing it may be a plus of some kind, but not doing it should not have any major penalties attached. The cake is still there, the same as it was before.

Welcome to one of the biggest ponzi schemes in medicine! I don't understand how taking a test every ten years is going to make doctors keep up with medicine. Why not have less stressful modules that are taken every 2 years, and have better structured cme courses? And for the sub-specialists like me, aren't we all tired of keeping up with multiple certain/recertification exams?

It is a another reason why health care costs are 17% of GDP. The expenses for sitting another re certification has to be passed along to somebody !

Think of the sheer number of tests that you took to get where you are today (and now with Maintenance of Certification kicking in it just gets worse). Our own medical associations have us by the short-hairs. If you don't stay current you will lose your credentials and then you cannot practice. If you do not maintain your national association membership status, you will lose your credentials. It is all a business proposition in which the physician is the one who has to shell out the expense.

Let us review (just the big ones): ACT, SAT (pre-ACT and pre-SAT) college prep exams. GRE (for those of us who may have taken a detour through graduate education before pursuing a medical education). MCAT, Shelf exaxms, COMLEX I, II, III and then residency exams: CREOG's for four years. Written Board exam and Oral Board exam (for specialty certification). Now where we used to think, "whew, I made it!" Now it's: OK, now I have a new set of crtiteria to maintain my board certification. In addition to my CME credits, I have to get certain types of CME credit that will apply toward being board certification that may be different from the CME that I need to maintain my state license. And for the OBGYN's our board certification is only "good" for 6 years. Why 10 for some and 6 for us? And of course, now kicking in will be the "maintenance of certification" requirement. How much of this do the Noctors have to do? It never ends.

I think that's outrageous!

There is clear intention to tie the MOC process in the future to CMS payments.

It is amazing how this process emerged out of the clear blue sky in a very short time. Very few physicians were involved in its development and implementation. The mandate to develop the process is reputedly from "above," i.e the government, since it clearly did not come from within the medical profession or the medical community.

It is an invasion of our lives and livelihoods.

At this time the only way to effectively change it is to have a massive refusal by all doctors to participate in the process. Anything short of that will defeat our profession and further subjugate the profession to bureaucratic mandates that are irrational and unjustified.

No one in our profession will ever oppose any stimulus for self education - that is the culture of our profession. This is not the issue in MOC. The issue in MOC is that external forces are defining and mandating the standards with which our profession should conduct itself. We cannot allow that.

I hope people who are currently certified in multiple specialties complain.

They are throwing us an anchor and then wonder why internal medicine is drowning.

THE ONLY WAY TO WIN IS BY MASSIVE and COLLECTIVE NON-COMPLAINCE!

Collective noncompliance is the only solution. What a crock MOC is. Veiled under the guise of "transparency for all physicians" (as my board told me) and the fact that "the public demands it" (what public?!) this is simply a money making opportunity for the boards. It has nothing at all to do with our knowledge, expertise, and interactions with patients. In fact, I find it rudely controlling and demeaning.

Let's band together and demand open book, for MOC

In Clinical practice , if I come across a challenging pt or some rare Endocrine issue

I go to the books/ up to date / or discuss with colleaugues

no where is there evidence that making physicians study for months to pass yet another exam

benefits pt care

it is ridiculous

Come on fellow physicians let's unite and be strong for once

let's stand up for our rights

AMA will still get their revenue, when we do the open book

Let's make it a practice that benefits both physician and patients

certainly the current practice model is not working for most MDs

Ready, steady let's GO !

There is no scientific evidence that shows board certification makes a better doctor. The process is definitely not transparent, ie, what are the sources for test questions? Why are doctors not allowed to discuss the content of the questions once the test is taken? If you look at tax forms 990 - public information that non-profits must submit - the money awarded the Chair of the ABMS ($492,000 in 2009),the ABIM (over $800,000 in 2009) and the ABAI ($98,000 - the Chair claimed 2 hours/week in this role), it is no small wonder that the train toward more cost and requirements moves on.

Are they seriously considering having us do MOC more often? And tying it to MOL?

Boycott the exam.

I've been through recertification for IM and nephrology. I don't take any issue with the exams --I found them to be reasonable.

However, the MOC modules and practive improvement are busy work. The MOCs should be given to my kids when they tell me they are bored. Between my office, the hospital, committee meetings, EMR, writing letters, justifying what I prescribe, taking my children to school, eating, drinking, and breathing, I don't really find the modules to be all that interesting nor informative. Mailing out flier and surveys to patients is easy; tracking down the frickin' surveys from the patients who don't return them is a consuming waste of time.

If the ABIM really wants to give me some input on how to run a better nephrology practice, then why don't they come and spend a week with me. I often feel that the administrative physicians driving these endeavors are out of touch with practicing, call-taking, blue-collar nephrologists such as myself.

The reason all of this has come to pass is that there is no real physician leadership in this country that advocates for physicians exclusively. Not for patients, not for social causes, not for hospitals, not for pharma, not for insurance companies, not for health reform, not for education "experts".

We need leadership to advocate for physicians in the face of the onslaught from all of this.

Boycott the process of MOC before it gets any further rooted into the system.

It's now or never.

We all need to convince our professional organizations that we don't want help complying with the process. We want help organizing to oppose the process.

The professional organizations (not the Boards) need to respond to the will of their constituents. At this time, they are not. What about boycotting membership in our professional organizations until they do what the overwhelming majority wants: to oppose the process of recertification and MOC as it is presently constituted.

Hit them where it hurts: withhold payment. Then they will react.

it is too expensive, too unimportant, and too meaningless in terms of my abilities as a doctor. there seems to be a great need out there for psychiatrists, with facilities settling for nurse practitioners because they can't get a psychiatrist to sign on. the irony is that i am boarded in pediatrics, and always will be, although i would never practice peds again without first doing another internship to catch up. this is all so strange, like somehow the doctors have become the bad guys who have to be watched or they'll misbehave. do they do this to lawyers, or engineers?

i'm going to henceforth not participate and rather focus on what i was doing before: CME in order to provide excellent patient care.

one of the best psychiatrists i know failed the psychiatric boards initially (not talking about MOC here); i don't think anyone should conclude that failing a MOC is any indication of their competency---i believe the whole MOC system is a scam.

The ABIM is sitting on 10's of millions of dollars -- meanwhile they receive millions more every year in fees ....Guidestar. Check it out. It's eye opening.

Why have we saddled outselves with this? Do the lawyers recertify? This is a hassel and a nuisance and an encumbrance that somehow our "leaders" burdened us with. No thanks.

MOC stands for Make Others Cash.

Like all other large organizations, the ABFM has but one real goal, self propagation. The MOC that has been forced on us by our own organization, was intially supposed to "improve our image" and prove that we kept up on our education. Well, it has now become an organization , like JCAHO, that exists to expand, and creates ever more difficult standards to meet to do so. I have been in practice for 27 years and have worked in all levels, and if I didn't keep up, people would see that easily. Our patients are educated and do a lot of web surfing before coming to the office and if we weren't also reeducating ourselves regularly, we'd look idiotic and start making mistakes. There should be some other alternatives, than being forced to take tests over and over, just to prove we've earned the right to keep our board certification!

Given the fact that the national specialist societies have great monetary stake in the cash action, I feel the only course at this point is to work at the state political and medical board level. The Feds have never been able to wrench the states constitutional right to regulate, and we need to prevent the states from giving this right over to some Private Organizations like ABMS or ABFM. We have been sold this with the argument that "if we don't do this the government will". If the states move in the wrong direction we can leave for other states or at least complain to our representatives. Once the private INCs find foothold, they will never let go or ever bother to listen to the physicians who are being forced to pay. If we keep following like sheep, we will continue to be fleeced!

Anyone conserned about MOC needs to look at:

http://www.fsmb.org/pdf/BD_RPT_1103_%20MOL.pdf

THis is the progress on MOL (maintenance of license). Here you will see a very strong push by the "stakeholders" to implement a whole new set of HOOPs just to keep your license (particualrly interesting is that 20 State boards were involved in a (Twenty state boards participated in the call, as well as members of the MOL Implementation Group.) :

"The draft report of the MOL Implementation Group was distributed via email in November 2010 to the state medical and osteopathic boards, followed by a first round of external stakeholders – e.g., American Medical Association (AMA), the American Osteopathic Association (AOA), American Osteopathic Association-Bureau of Osteopathic Specialists (AOA-BOS), American Board of Medical Specialties (ABMS), American Medical Colleges (AAMC), Accreditation Council for Continuing Medical Education (ACCME), Accreditation Council for Graduate Medical Education (ACGME), Council of Medical Specialty Societies (CMSS) and the public.

