Journal of the American Medical Association (09/22/23) Uprety, Dipesh; West, Howard

This commentary discusses the American Board of Internal Medicine's (ABIM) maintenance of certification (MOC) examination requirements, assessing whether they present more of a burden or benefit to physicians. New ABIM mandates require licensed physicians to satisfy MOC activity in two-year increments with a threshold of 100 MOC points every five years. Doctors estimate that a new annual fee of $220 to maintain additional certification means they will pay tens of thousands of dollars in fees to keep MOC credentials in internal medicine and one to two specialties over the coming decades. "The unilateral imposition of escalating demands has created frustration among many physicians because the introduction of new ongoing requirements is expensive, is time consuming and often includes material of dubious relevance and quality as reliable questions," write Wayne State University's Dipesh Uprety and Howard West of the City of Hope Comprehensive Cancer Center in California. The authors highlight the limitations of available data related to the ABIM MOC program's association with quality of care. "Taken together, the evidence cited by ABIM to support the efficacy of the MOC program is not unbiased because ABIM invariably conducts and directly funds the work," they note. "The resulting evidence relies on retrospective associations and causation rather than proactively assessing causation and assesses end points that are not prospectively defined as being of greatest value to clinicians." Uprety and West recommend performing a randomized clinical trial between MOC and non-MOC testees to assess its effect on patient outcomes. They also write that mandatory training and obligations are already overburdening physicians, contributing to occupational distress and burnout amid increasingly severe doctor shortages. The authors conclude that ABIM's MOC requirements are an additional strain "in a world where physicians are already burdened with mandatory health stream modules, electronic documentation, complex billing necessities and the increasing obligation of obtaining prior authorization for almost every test."

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