If doctors are justified in MOC pushback, what next?

Should doctors rest on their residency laurels, never to learn another thing as they settle into their careers? Of course not. For years, state medical boards have required physicians to complete a certain number of continuing medical education (CME) credits to keep our state licenses active.

However, lately, specialty medical boards have added an educational layer known as maintenance of certification (MOC). In previous years, aside from meeting CME requirements, we just needed to be tested on a periodic basis. All that has changed with recent MOC mandates, which call for training above and beyond state board requirements — with a heavy investment in time and fees.

Doctors have become increasingly vocal about the changes. In fact, a recent petition started by internal medicine doctors gathered over 10,000 signatures protesting the publication of names of doctors who did not comply with MOC requirements. Many of those doctors refused to comply because they were opposed to the MOC changes.

Some associations who administer MOCs say they are voluntary, but that's not the reality. Without board certification, a doctor cannot have hospital privileges or be contracted with insurance companies. According to a May 2014 physician poll on Sermo (2,211 respondents), only 3 percent of doctors think the current MOC process works well.

Here's why, according to my research and observations, many doctors are opposed to MOC:

1. It is expensive. Payments total tens of thousands of dollars over the course of a doctor's career. That excludes study materials and conference travel costs associated with preparation for and completion of the modules and tests.

2. It is time-consuming. Time involved in complying takes patients away from treating patients. Additionally, some doctors point out the redundancy of studying for MOC testing while also preparing for state CME and board requirements.

3. It has little relevance to the daily practice of medicine. Many doctors feel the MOC tests for obscure information that has little or no translational value to patient care.

4. It may trigger licensure concerns. Many doctors fear that MOC will be converted into maintenance of license requirements — meaning that they would be at risk for losing their medical license if they failed to participate.

5. Colleagues are uniting in opposition. Many doctors are refusing to comply and encouraging others to follow suit. Petitions are circulating and political organizations are gearing up to stop MOC.

Doctors who have spoken up say that CME and practical patient-centered exams every 10 years are sufficient to stay current with medical advances. Nonetheless, amid the rising antagonism to MOC, we must ask, "What is the best way to detect clearly outmoded MDs/DOs?"

A simple solution is to let CMS state licensure requirements combine with specialty board requirements. This would mainstream the process and ensure that physicians are up to date on the latest research, diagnostic protocols and tools.

Additionally, CME could be required for certain topics. Currently, physicians must achieve a certain number of prescribed credits. The entire CME requirement system could be overhauled to give physicians the option to pursue self-study while making sure they maintain their competencies. Regular testing would ensure adherence to quality standards.

Finally, doctors should be studying practical information that they can immediately apply to their patients. Practicing doctors should help craft content and test requirements, and give input for CME goals.

The current system seems punitive and predatory in the eyes of many physicians. The time has come to make the MOC process meaningful.

Linda Girgis, MD, FAAFP, is a family physician who treats patients in South River, N.J., and its surrounding communities. She holds board certification  from the American Board of Family Medicine and is affiliated with both St. Peter's University Hospital and Raritan Bay Hospital. She also collaborates with Rutgers University, University of Medicine and Dentistry of New Jersey, and other universities and medical schools where she teaches medical students and residents.

This article was originally published on the Sermo blog.