The report was also distributed to a subsequent second-round of external stakeholders – e.g., ABMS/AOA-BOS member boards and state medical and osteopathic associations. The deadline for submitting feedback was December 31, 2010."

I just did this donation. I think the boards are adding an extra burden I dont need. I dont know that the MOC is worth the time nor the money. I think the fact that only 1% of us who have gold certificates ever do it tells you that a prudent and good physician doesn't see the value in it. I like a free market economy where those of us who see value in it use it. I will take all the courses for Literature Review this year because its is great and has value. I will spend 5K dollars doing it. But to force me to do 500 dollars a year to three boards... BS

Recertified last fall and REFUSE to do it again in 9 years - of course I will be 66 and hopefully retired!

MOC is a scam. The most annoying part of the scam is that old docs who trained many years ago are grandfathered in, while relatively recent trained docs like me (finished residency in 2001) have to jump through all these hoops.

And I do not believe that having gone through MOC makes me a better doctor.

Over the course of a 30 - 40 year career, the financial cost of each MOC cycle, review materials for each new cycle, review courses and lost income from time away from the office to take an exam in a secured facility which is yet another cost...is in the tens of thousands. Thousands that those grandfathered don't have to spend. Add review courses and even more time away from your practice....The MOC process needs to be simplified: it's discriminatory, too costly, too time consuming and clinically irrelevant to the practicing physician. And without competing boards to recertify, this qualifies as unfair business practice. Lawyers have other terms for this type of injustice of course.

So glad to be DONE with this..re-certified last fall...will be 66 when it "runs" out....NO MORE. I refuse..way too expensive and time consuming!

As an academic physician, we are under continual careful scrutiny for RPT, and repeatedly evaluated by students, residents, and fellows, all of whom look at our practice-specific accomplishments and abilities. There are so many other quality checks and balances, that MOC doesn't make sense unless it could be clearly relevant and "value-added". I note that the essay in support of MOC acknowledges the large time requirement. Does that time come at the expense of patient care, family, research, teaching, or somewhere else?

My recommendation is not to enroll in the MOC program. Clearly, as time passes, many primary care internists (and family practitioners as well) tailor their practices in response to the number of specialists in their communities and their own personal strengths and weaknesses. After several years in practice their skills and knowledge bases are often quite different from the core curriculum that they possessed when they sat for their initial certification exams. Recertification overlooks this inevitable and natural tailoring that many doctors’ practices undergo. In the real world doctors turn to the Internet, their textbooks, and to colleagues when they need help in solving problems. But the closed book approach used in recertification ignores this. Many physicians feel that recertification is too costly and too time-consuming. Worse, the board review courses that many doctors attend are also costly, reinforcing their concerns that CME has become a profitable industry geared more toward exploiting doctors than helping them.

I certified in 1995, recertified in 2005 and will not go through the process again, for all the reasons cited by Goldman et al. Since I am not 'grandmothered' I don't know if this will affect my ability to continue to be a preferred provider with insurance companies. But I was so offended at the nature and cost of the recertification testing process that I will not repeat it. I would add that as a solo practitioner, the cost of the program is truly prohibitive; I need to use my CME dollars for courses that will actually improve my ability to care for patients. Among other resources immediately available to me, I have UpToDate open on my computer at all times and use it frequently during the day. Testing me without access to those sources is meaningless.

"Potential benefits" and "could actually improve care". MOC is an expensive and time-demanding mandate that has no evidence-base support for its requirement. I agree that there is an issue of public trust that must be sustained and that re-certification is an important goal; the literature that supports the notion of deteriorating skills is convincing. However, the current MOC model misses the mark badly. Self-assessment tools and practice-assessment tools (that evaluate how your practice adheres to specified guidelines) are very valuable, including areas like patient safety. The PIP seems to be misguided; practice improvement is difficult to do in the small practice setting and is a hallmark and requirement of hospitals and multi-specialty practices such that adding it as a requirement seems misplaced. If CME and exams have not demonstrated evidence of improved practice, they should be replaced by strategies that work. That in itself would decrease the cost of MOC and increase confidence that it is about the result, not about continually expanded requirements even without demonstrated effectiveness.

I am a "grandmother", having initially certified in 1980. I voluntarily recertified in 1994, on a bet with a resident, and again in 2005. It had been my intention to maintain my time-limited certificate which would mean that I would take the secure exam again in 2015 at which time I would be 64. However, the process is becoming increasingly complex, laborious and EXPENSIVE. And I am an academic general internist who is able to approach the broad content of the internal medicine exam with a modicum of confidence and does not have to bear the additional expense of maintaining a certificate in a subspecialty. I emphatically believe that physicians should be expected to demonstrate continued competence over a life-time of practice and that "grandfather/grandmother" status in not appropriate. However, we need credible, appropriate, cost-effective methods ultimately linked to the outcomes of the physician's own patients.

I am grandfathered for Internal Medicine, but took the re-certification exam in my specialty area: Geriatric Medicine. The ABIM MOC program needs to be improved before I would recommend it to the physician in the scenario. 1. The Canadian Royal College program is mandatory for all specialists, but does not have a formal written exam 2. The completion of the modules within the ABIM program were useful, but I would get rid of the written exam in its existing form for re-certification puposes. I agree with Goldman, Goroll & Kessler in the creation of a smaller 'core competencies' exam, if its utility is research-proven.

I am double-boarded, grandfathered in one specialty and recertified in another. The artificial criteria and categories used for recertification ("systems based practice," etc) are jargon terms that cannot be easily and meaningfully evaluated. Exams test esoterica rarely seen in practice. I do believe that recertification is a worthy idea to insure that physicians are up-to-date, but we don't have the tools at preset to do this task effectively and efficiently.

I certified in 1997 and recertified in 2007. I practice general internal medicine which includes work in the outpt, hospital (including ICU), and nursing home settings. I wholly support maintenance of knowledge and competence and demonstrating this by being tested to maintain board certification. However, I did not think the ABIM process was an adequate tool for doing this. My overall feeling in going through the process was that it too often was not directed toward maintaining and building on core competence. The process is overweighted with specialty material and minutae which harkened back to my residency days. The ABIM does us a disservice when it impresses upon us to use our valuable time and effort on these irrelevant exercises. The test was similar - intellectually titillating but light in relevance. I feel my money and time has been much better spent over the years by going to medical conferences and my specialty society's meetings.

I would suggest a half way approach, actually. Our potential candidate should enroll in the MOC process and enjoy the excellent education modules and classes but not sit for the stressful closed book exam. His patients will benefit from his renewed learning and attention to evidence based medicine, as will his students, residents, and fellows.

The authors of the "pro" argument say that there is evidence that MOC is associated with better care and outcomes, but some citations show certified physicians provide better care than never certified physicians. Some show that better scores on MOC tests are associated with better care and outcomes. None compare physicians who voluntarily agreed to participate in MOC performed better in practice than physicians who decided not to participate in MOC, analyses that should be adjusted for age, specialty, and quality of care before MOC. I wholeheartedly embrace the notion of evidence-based care. We should similarly embrace evidence-based policy-making. The ABIM has an obligation to do the definitive studies and assess whether the enormous time and effort is worth it. I am simply unwilling to spend the time and effort to participate in MOC until there is clear evidence that the benefit to my patients is worth the cost and, more expensively, TIME.

There is actually a third category. I am both grandfathered and not. My Internal Medicine and Cardiovascular Board do not expire but my Interventional Cardiology Boards will expire. While as a nerd I enjoy the intellectual challenge of the exams, I find that the many of the questions are not relevant. More importantly maintaining multiple subspecialty board in Cardiology, interventional, imaging, nuclear etc is quite expensive at a time when reimbursement is declining. Annual or Biannual self-assessment examines provided at a more reasonable costs (ie $500) to diplomats for self assessment would be of value and a service. The Board could then prove that these test score predict competence. If the test scores could be shown to predict future performance, then they would be of value to credentialing agencies and therefore of value to the physician practically. Currently these exams are not cost-effective.

I am both grandfathered and have completed the MOC for a third Board in Interventional Cardiology. I can say without fear of contradiction that the recert process was a complete waste of time and resources. There is no way that the current process is anything other than a money grab and has little or no meaningful impact on practice or knowledge base. The web site was atrocious. The PIMS were a complete waste of time and I would strongly encourage any to not pursue this unless it is important to you personally. I found the process a huge waste of time, and a parade of foolish kindergarten like activites of no practical benefit except that the only thing worse than not being certified is having been certified and then not being certified(which is the only reason I did it). You can print my Name as I have sent these and many other comments to the board and found their responses arrogant and non satisfying (I hold 3 Board certifications)!!!!

