There’s a lot of interest in Maintenance of Certification. PAMED recently did a poll, and there is a lot of dissatisfaction with the process.

As we approach the end of the year and try to celebrate the holidays, those of us on deadlines face the task of doing whatever component our specialty requires. In my case, completing MOC before Dece. 31 means putting off the inevitable exam another three years, and going on a 10-year renewal cycle, rather than seven.

Physician board members of the Pennsylvania Medical Society (PAMED) learned about the costs incurred by internists in their desire to keep their certification, and the seeming waste and costs incurred by the American Board of Internal Medicine (ABIM).

There are arguments on both sides, pro and against any MOC process, as the Philadelphia County Medical Society dissected in its recent debate with the president and CEO of the ABIM.

Why Should We Do MOC?

Those pro argue that it is necessary to keep our colleagues honest, and maintain skills. It is all too easy to just show up for any mandatory CME requirements and not really learn anything. Clocking in the CME can be done without really learning anything, though our legislators continue to feel that adding more requirements to our CME plate is the answer.

Their solution always seems to be, let’s make them take a course. I feel like we will soon be forced to take a full set of mandatory courses, rather than getting to pick and choose our own topics on interest or perceived need.

Making someone who never treats or sees patients with a need or desire for narcotics take mandatory training on the subject seems like a monumental waste of time. But CME is another blog.

Why Shouldn’t We Do MOC?

Those against argue that any good clinician (who of course is whoever is speaking) will keep up their own training and doesn’t need an onerous process mandated by some anonymous group of eggheads (however well-intentioned or compensated) to tell them what to do.

Finding out that the process may in some cases be corrupted by the dollars that flow through from physicians, the endless source of dollars and threatened by loss of privileges in hospitals or insurers if they lose the moniker of “board certified” feels like extortion. But instead of having your arm broken if you don’t pay up, you lose status and income if you don’t do what they say.

The challenge for the supporter of MOC, while the process may feel like it is onerous, expensive, corrupt or corrupted, there is a public need to establish some level of skill and ability.

The previous acceptance that if you had your MD or DO, you were a physician, and therefore expected to have a level of skills that should allow you to give the best care possible is gone. Insurers and data analysis are revealing the dirty secret that there are “bad” clinicians among us, and that information is leaking to the public health advocates and legislators who are asking for proof of some kind that we are as sharp as we should be.

We can go off the path here and argue what “bad” means, but let’s admit that we all know a clinician or two who we would not send a family member to. How do we call out those clinicians, without burdening the rest of us with a process designed to detect and call out the few bad ones? How many of you bristle at group requirements designed only to catch the few bad eggs?

The devil is in the details. We need to better police ourselves. To do that, we have to devise our own quality measures, measure each other against them, and actively and aggressively pursue and correct any defects found.

We have to act within our specialties to do the best job of finding and fixing the bad clinicians among us. That is what a maintenance of certification process should be about.

We have to open our records to external review. We need to create a process that measures outcomes, aggregates data across all the insurers we participate with, and gives us a true sense of our own clinical and financial outcomes, because, yes, we have an obligation to provide the highest value health care we can.

With the analytics available today, can we take the dollars we all spend on the current process and dedicate those funds to aggregating our own data, and then acting on it, rather than awarding a renewal.

Some specialties are already doing that. Let’s convince the rest to do the same.