Facing a revolt among their diplomates – a revolt supported by the Texas Medical Association and state medical societies across the country – the boards that run maintenance of certification (MOC) programs have run up a white flag.
“We are committed to working closely with you to improve the experience of participating in continuing certification and to ensuring that every participating physician will find value in the process,” the American Board of Medical Societies (ABMS) wrote late last week in a statement delivered to state medical societies and national specialty societies.
“They are finally admitting that they see the problems, and they say they will correct them,” said TMA President Carlos J. Cardenas, MD. “Now we have to ask, ‘Will they actually do this and will it be enough?’ ”
The ABMS statement follows an extraordinary December meeting among its boards and representatives of state and specialty societies, coordinated by the American Association of Medical Society Executives. That meeting, in turn, was spurred by TMA and other state societies working their state legislatures to pass laws cracking down on MOC abuse.
In 2017, for example, TMA strongly supported Senate Bill 1148 in the Texas Legislature. The new law, written by Sen. Dawn Buckingham, MD (R-Lakeway), and co-sponsored by Rep. Greg Bonnen, MD (R-Friendswood), prevents the Texas Medical Board from using MOC as a requirement for doctors to obtain or renew a medical license. It also bars hospitals and health plans from requiring physicians to obtain MOC for credentialing or contracts. A hospital may require MOC only with an affirmative vote from its medical staff. It was signed by Gov. Greg Abbott in June and took effect Jan. 1.
“The ABMS Member Boards understand that programs for MOC should deliver more value to participating physicians than they currently do,” ABMS wrote in the statement. “You have reported concerns from your members about complexity, convenience, relevance to practice, and the indirect cost of participating in the programs.”
The exam materials’ lack of relevance to day-to-day practice is what made the time and money invested in MOC so galling to physicians, Dr. Cardenas said. “We are committed to lifelong learning because it makes us better doctors. It’s better for our patients,” he said.
He expressed cautious optimism for the ABMS statement’s pledge to ensure that physicians “find value in the process” by, for example, offering diplomates more flexibility over the scope and frequency of the exams. “This will be a big win if we really get there,” Dr. Cardenas said.
Many physicians accuse ABMS and its member boards of lacking transparency in their governance process and of using MOC as guise to pad their balance sheets. The ABMS statement also promised “a new governance structure that creates mechanisms to increase physician input” and a national physician survey about MOC – both by the end of 2018.
Currently ABMS is governed by a 35-member board of directors with representatives from the 24 member boards and the public.
“When and if they really start listening to the physicians – when and if they become a bottom-up organization like TMA – that’s when we’ll start to see real progress,” Dr. Cardenas said.
ABMS lobbied the Texas Legislature against SB 1148 last year. According to Texas Ethics Commission records, the group paid $25,000 to $49,999 to its lobbyist, Tim Schauer of Houston.
After the bill passed, the Journal of the American Medical Association published a commentary from a former chair of the American Board of Internal Medicine Board of Directors. Dallas internist David H. Johnson, MD, called SB 1148 a "threat to professional self-regulation" by physicians and went on to write that the bill "weakens [physicians'] claim to self-regulation by establishing a precedent for additional governmental intervention into the practice of medicine."
Five months later, JAMA published Dr. Cardenas’ response to the Johnson commentary, in which he rejected the idea that the MOC boards amount to “self-regulation” for physicians. "They are, instead, profit-driven organizations beholden to their own financial interests," Dr. Cardenas wrote. "In fact, they are now one of the outsiders intruding into the practice of medicine."
TMA continues to monitor implementation of SB 1148, including reports that some hospitals and hospital systems are trying to undermine the power the legislature entrusted in hospital medical staffs.