The Board Certification and Recertification programs they way they are currently structured do abolutely nothing to assess how a physician practices or the quality of a physicians practice. (The Practive Improvement Modules do not meet these goals.) They also are expensive in terms of the fees asked as well as the time spent away from practice.

Taking and passing 3 ABIM board examinations was enough.

The current structure for recertification provides only a partial assessment of the skills required for my practice. The effort and energy for recert will have to come from other valued activities and I believe that the net result will be deleterious to my practice. As I work in an academic environment, I feel that I have adequate opportunity to "keep up" with new findings.

The MOC Program is too burdensome, expensive and everchanging. I consider it cannabolism. Everyone else wants a piece of us, I expect better of our own kind.

I am a granddad in Internal Medicine and pulmonary disease. I am also certified in critical care. I have taken 2 recertification exams, the most recent in April 09. I am also a professor of medicine and chief of medicine at an affiliated VA hospital. I attend morning report and practice inpatient clinical medicine 5 months of the year. I'm not sure what the MOC means to someone like me. However my real concern is with the process (clunky for the PIM) and the general lack of validation of any of the instruments. Its a pig in a poke. I guess you could dress it up (lipstick on the pig) with professionalism. However, I am skeptical that we a) know how to teach it and b) can modify the behavior of the unprofessional by an exam. Finally it would be one more element of uncertain value.

I support continuing education for all physicians. If ABIM were to have a review program for recertification without a test, it would meet the desired goals of updating MD's to the latest medical information and standards. The exam does NOT test for standard quality of care, only esoteric diseases and situations that we do not see in daily practice, and would refer out to specialists. For now I view the ABIM as a self-serving money-making organization. Show proof that the MOC is better than CME's in standard clinical practice, and I will retake the exam. In an age of physician shortages, the last thing I need to do is waste my time and money on an unproven program.

I became Board certified in 1981 and have subscribed to every edition of ACP's MKSAP since then, generally reading and testing for well over 50% of the possible CME credits in each series. I find it an outstanding learning tool for a very reasonable price. I took the Geriatrics certification challenge exam when it first came out although I was a bit dismayed that it cost me significantly more as an Internist than it cost my Family Medicine peers for the SAME CERTIFICATION. When it came time to retest 10 years later, I declined. I simply saw no added benefit to having the Geriatrics label and did not see why I should have to pay 50% more than FM for the honor of taking the test. I'm not convinced the voluntary recert program would be superior to MKSAP and have no doubt it would be far more expensive.

I would support the Maintenance of Certification Program if it were relevant. The medical knowledge portion, including the recertification exam, fulfills that requirement. However, the practice improvement modules offered were superficial and a waste of time, time better spent obtaining more meaningful NCQA recognition.

ABIM is a self perpetuating board, who selects their own members and criteria. I would never favor participation in such a system. I have no issues with assessing my knowledge but my practice is limited in its scope and this will not reflect my practice. Frankly I think we should make a practice of discouraging participation particularly given the arbitrary and changing requirements and the time and expense involved. The physician members of the ABIM are likely the most powerful and unregulated group of physicians in america.

First, demonstrate that health care outcomes, patient, practice, financial, etc., are improved by an MOC program. Second, genomics in medicine is intended to allow individualization of diagnosis and treatment for patients yet an MOC is a generic, "one size fits all", program. Target the MOC to the practitioner.

This is obviously a money making operation and nothing more. If it were that important there would be no grandfathered class at all.

I do not need the carrot/stick of recertification to stimulate me to pursue continuing education and keep up in my field. I feel I can keep up in my subspecialty by reading the peer reviewed journals I read, attending the educational meetings I attend, and providing the consultation I provide my colleagues.

There is no value in the present testing method. The hardship and anxiety provoked by the obscure information tested is completely punitive and untenable. As well the financial hardship is improper. For those of us with full practices it is impossible to take care of patients, be a husband, father/wife, brother/sister and friend and study for this exam. A review of patient charts/notes is all that is necessary to document appropriate knowledge and care.

This program is a "If some is good,, more is better" belief. Unlike initial certification, it has never been proven to improve care. It seemed like a good idea at the time (1940's!!)We really should compare two MD populations, in some major specialties, of those starting in practice just before and just after the requirement, to see if there is ANY meaningful difference, which I strongly doubt. The huge financial bias of ABMS and the specialty societies means that they could not conduct such a study themselves. But it needs to be done. The longer we continue with this present system, the longer we delay discovering what WILL work to improve care.

The practice improvement portion of the prerequisate for the test is confusing and onerous for those of us in a hospital based practice. It has done nothing to improve the way I practice and is simply an added burden. I am certified in internal medicine and two subspecialties. I voluntarily recertified in all three,(I was grandfathered in one), but I won't do it again until the PIM is removed or modified.

My guess is that many of the people who are strong advocates of continuing recertification have significant financial interests in mandating and expanding these programs. Just as we have begun to challenge the ability of those with financial interests in a given outcome to conduct a fair and unbiased clinical study, we should be wary of instituting changes based on recommendations of those who stand to gain financially from these changes. He is a good doctor; let him decide how he will continue to remain a good doctor.

I agree with Dr. Goldman. While recertification within ones specialty is important the current MOC for interventional cardiology is poorly designed with some components a waste of time and others not relevant to my practice. I just completed the process and as I was going through it I felt that it had been either poorly thought out or rushed through without proper input from those in clinical practice. I hope when I need to recertify again these issues will be addressed.

required continuing medical education should be enough to maintain ones certification once obtained. I don't believe test taking ability makes one a better physician. Further programs that require additional cost only increases stress and financial burdens on physicians that are already struggling to survive overtaxed time and financial constraints.

Would like to see published views from physician-parents of young children. We may often find ourselves in positions where there is little/no work-time allotted for study, even for this purported important process. My older grandfathered colleagues, who have more time, have not volunteered to recertify. If the process is reformed, it needs to be streamlined with regard to the time investment required for completion. These requirements to maintain one's ability to continue to practice medicine can exhaust younger stressed physicians.

First: a deal is a deal. Residency in the 1970s was much tougher than today's version. More important: A year's preparation for recertification might make the system "feel good" but answering test questions does not necessarily relate to the academic needs of everyday practice. Practice (and the ethics it demands) is today "open book"--even in extremis situations. If you want to offer quality to experienced practicing physicians devise a way to give practical experience in methods being crammed down our throats--ultrasound, central lines revisited, colonoscopy, biopsy... Academia should ask why it is that so few physicians in practice ever return for even a year of glorious residency or a little bit of fellowship. Lame lectures and 10 questions for CME are no substitute for experience. Accumulated work toward post graduate degrees for physicians would fill a void, tests won't.

Recertification gives too much power to accademic ivory tower physicians who nearly never get the private practice of medicine right. They are like Pentagon officers with little battle experience micromanaging present battlefield conditions. Academics, researchers, are important for medical progress but they should keep out of the micromanagement of medical practice. They do all the writing and therefore express nearly all the opinions about how medicine is run. As a practicing physician I see most of the problems in medicine today as due to their unknowledgable meddling. No to recertification.

I recently had to recertify in Infectious Diseases and found it to be a waste of both time and money (the cost exceeded $1500). The process was of no value to my practice, particularly the requirement to complete self-evaluation modules. Although I was recertifying in Infectious Diseases, the ABIM website offered just 3 self-evaluation modules in ID. In order to reach the required number of "points", I was forced to complete 5 modules outside of my specialty. How does that help me as an ID clinician? The only useful aspect of the MOC experience was my personal decision to attend an ID Board review course and the self-study that followed. I found the exam itself, the culmination of the MOC process, was a poor test of my clinical knowledge, emphasizing basic science more than clinical diagnosis and management. I am not looking forward to repeating this process in 10 years and hope that by then some changes will have been made to the MOC program.

The MOC program addresses via a 'cookie cutter' approach a basic level of challenge that the MD in the vignette clearly already far exceeds. Also, I am troubled by financial information in the 'con' commentary suggesting the MOC program of the ABIM is using MOC income to fuel huge increases in income (i.e. profits) to the Board and its foundation.

