Maintenance of certification (MOC) continues to arouse strong opinions among physicians, as evidenced by the number of resolutions on the topic that come before the AMA House of Delegates at its twice-annual meetings. Many physicians believe—and AMA policy reflects—that the MOC process should not place an undue burden on physicians' time and finances.
Most importantly, MOC should be relevant to physicians' real-life practices, provide a true gauge of physician competence and reflect readiness to deliver the highest quality of patient care.
A quote in a recent Wall Street Journal article on MOC reflects both sides of the issue. "A lot of us are small-business men trying to continue our practice while trying to maintain balance and sanity in our life," said Jay Geoghagan, a cardiologist in Little Rock, Ark. At the same time, he added, "Patients should have some assurance there is quality control and that their doctor is keeping up-to-date."
A new peer-reviewed article by Hawkins et al, published in the Journal of Continuing Education in the Health Professions, adds to the growing body of evidence in support of MOC and its positive impact on physician practice. The authors examine the four parts of MOC—licensure and professional standing, lifelong learning and self-assessment, cognitive expertise, and practice performance assessment—and conclude that "a sound theoretical rationale and a respectable evidence base exists to support the current structure and elements of the MOC program."
The authors note, however, that "it is incumbent on the [American Board of Medical Specialties] ABMS and ABMS member boards to continue to examine their programs moving forward to assure the public and the profession that they are meeting expectations, are clinically relevant, and provide value to patients and participating physicians, and to refine and improve them as ongoing research indicates."
To help ensure that this is the case, the AMA is working closely with the ABMS and other key stakeholders on issues around MOC. For example, the AMA Council on Medical Education continues to press the organizations that develop and implement MOC to make sure the process is not overly burdensome or costly to physicians, with annual reports to the House of Delegates on its progress.
The AMA continues to work with the stakeholder organizations, including the ABMS, to reflect the needs of patients and contemporary physicians to improve the system. For example, the AMA Young Physicians Section and AMA Organized Medical Staff Section sponsored a panel discussion on MOC and maintenance of licensure at the AMA Interim Meeting in November. The session allowed participants to air views on these processes, both pro and con, and work towards consensus.
The AMA Council on Medical Education is building on this dialogue with a planned conference in June on Part III of MOC (a secure examination that test cognitive expertise). This event will bring the ABMS, AMA and others to the table to continue work in ensuring that MOC is practice-relevant and optimally meets the needs of the profession and the public.
