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At a meeting in December 2009 between leaders of the Los Angeles County Medical Association and the Young Physicians Organization over 70 physicians raised concerns about the time commitment requirements to complete the Recertification process while already having to keep up-to-date with mandatory CME responsibilities and other related requirements.

Almost all the attendees agreed that the current Board Recertification process requires a time commitment of typically 6 months for completing all the components.

As one YPO Board member asked at that December 10, 2009 meeting in Beverly Hills, "How can we make sure this process leads to better patient care when right now it appears entirely unnecessary and completely irrelevant to our daily practice of medicine?" Another member said, " The Board Recertification process requires unnecessary, unreasonable and irrelevant demands which ultimately detracts from Patient Care."

One result of this meeting was that another informal gathering was held on March 3, 2010 between members of the, Los Angeles County Medical Association and leadership of the American Board of Internal Medicine which addressed critical issues related to the efficacy and fairness of the Maintenance of Certification program.

The discussion centered around controversies and misconceptions with the examination process as incoming ABIM Chair Dr. David Reuben addressed several concerns and ideas for reform. He opened with a brief presentation about the use of the examination process and candidly answered inquires related to costs, administration expenditures and standards of evaluation.

Many of the physicians in attendance at the March 3 program echoed concerns raised in the December meeting. "This MOC process is discriminatory, costly, time consuming and of questionable relevance to our daily practice of medicine." "The process does not make one a better physician, does not improve ones ability to take care of patients or make for better patient safety. This process requires reform not just for doctors, but for our patients".

As Dr. Reuben addressed each topic and inquiry, he made a point to say that opportunities for improvement of the process would be addressed by the ABIM Board as a result of this meeting. He mentioned that the fact that not every doctor is taking the examination would be reviewed and that the Board would look into making the process more efficient for physicians as well as continuing to ensure that testing is relevant to todays physician practice.

Better Care for patients?

Doctors at that special meeting reiterated a common theme among all physicians: "How does all of this lead to helping my patients?" The resounding consensus was that it doesn't in any way at all.

While issues of fees and time away from patient care are important concerns for physicians, the Change Board Recertification community of physicians is committed to providing a dialogue and process to help reform the entire process.

Does the Recertification process help doctors improve their skills? Is it a predictive measure of one's ability as a doctor? And perhaps most importantly, does it help physicians provide better care for their patients?

A growing number of physician leaders across the country are passionate about this issue and are determined to voice their concerns. In fact, physicians have been interviewed and have expressed that in previous attempts to point out their concerns, their efforts were strictly rejected without any recourse or further action. As a result, physicians across the country are determined to push for changes in the Board Recertification procedures and requirements.

Better for physicians?

From the House of Delegates Report of the Council on Medical Education, Update of the American Board of Medical Specialties, Program on Maintenance of Certification: "CME Report 7 (A-02) established new AMA policy H-275.932 (AMA Policy Database) which opposes the use of recertification or Maintenance of Certification as a condition of employment, licensure or reimbursement. In fact, the ABMS does not endorse the use of certification, recertification or MOC for employment, licensure or reimbursement and has specific policy that opposes the use of board certification for the delineation of clinical privileges, as well as for the initial state licensure and licensure re-registration."

From the HOD Resolution 323 (A-08) adopted as amended, as introduced by the Young Physicians Section on Improvements to the Maintenance of Certification Process: "The MOC process can be onerous for physicians in terms of costs, inconvenience and time away from practice...Whereas, MOC increasingly used by hospitals as criterion for maintaining staff privileges..."

It is clear that the initial policy which opposes the use of recertification or MOC as conditions for employment, licensure or reimbursements are being challenged if not directly contradicted. Staff privileges are in jeopardy if a physician doesn't comply by doing the MOC program.

And there is a recent notice from the ABIM informing that they are now collaborating with health plans with regard to MOC.

From that ABIM announcement:

"Earn rewards and/or recognition from many health plans for completing an ABIM PIMsm Practice Improvement Module."

It continues,

"Reward programs facilitate the quality improvement process by offering monetary compensation to physicians who complete a PIM".

"In a Physician Directory, a completed PIM designation will show patients that a physician's quality improvement work distinguishes him/her from other network providers".

Clearly, this is in direct opposition to the AMA policy and due to grandfathering qualifies as unfair business practice.