ABIM prices have increased 500 percent this year. There is no return on investment for this physician. You will likely see boarded physicians really consider whether they will recertify with the new price structure. It just may not be feasible for solo practitioners and small practices. I run a free clinic and will really have to think about whether I can afford it.

I am grandfathered in Internal Medicine and Nephrology, but time limited in Critical Care. I thought the exam was worthless. The study books were OK. The "project" is worthless also.You are quite right; the ABIM has a monopoly. I would prefer the ACP,etc develop their own certifications.

I think that as a profession we must have a recertification process. Let's not forget that physicians spending time reading the NEJM online, and commenting, are more likely to keep themselves up to date. Unfortunately, I think we need a manditory system to capture those physicians who fall behind, even if they are in the minority. However, my biggest complaint with the current process, as others have commented, is the price tag. This process is manditory for me, and I feel that the ABIM can simply charge whatever it wants and make whatever profit it desires from this. I worry that my fees are now transferred to the Foundation, which can use them for it's own political lobbying. Fees for manditory exams / processes should be limited to actual costs, and there should be complete transparency.

Let's face it. This is about money, not quality, not public trust. I will go to my grave without a single patient asking me if I'm board certified or not. The public trust argument is artificially created by the ABMS to make us think the public cares. The public has no clue about board certification. The American Board of Pediatrics makes the same argument about MOC and says 'we have to participate because our parent organization (ABMS) requires us to do so.' This is purely self-serving and required so as to keep all the Boards in business. The American Board of Pediatrics also sits on huge reserves and pays their executives quite well.

I am grandfathered and voluntarily recertified successfully twice! most recently 2008 (in BOTH IM and Geriatrics too) so I feel like I can speak to this. The process has become more convoluted and less relevant to my practice in several areas. I agree with MOC but not in its current iteration.

watching my peers recertify has reinforced the feeling that the it an overly expensive time consuming activity with only marginal education reward. a literature based recertification that would highlight the advances over the previous ten years might be more appropriate. the quality improvement modules do not appear to work well in our small rural hospital. the Abim apparently does not believe our CMS data on CHF (100%) and MI.

I found the process of recertification arduous, expensive and completely irrelevant to my practice of medicine. I have a significant primary care practice, I care for my hospital patients, I direct and care for patients on an inpatient hospice unit, and I am the Chairman of Medicine in my small urban community hospital. The process is flawed and needs to be completely revamped. In these difficult financial times for hospitals and doctors, it clearly displays how out of touch the ABIM is with the realities of the practice of Medicine in 2010. Moreover, that the board can pocket such exhorbitant fees at tremendous profit without expending a dime on evidence based literature that the process is worthwhile and meets its objectives and achieves superior outcomes exemplifies how unfair the ABIM's monopoly on internal medicine truly is. Given the fact that most quality of care issues in hospitals are dependent on physicians, and the public outcry for better performance, it is time the ABIM took a dose of its own medicine.

There are many compelling reasons for MOC, yet the way that it has been developed in terms of time-burden and meaningless exercise cause many not to have interest. It also appears to be a money grab by the certifying board- it's $1000 in plastic surgery. Why not make it similar to ACLS and let the board-professional society develop a curriculum that would allow physicians to practice at the current state of the art?

For as long as he is attending regularly postgraduate courses, that is already a guarantee that the physician is indeed up-to-date. His active practice also will reflect his performance as a internist/endocrinologist. I think the sum of $160/year is quite too much also and not worth spending on such a program. What is important is that this internist does not have any malpractice incidents during since he was certified the first time.

MOC could have been designed to be much more relevant and reasonable. As designed (especially the secure test) it simply plays to the traditional strengths of the ABIM which is designing test questions. It could and should be a much better process.

This physician is in an academic institution teaching residents and actively is attending internal medicine conferences and keeps himself uptodate - which is eventually the idea of recertification partly is. It is unnecessary to subject this person to an expensive exam and MOC.

I am due to recertify in Nephrology for the second time by 2012. I am grandfathered in IM. The process has become more tedious, expensive and time consuming over it's 20 year life and represents a significant intrusion into my personal and professional life. I doubt I will recertify again in the current system.

In the beginning the road to recertification was fairly straight-forward. Now the ABIM has made it so complicated that it is difficult to meet all their requirements just to be allowed to sit for the recertification test. If the ABIM were to simplify the process (What was wrong with just taking a test?) I would switch my vote and ask that everyone consider recertifying because the process of studying for the exam is a good way to keep physicians knowledgeable of recent developments. But as long as the ABIM continues to insist on physicians jumping through a lot of unnecessary and time-consuming hoops, I would advise anyone who has a permanent certification to be wary of the process

Because of a heavy emphasis on continuous learning, it is important that any certification program be worth effort and time. There are other ways to learn that may have more impact and may be more valuable--with less effort and with less time.

I have taken and successfully completed the MOC and been recertified in IM. I found no meaningful benefit in any part of the process. The correlation between quality of care provided and participation in the process is just that; I see no evidence of causality, and my personal experience suggests that there will be no identifiable sign of benefit. I suspect that better physicians are more likely to participate, not that physicians will be improved by the process. I heartily endorse my old preceptor Dr. Goroll's comments. In previous years I served as a reviewer, but after completing the current cycle I am trying to share with the Board specific concerns with the modules and the exam, and await acknowledgment. I do hope that the entire process continues to evolve, until one day it becomes valuable as well as (for some of us) obligatory.

if a physician has to prove every few years that he/she is capable of doing what a physician is supposed to do by certification then the emphasis shifts to COM regardless of any thing. physician is human being a life form that is inherently greedy and selfish and will do any thing to better its comfort.

I think sometimes, the Boards are too tough and out of reality. A person who has been practicing for years, most of the time is up to date with the diagnosis and treatments that come by with time. This program should be aimmed in a different way, maybe completing certain amount of credits per year, with the most relevant topics that had arrived in a certain month... How to decide wich is a relevant topic? Hard. There will always be some "relevant financial associations". But that is the task that must be met.

If education is the goal, why not create an online teaching tool that would ask the same questions, and allow review if the question is answered incorrectly?

To spend money on an expensive diagnostic test with no value that has been proven in a properly controlled trial flies in the face of evidence based medicine. To recommend enrollment in the MOC would be to suggest superstition over science and be a prime example of doing exactly the opposite of what a competent physician should do.

The amount of time and money required to pass this exam in a cash strapped economy unfriendly to primary care is cruel and unusual punishment. I love medicine and the practice of medicine but I strongly agree that the financial burden and scope of the knowledge required for this test should be changed to favor the practicing physician rather than tax him or her

I took my recertification and felt that it was way too expensive and did not really challenge me.

I have not found that the 'academic' and practicing physician bridge has been effectively compromised by the board exam. Since the boards are mainly developed by mostly Academic non-community Physicians who do not really understand non-Academic Internal Medicine, how would their determination of proper knowledge of actice, practicing physicans be properly measured. Many Academic physicians see a fraction of patients that non-Academic physicans treat and in a compeletely different environment. Until the certification program truly represents non-academic practice, it is a waste of time

I made similar arguments against re-certification in its current form in an essay published last year in Family Medicine. It was entitled "Five Easy Answers." It would be my hope that the ABFM and the ABIM could work together in lobbying for major changes in the way physicians are board-certified.

My "no" vote is based on my perception of the expense verus benefit ratio. I do need to re-certify in geriatrics (which I do exclusively)but am grand-fathered in Internal Medicine. So I have participated in MOC. I do not substitute required MOC CME for the other CME activities I chose to do. (Obviously increasing the cost substantially). My CME choices reflect areas I particularly identify as helpful to my practice. For example I have done a lot of my CME hours in the past year through a self-study program from the American Asociation of Hospice and Palliative Care Medicine (UNIPAC). I wanted more formal training in palliative care techniques to supplement the knowledge that I have picked up along the way. Those hours do not contribute to my MOC but do improve my practice.

There is no evidence that the MOC program improves outcomes for the patient or the doctor. The program is not tailored to the way people practice and what they do to keep current. I view it as merely a fund raising effort for the relevant boards, as the financial data shows. MOC together with the re-certification program is one of the biggest self inflicted wounds doctors have ever administered.

I have taken the MOC for Infect Dis and it is not useful for the purpose of recertification. The mechanics of ractice improvement are of considerable importance, and ABIM may want to offer assistance to its members in this matter. However, I fail to see the connection to recertification which should remain focused on staying current in medical knowledge.

The physician practices Internal Medicine and Endocrinology practice equally. So technically, he has to re-certify for both. In IM recertification, about 7-10% content will be from Endocrinology which will be a waste of time and resources for him as he will be tested in that area extensively for his Endocrine Board also. This repitition of content may be more cumbersome for physicians e.g, who are quadruple boarded in Internal Medicine, Pulmonary, Critical Care and Sleep. Minimizing repitition in multiple specialty recertifications may serve as in incentive for such physicians.

The recertification process is not well thought of, neither with goal to keep doctors educated or updated. It is only a way to collect money, intimitate physicians and give the insurance companies the upper hand above them. Show me the data to support otherwise!

I am grandfathered and have voluntarily completed the MOC process. I however, oppose mandatory recertification at this time. In this country, we continue to define the practice of medicine in narrower and narrower terms. We are told by insurers and hospital credentialling that a physician can only practice in those areas common to their current practice (despite certification). Meanwhile the non-physician practitioners have a wider and wider scope of practice. Will the educational requirements for non-physicians ever catch up? I doubt it. Essentially a MOC process will drum some out of practice and the already strained medical system will have even fewer highly trained practitioners. Attention should be paid to demanding the highest educational standards for ALL who practice medicine, physicians and non-physicians alike. MOC doesn't really protect the public without broad reforms in educational and licensing standards.

Recertification is increasingly being used as a credentialing tool. Given the very high pass rate it seems as if one is paying a guild fee rather than obtaining a validation of competency. CME training should be enough.

ABIM really needs to re-assess it's approach to re-certification. FOR ALL of us. Personally, I don't like the grandfathering fascination, as it implies some sort of entitlement and "above it all" for too many older practitioners who have perhaps lost touch with the needs of their communities in terms of being up to date. Let's keep the playing field of Internal Medicine even for all.

On two occasions in recent years "ACP Internist" has published information on candidates for ACP office. On reviewing their Board Certification status, it appeared that not one of the candidates that had initially certified prior to the grandfather deadline had recertified. I wrote letters to the editor on both occasions. I pointed out that I was sure all these physicians are competent, consciencious and would anything they could to improve their patient care. It appeared none of them felt recertification would would advance these goals. The letters were not accepted for publication.

i have yet to see any study that re certification makes a difference --what ever that means--in fact there are no studies to even imply that it is safe--who is seeing his patients 1 week a year--also requiring people to attend meetings is no different than forcing people to attend AA meetings--

Physicians should be enrolled in medical maintenance but it should not be tied to maintaining certification and potentially the penalties that derive from that label. Once board cetified,an exam should not invalidate that status and potential loss of ability to maintain priviledges at hospital and the Nazi-like insurance companies that have ruin medicine.There should be a compeling program that allows MDs to stay up to date but not in a system that penalizes the ones who are committed to staying current.

This is a no-brainer.The costs outweigh the benefits.

No evidence to support that outcomes are different. Does not limit practice if you do not take it. I have recertified twice but still am not convinced of the value either

Been there, done that. Did a voluntary recertification in 1979 - before there was the current mandatory recertification. Waste of my time, effort and $. My HMO practice enabled me to keep current and learn much more than the bookwork involved in the exam. It is now wasting everyone's {individuals and Boards} time, effort and $ for a self-limiting "problem"

I think board recertification is unnecessary and expensive for the busy physician. It is just a recall of the medical fact and do not reflects the quality of care. I firmly believe that ABIM purpose is to make money from the phyiscian who is forced to take the exam for maintaining their privilege in the hospital.

Only the USA requires an expensive and time-consuming recertification process compared to other nations. As discussed in your article, it is burdensome for the busy clinician and does not improve clinical practice in any proven way. It is a cash-producing process that benefits only representatives of the ABIM.

The main reason I wouldn't enroll is the practice performance module. This is a time consuming intrusion where the ABIM has no business sticking its nose. If we don't do a good job at running our practice and caring for our patients the market will surely let us know. There are plenty of options for patients. The ABIM doesn't seem to realize that we already work 10-12 hours per day. They use their monopoly hold on recertification to take our free time and hard earned money away. . They have no right to assess or make me assess how we run our practice.We are busy at that all the time. It is a rude intrusion into a very busy life. I can't believe they get away with this. Knowledge of medicine and clinical practice. is one thing. I begrudgingly admit that the study is beneficial even though many of the chapters in the cardiology sep are poorly written. But leave my practice alone. We run a very good practice, thankyou very much.

A better assessment would be a case, where the physician would need to locate and produce the highest quality evidence available for the clinical question, such as a guideline recommendation or best trial publication.

Dr. Goldman et. al. are spot on regarding fact regurgitation being a poor method to assess the value of a physician (by the way, I have proven myself to be one wicked test taker with a #2 pencil facing 5 blank ovals). This mentality harkens back to the "Superman Doc" era when medicine was complicated but could be mastered in its totality. We have entered the era of complexity. Complex tasks are skillfully accomplished through teams and knowledge acquisition, not super heroes. In this setting one of the most substantial drains on value is the disruptive physician. Maybe the test should be reduced down to one true / false question: “Are you a jerk?” I am all in favor of finding methods to assess physicians, but we need a better spectrophotometer than a #2 pencil.

I found recertification and the preparation for it (twice) interesting and challenging, but I felt that there was little correlation between passing the exams and performing well in clinical practice.

This topic will never go away. You may see the paradox in that the requirement for recertification in time-limited certified specialist is enforced by those who have been granted “grandfather” status. If recertification is so good for time-limited specialists, it should also be good for “grandfathers”. Or, if it is not good for grandfathers, then it is not good for those with time-limited certification. So, either all should recertify or nobody should recertify. The 2 reasons given in your editorial why grandfathers do not recertify (lack of relevance and the test relying on memory alone) are also good reasons for all (oh, by the way, you forgot to mention cost!). So there are only 2 possible (and excluding) solutions to the problem: either drop a bad system (preferred) or create a good system (also preferred). See the paradox?

Statistics are given by both sides to support their positions, however as the physician undergoes appropriate CME and holds a teaching position responsible for residents, I doubt little can be gained from this "voluntary" program.

I wholeheartedly agree that the current MOC procedure is time consuming and very expensive. There isn't a living physician who would not like to transfer $13 million into their retirement fund. When we all have to do CME to maintain licenses, what addition does MOC offer? Why not have the CME programs, which also have become near exorbitant in cost, have post program evaluations and allow accumulation of "credits" to go towards recertification?

If we pay more attention to verifying CME requirements for state licensing, I believe that re certification is unnecessary, and just a means of pacifying the public!

I do not see the benefit of MOC when we have demonstrated already that we are competent (at least to ABIM) ...what are CMEs for??

a fully experienced doctor in control of a hospital while working there needs not to get updated in such a manner. He surely will work sufficiently for more years to come

I believe that Board Certification relies on poor tools to measure competency and therefore do not think re-certification has any merit. I passed my boards the first time and thus have no axe to grind. I've known plenty of Board Certified Docs that I would not want to take care of my family and some who did not pass their boards that I'd trust with my family. Poor tools lead to poor measurements which cause poor decisions. We need to admit that no good tool to measure competency has been invented, and quit placing expensive and time consuming requirements on docs to jump through hoops of questionable significance.

The doctor in the vignette is in constant contact with scholars, both pregrade and postgrade, is very enrroled in the attendance of real patients and has the maturity to know his/her strengts and weakness, so it is up to him/her to decide

I am a recently board certified internist (2009) and I can confidently say that although I am all for keeping one's knowledge updated I have issues with the current format of the board examination.Firstly, they lag behind the latest recommendations by at least a year and a half.Second, a lot of rote memory is tested resulting in "board review courses" cropping up which teach "the best answer for the boards" instead of optimum clinical decision making,which is really the main issue facing any internist.The physician in question is in an academic environment where he is constantly teaching and learning.An argument can definitely be made for the practitioner in remote areas far removed from academics for mandatory evaluation as these doctors are much more likely to get into a rut.Whether the boards in their current format achieve that is questionable.

too expensive, not relevant, difficult to understand the process (I am currently trying to understand the process involved in my second ABIM recertification, and have given up one subspecialty certification- adolescent medicine- as it is too expensive to maintain with my pediatric critical care certification and primary job)

Hearing from the content of the MOC program from several colleagues that took the different exams, I have decided against taking the one for my specialty. I find that I am more up to date and standing in the real world by selecting myself and asking busy colleagues what is important day by day and immediately going to the source, peer-reviewed journals, that have review articles in the style of The NEJM, JAMA, Annals of internal Medicine, Archives of, Journal of, Pediatrics, Clinics, European, Latin American, Asian, Australian journals, etc. I also patronize places like Medpagetoday.com and sometimes others like it, where the NEJM post and advertises. I appreciate the effort and good intentions by the MOC professionals, but it is a lot of my time and scarce money to prepare for the exam/spend on it, and the added expenses but my honest feeling is that I am better prepared to face the daily tide my way. The above said with all respect.

The total costs of recertification are high. Although more good physicians are certified than not certified, the actual certification process contributes more to lightening of one's wallet than to the learning process.

I would prefer and welcome an audit of my practices.

Not relevant to everyday practice, too expensive.

I have initiated the process myself, which is reuqired. I have become quite cynical about the entire thing!!!It unfortunately appears to be geared towrds generating revenue for the Board. I have not find it at all to enhance my clinical skills or improve my patient care.

The MOC is designed by non clinicians who constructed an expensive examination that is not relevant to the practice of medicine.

State medical boards require CMEs. That is enough regulation. Why do the academic elites keep insisting we ceaselessly self-flagellate ourselves including those who weekly publish their politically motivated agendas in the NEJM? Is there no end to the regulation? PS: I passed the exam in 1989 and voluntarily took/passed again in 2002.

I enrolled in the MOC programmed and recertified last year. Total disappointment. I will not do it again. Waste of time, money, mental resources. It reminded me strongly about forceful rulings of a failing socialist system from behind the Iron Curtain, where I was raised, to appear sound and progressive based on bureaucratic and unproductive measures. The system will reinforce the deterioration of the real quality of medical care in the USA. It addresses the WRONG topics. The specialty questions are way too difficult and unrelated to day to day practice.

This physician has determined and utilized the CME he needs in order to practice effectively and safely for his patients. His engagement in a training program, including acute care (inpatient teaching)as well as office practice guarantees inspection and feedback from a competently run training program regarding skills and knowledge base. Those who do not have the training/teaching opportunities, or who have not utilized a careful approach to CME, need to be pressed into MOC or similar processes. This physician has made the necessary determinations and followed through.

I am a board certified endocrinologist and have re-certified but feel the program can be significantly improved. Despite being a sub-specialist, I wanted to also maintain board-certification in internal medicine leading me to prepare for and take the exam twice (having fulfilled all the other requirements for MOC). As I do not practice general internal medicine, I found the exams very difficult and failed the exams twice, each time by less than 10 questions. I remain very disappointed that I have nothing to show for all my efforts (and money). I fully support re-certification but feel the current program does not meet my needs.

THE CURRENT SYSTEM DOES NOT TEST KNOWLEDGE OR PROVIDE SERIOUS CLINICAL QUALITY IMPROVEMENT STRATEGIES.THE CURRENT MOC NEEDS A RESUSCITATION PROCESS

I wouldn't if I didn't have to (Psychiatry). It would allow me to read more things that were interesting to me and germane to my practice. Last year, I did 225 hours plus of CME---I required only 25 for my state license. I'm an active learner and self-motivated. I would think the threat of a malpractice lawsuit for not following current standards should be sufficient.

The exams are not relevant to practice

Why is my ABIM certificate is limited for 10 years, however for physicians certified before 1986 (grandfather) is considered valid for life. Was my exam and my training inferior !

The recertification process doesn't seem to actually do anything to improve the quality of practice or verify quality. Just as the ABIM seems to be reaping a financial windfall from the process, so is the American Board of Pediatrics. The ABP initially used a very derogatory wording to indicate these who have not participated in MOC. After negative feedback, this was improved, but still is more negative than that used by the ABIM. This type of coercion is demeaning for professionals and only adds to the resitance of many "grandfathered" physicans to comply. Additionally, the proctored exam experience, as currently administered, adds to a negative impression of the entire process. If and when this becomes a better thought out and executed exercise, I would consider participation. Until then, my impression is that it is more about Board power and financing than anything. else.

No evidence that recertification is associated with better patient care. Not cost effective.

those who are already board certified and practicing full time medicine,does not need to go thru re certification.

I am "grandfathered" in internal medicine, but my board certification for endocrinology has lapsed. I elected not to recertify in endocrinology. I am 60 years old and my practice is very busy. The task of recertification is more than daunting and would require too much time away from my practice, time I don't have. I keep up with my more than my needed CME requirements, and attend meetings in my specialty. If I had to recertify in internal medicine, it would be an even more impossible task, as I don't practice general internal medicine. I don't treat conditions outside of my specialty. There need to be standards, but the ABIM has made the recertification process oppressive and impractical for busy practitioners. A more simplified approach would be welcome, but I'm not doing the present program.

It is extremely distastful to be subjected to more and more requirements, more and more hurdles, more and more reviews, by peers, insurance companies, and even our constituent boards, when little or none of this activity is evidence based. While we are admonished to use only empirically proven therapies with our patients, it seems that we ourselves are the subject of an ill thought out educational experiment; in many cases, without our consent or even a reasonable method of opting out. This whole line of thinking needs to be curtailed, and the MOC reconstituted only when there are proven methodologies that actually improve things.

One of my colleagues, in his late 40's, is scheduled to retake Internal Medicine, Pulmonary and Critical Care Boards this year. The cost is very high, the documentation is punitive, with affidavits from patients and doctors, the time expenditure is damaging, and the only proven benefit is in defense of status if some agency decides to use certification as a political lever. I think the current system is abusive. This is obviously a different issue from the grandfathered awardee, but analagous. I think CME is enough.

I would need more time and input than just this first exposure to the concept to convince me to enter the program. The information and tools to refine this concept already exist--they need to be vetted more and adapted to document meaningfully the competence of physicians whose careers are much more varied now than when they first took the ABIM (and GI Subspecialty Certification) exams. I am 65 y/o and active in an administrative career writing expert reviews and testifying in appeals cases. My unique needs would vary from many other colleagues my age. But I would like to put some more validity into my credentials and document that my expertise is current and relevant. I'd welcome a reply and ongoing dialog.

Recertification by exam is useless especially if their speciality is a 'singular speciality' and will not cover all the areas of their practice. I feel doing and completing ongoing CEU's is much better as it provides current theories and relevant areas of practice that have changed. It also provides a forum for practitioners to share and network their ideas.

In the internet age recertification occurs for me every day when I investigate each problem where I do not feel entirely proficient. At the point where you will be testing me on "expert" (do you suppose they have better reading comprehension?) recommendations based on level 3 data I will be quite happily excused from the ABIM and ACC. Every practitioner has access to the original data supporting various treatment recommendations and it remains our individual responsibility to translate that into patient care.

In my opinion the concept of MOC is a good one. It compels the physician to remain current with techniques, guidelines, and new therapies all of which enhance patient care. My major complaint is the cost. Most CME are obtained at little or no cost including the CME obtained at annual meetings, grand rounds, and even sponsored symposium. Although the quality of the MOC may be some what better. I believe that cost and time constraints are major considerations. I am currently enrolled in the MOC and will take the recert. exam this April.

It should be about value for time and money - there are and should be adequate systems / patient choices for distinguishing between good and bad and dangerous doctoring - the incentives are there for doctors to seek their own education with better control over their time and money than the MOC currently does. This is not to say that improvements in encouraging continuing medical education and discouraging / preventing poor medical practice cannot be made

Health care expenditure is affecting the decision making in taking care of patients, which is not addressed or taken in to consideration during the process of certification or recertification. In my own practice of medical oncology in USA, I can access the latest recommendations to care for most cancers with in few minutes and take time to explain to patients with out taking the recertification examination. But none of my training or qulifications trained me how to tackle the problems most patients are experiencing because of the rising cost of medial care and decreasing benefits for "covered patients". All the efforts should first be directed in to health care reform (I don't think any of the options on the table at present serve any purpose, except for few self interest groups).

As a pulmonary/sleep/critical care and internal medicine physician who's practice is 80% critical care, 15 % pulmonary and 5% sleep, with 0% internal medicine I think it's appalling that I will have to take a very expensive test every ten years to in Internal Medicine just to maintain certification in the fields I actually practice. I do believe that a more focused exam tailored to my practice would be a good idea, but asking a critical care/pulmonary physician to review all of internal medicine, and to then to not allow him to sit for the boards that he in fact does practice defies all logic. Other then one particular possibility... and that would be money for ABIM.

Too expensive at a time when reimbursements are shrinking!

medical staffs, hospital administrations and professional societies are more than capable of assuring quality in what we do. the maintenance of certification program implies a measure of distrust in physician qualifications and medical systems which already oversee physicians. time and moneys are better spent supporting tort reform and convincing insurers and governmental authorities to apply rational thought to the health care debate.

thank you for allowing me to participate in this discussion. i feel testing is antiquated as a means of assessing and encouraging competence. we need to be professionally challenged in our continued education. patient management issues frequently encountered by an internist should be the foundation of our continuing education process. A resource such as Uptodate could serve as the reference for completion of case studies pertinent to internal medicine. "board certification" would be a continuing process with a predetermined number of case studies required to be completed each month. the current emperor has no clothes - recertification is required every 9 years!!

I am not sure that MOC, as currently structured is appropriate- too expensive, too onerous and not totally relevant.

Would encourage if the cost to the physician is limited. The cost of the review courses, time and expense if difficult for many primary care physicians.

I agree with the comments regarding the usefulness of certification. If other critical professions,such as airline pilots,require modular certifications programs addressing specifics areas and skills,why can physicians do better? Also the cost is substantially more than stated, if loss work time ,books and multiple courses ... to get the right information, are taken into account.

We have enough ridiculous responsibilities. Clearly, it seems this physician is staying up to date. Life is short. MOC serves two purposes - it helps trial lawyers if you don't do it and it is another money making venture for the board system. We've paid our dues to the system through years of hard work, ongoing CME, and the initial fees for boards. I am unaware of there being any proven correlation between quality of care delivered and MOC (or, for that matter, the ability to pass any written examination). In light of this, it's a waste of money and time.

The MOC program does not guarantee clinical competence in internal medicine physicians and represents a mere sampling of clinical scenarios that internists see routinely; as such this takes away valuable clinically relevant searches and patient-directed investigations of the medical literature.

as authors state, process not worth the time and effort and certainly not worth the cost

As Chief of Medicine, the MEC and I struggle with this problem. Our biggest concern seem to be those politically correct requirements for MOC that do not measure the knowledge and abilities of the physician. Many of our colleagues seem justified in complaining that MOC has gotten OOH (Out of hand).

Although grandfathered, I took one recertification exam and found it excellent and helpful. Subsequently a host of "modules" appeared which seemed busy-work, not helpful to me.

better to refer to an authoritative source of medical information, such as UpToDate, on a regular basis and whenever possible for information on a timely basis that is relevent to the patient or condition before you at the time.

I don't think recertification is an effective process and find the time required to prepare detracts from my normal study time. I would not recommend participating in the process.

The physician in the example leads a life sufficiently tailored to his ends learning that he need not bear the additional expense of ABIM MOC. The weakness of the above statement is [noted in option 1] that he presently spends about #1K per year and the MOC might save him money and time. I agree that one size does not fit all. The choices for describing my status did not have a good option for me - I imagine I should have selected "other." I am "grandfathed" red" in internal medicine but have a time limited certification in my specialty. I imagine you are wrestling with the following: perhaps we should do away with grandfather status.

recertifying is time consuming, expensive and distracts from family and practice. there are no rewards if successful, no increase in reimbursement from insurers who want recertification to use as advertising gimmick. the testing industry is big business rewarding a few.

Case in point. The endocrine board recertification exam contains a large number of questions related to pediatric endocrinology. Pediatric endocrinology is actually a completely separate speciality from adult endocrinology so that content is completely irrelavent to those of us in adult endocrine practices. There should at least be separate exams to reflect the clinical reality and to make the exam meaningful!

A third and more important Recommendation would have been "No Recommendations - Physicians Personal Choice". The arguments for enrolling were self-serving. In many cases, enrollment would be appropriate. In this case the Physician has chosen spending time and effort caring for patients rather than additional "book learning" which in many cases is only of academic (but not practical) interest.

He is doing more than most. His activities equate to more than MOC and it would be unfair to him if other physicians only performed MOC and didn't participate in the educational opportunities that the discussed physician did.

Do not recertify unless you decide you want to. If the ABIM had felt it was important for you to recertify, they would have made it mandatory for all physicians instead of exempting themselves and creating the grandfather dichotomy.

As a family practice physician who is currently board certified, I find this process an incredible cost compared a yet to be determined benefit. Ninety percent of those taking the exam pass (what a reassurance that I am not in the bottom 10%). Despite statements that board certification not be used for insurance qualification and hospital prevlidges, it is. This provides the boards with hundreds of thousands of dollars without any proven benefit. I would submit that the burden of proof that board certification improves patient care or outcomes should be upon the board before requiring this huge national cost to physicians. The "grandfathered" physicians are fortune not be be coerced into this farce.

Of course those not grandfathered will likely favor re-certification. However, I have credentialed hospital based physicians for 15 years. I have yet to encounter a grandfathered internist who is not as competent as a re-certifying internist. Those younger folk may be keeping the elders on their toes, but certification exams certainly aren't.

A grandfather ABIM certified in 1977, I have twice undertaken the recertification process voluntarily and successfully. On both occasions I found the material in the exams to be remarkably irrelevant to my daily practice of hospital and outpatient internal medicine, and considered my participation (especially in the second program) to be time poorly spent. Surely, in this "Information Age", we should at last abandon the "memorize the phone book" approach to medical education.

The doctor passed his boards when lifetime certification was granted. Changing the rules is moving the goalposts. It is also unjustified.

After a physician certifies for the first time in a specialty or sub-specialty they embark on a life-long journey of learning and gaining further experience in their field. Every physician's career path is different, with some, particularly those in academic medicine, getting more focused on certain aspects of a particular specialty. The one-size fits all approach for periodic recertification often detracts from the individual physician's career development rather than contributes to it

You have got to be kidding. This physician stands to spend a lot of time learning a great deal of material he will never see in practice--otherwise, he would already be seeing it. The recommendations of Drs. Levinson and King represent a degree of conflict of interest that would never be considered acceptable in the clinical practice sphere. I just recertified in Internal Medicine and for me, it was time well-spent--but that was because I was entering a type of practice that was much more broadely based than what I had been doing. But for a physician who is academically involved, and has been practicing in a stable arrangement for years--what a waste of time.

I TRAINED TO BE AN INTERNIST AND STILL CONSIDER MY BOARDS IN INTERNAL MEDICINE A MAJOR SOURCE OF PRIDE. BUT I PRACTICE EMERGENCY MEDICINE AND HAVE BEEN CERTIFIED AND TWICE RECERTIFIED IN THAT SPECIALTY. I THOUGHT SERIOUSLY ABOUT BECOMING RECERTIFIED IN INTERNAL MEDICINE- UNTIL I EXAMINED THE PROCESS REQUIRED. IT SIMPLY IS TOO CUMBERSOME, DEMANDING , EXPENSIVE , AND IRRELEVANT TO HOW I PRACTICE, PERHAPS WHEN I RETIRE ACHIEVING RECERTIFICATION WILL BE AN INTERESTING HOBBY BUT FOR NOW, AS DESIGNED I CANNOT SEE IT AS A GOOD INVESTMENT OF TIME OR RESOURCES,

Many years have passed since CME activity was first mandated, and has remained the closely guarded fiefdom of the academical medical establishment. In that time, licensure requirements have forced us all to go through the motions of accruing the mandated number of CMEs. While a plethora of various programs from the simple to the complex, from the sincere to the cynical, have been made available, none have achieved the desired goal of truly increasing knowledge. Informal interaction with colleagues, whether face-to-face, over the phone, or via the written word, has been the only way I have genuinely "kept up". The financial rewards for testing institutions and ego gratification available for the potentially recertified bears no relationship to the acquistion or failure to acquire meaningful knowledge.

It is unfair that the ABIM charges close to $2000 to recertify and then justifies it by comparing it to the cost of CME's spread out over 10yrs. The CME's earned by recertifying are only good for 2yrs and no one practices from memory any more.There is yet to be any evidence that recertification enhances or improves pt care, esp among academically practicing MD's

Expensive and time-consuming. I have different methods of life-long learning that I believe are more relevant to my practice of medicine than the MOC Program.

My practice profile is very similar to that described in the vignette and I have not recertified for the persuasive reasons outlied in the commentary. I have recently taken vascular medicine boards which are relevant to my daily practice and passed them. In addition, I anticipate taking certification exam in Lipidology, also directly related to my practice. How many exams are we expected to take over our careers? I only know of two professions that require rigorous maintenance of knowledge base for maintenace of a license-education and medicine. There is a limit to my willingness to participate in a program that is largely unproven, expensive, and onerous. I remain skeptical that infrequent periodic examination apart from the work environment is the appropriate tool for ensuring proficiency.

MOC is a scam to get more $$ out of docs. As a family physician in a narrow practice setting, who regularly does searches to be sure knowledge and practices are up to date, I was grossly offended by the imposition of MOC requirements (especially the inequitable manner in which they were imposed; we 2003 re-certifiers were the first class to have MOC required, while those who had recertified the year before did not have to worry about MOC until 2009).

It's all about making money. recert costs money. red light cameras are not about safety, they're about generating revenue for the municiaplity. likewise, recert is about revenue and not about competance or safety. that can easily be addressed with other means

Physicians in most states are saddled with CME requirements. Most of the MOC questions are not relevant to a mature clinician. We have access to internet resources for researching patient problems. Make all MOC activities voluntary for participants and instructors and kick pharmaceutical interests out of our specialty societies. Do attorneys and politicians have continuing education requirements?

I echo what the second essay details. The ABIM is simply viewed as nothing more than a money making enterprise by myself and every doctor I have every spoken to. The means of recertification need to be changed to something less burdensome and onerous so that doctors are not taking time and money away from their families and medical practices to satisfy requirements that the majority of us had no say in establishing. Do accountants, brokers, lawyers, and other professionals have to recertify in such a fashion to maintain their licensure or bar?--they too have fiduciary responsibility.

I have completed the recertification process. In a few words, I do not think it benefited me at all. The most useless part was the "practice improvement" module. My practice is NCQA approved with the highest ranking. I receive the upper level rankings by my patients and peers. I do think that the process is useful, but in its current form is onerous and time consuming when we have less and less time to do such a process. I think that the update test modules were excellent!But having to do so many with each showing so little change is a waste. Give us the info we need and make it relevant and easily accessible then test us in a time and cost efficient manner and I would greater support the overall procss

I don't think the cost, $1,570 to $1,720, is at all reasonable

Keeping current has nothing to do with passing an exam. Recertification is all about MONEY. Let him just write a check instead of wasting his time

The certification exam in Internal Medicine does not adequately assess the skills needed to be an internist in the first place. It is all very well to say that oral exams are not 'objective', but how do you test the ability to take a thorough history and perform a competent physical exam without them? The multiple choice test addresses a subset of the necessary skills of an internist, and not a very large subset at that.

Well, I think that for very seniors physicians who had board certification in the first place about 20 yrs ago should have their evaluation of Medical knowledge in some different format or way. One senerio can be taking one to two systems per year, just like CME. I think the basics are changing due to advances in Immunology, radiology, Bio-med...and with basics that long ago..it is difficult to keep up with all at the same time and then preparing that for an exam may be too volatile for them. Taking it in blocks may solve the problem to some extent.

no one test that is reliable enough to assess all the skills acquired through experience and exercise of the medical profession, and the degree of update does not have a reliable direct relation on the patient-doctor relationship because physicians providing media service rather than results, we can not totally reliable so qualify a physician as better or worse according to a updated test results.

examination and clinical practice are somewhat different esp. you are in academic medical center or community hospital, knowledge is not the only thing in medicine for patients, how about any difference in patient's outcome between recommendation 1 and 2.

I recertified once and the test was so out of touch with the practice of internal medicine that I decided I would not do that again. I have been associated with a training program since beginning practice in IM and ID. I have attended CME all through the years and continue to teach. I feel that the amount of money spent and time that it takes, should lead to a process that would be more relevant to practice much more than it was. Today it is hard to keep your head above water let alone spend money that is very hard to come by for something that is not better suited to what we do in the real world.

We physicians are recently facing a wide-spread increase in bureaucracy and micro-management of our professional skills, based on assumed deficiencies and mistrust. The monopoly exerted by uncontrolled credentialling bodies mostly run by educators, not MD's, plus the high costs of MOC exams are incentives likely to increase the demands regarding MOC forever, unrelated to clinical needs and demonstrated effectiveness. This type of centralized control of a previously free profession in a brave-new-world fashion with regular mandatory training in the doctrines of the day (and conformity to "The Committee's" changing rules) was a hallmark of communism. Is this where we are headed? What has happened to American Medicine, who's quality and innovative potential was among the best of the world before all these MOC rules were invented? Do we really have evidence that forcing experienced clinicians back into a school system of standardized conformity will improve clinical outcomes? And why does it have to be mandatory and punitive (loosing your Board Certification if you fail)? Isn't that very un-american?

I did enroll in the MOC program and have completed many of their modules. The questions are extraordinarily arcane. Many of the answers are then hard to understand. After a major effort ABIM did provide explanations for the answers but that raised some additional concerns. ABIM is a business and is not seriously interested teaching. After my recent spat with them where they have now blocked the copying of the test because of "security concerns". I have had enough. I don't want to be tied to a computer while I think about the questions.

Many Internists decide to concentrate on certain subspecialties once time progresses. Many become recognized by their peers as having special expertise in that field and become local "specialists". It is unfair to expect such individuals to take modules far removed from what turns out to be their primary daily activity.

The MOC program has nothing to do with the physician's daily practice. Many of them are only for individuals at academic centers. I personally voluntarily recertified in 2000.

Recertification of already fully certified specialists is a betrayal of trust on the part of the certifying board and a poorly disguised attempt to “get around” the fact of lifetime certification. If the boards do this in the public interest, as they claim, why do they charge the doctor over $1000 for the privilege? Why not charge the public, i.e. the government? When will lawyers be recertified?

Re-Certification exam is a gimmick

When credentialing we are often asked not if we have ever lost board certification, but if we have ever failed to recertify. If you don't try you can't fail. I do the MKSAP for credit and attend the ACP annual meeting to stay up to date; I don't think recert is necessary.

This physician as is stated in the vignette, remains qualified and keeps up to date. Asking for an additional $1600 from a beleaguered, financially disrepected SPECIALIST is adding insult to injury.We as Internists may not have the $1600 to plop down , although that may be chump change to a cardiologist,gastroenterologist or orthopedist! There should be other non-finacially punitive ways to monitor our efforts to remain relative.

As a ABIM grandfathered internist and a ABP non grandfathered pediatrician I have the perspective of being required to recertify for one specialty and not required to re-certify for the other. For 20 years I have continued to re-certify in Pediatrics and continued to enjoy my lifetime certificate in IM. I find the portions of recertification that are most valuable are the practice improvement, quality focused portions. The closed book testing of knowledge has seemed to be the least useful. I don't feel less competent in IM because I do not re-certify. I would consider re-certifying in IM if the process were not so expensive, time consuming and did not focus on a proctored test. I am also bothered by the Journal allowing the first opinion to be written by physicians who receive direct compensation from the ABIM. Research papers are written by those who perform the research -you can recognize but not eliminate the conflict of interest. The Journal had the opportunity to solicit authors without conflict and did not.

The test is expensive. The 5 core booklets have no bearing in what an Internist does. The test is a sham! It tests non relevant material,in today's climate ,we dont do swans ganz, ventilators, we use intensivists, infectious disease, oncologists. We spend nothing like the test incorporates in our practice. The ABIM should be ashamed of the product and price they put on the real Doctors!!!

Not able to train smart people in 15 years (4yrs Med school after 4 years of graduate school + 3yrs of resid + 3yrs of fellowship) to do something that they will do in the next 15 yrs is truly a problem. What is the value of a degree that takes fifteen years to acquire and is effective only for eight;(time lost due to finding jobs, preparing for tests, etc first and last year). In Medical school we learn the science of medicine, in residency and fellowship the art of medicine and in practice we learn the wisdom and zen of medicine. The practice of Medicine is not 100 percent based on the Level 1 evidence so why should 100 percent of its practitioners be forced to conform to such knowledge; Knowledge that is always in flux; Knowledge that is not enduring.

The MOC is way to expensive,to complex, and to time consuming.Trying to mgtm a practice,cme,family and trying to have a life and cram this in as well !!! Its just to much.It needs to be way simpler.

The current board certification works strongly against highly specialized academic physicians. I see almost exclusively breast and brain cancers and have not seen a hematologic malignancy in more than 20 years. Yet to become board certified I would have to spend a lot of time studying clincal aspects of diseases such as MDS, AML etc that I will not treat in the remainder of my career.

Taking a closed book test and being tested on obscur things do not help m in my practice in any way. Doing the MOC modules in my speciality (endocrinology) ie. having to look up things that I dod not know is a lot more useful and cheaper

The process does not help physicians. It is only done on the computer now so when I the internet isn't available a can't work on recertification. I strongly would not do it unless it becomes more user friendly.