Maintenance of Certification For Nephrologists

Stuart Linas

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In this month’s issue, ASN Kidney News editorial board member Edgar Lerma interviewed Stuart Linas, MD, about the American Board of Internal Medicine (ABIM) Maintenance of Certification program for nephrologists. Linas is the Rocky Mountain Professor of Renal Research at the University of Colorado Denver School of Medicine.

When and how did the requirement for recertification come to be?

ABIM’s Maintenance of Certification (MOC) program dates to 1990, when it introduced “time-limited” certifications for many specialties, including nephrology. The other 23 member boards of the American Board of Medical Specialties, which develops standards for evaluation and certification of physicians, also have introduced MOC programs for their diplomates. ABIM Maintenance of Certification requires nephrologists who certified since 1990 to renew their certification every 10 years by taking an exam and completing a process of self-assessment.

More than 8500 total valid certificates in nephrology have been issued by ABIM, and more than 80 percent of nephrologists who certified between 1990 and 1996 have chosen to maintain their certification.

What are the pros and cons of recertification as it applies to physicians? To patients? To HMOs?

MOC is a meaningful way to get feedback about your practice and to make sure you are up to par with today’s standards of care. And it sends a signal to patients that your skills are current.

For me, MOC provided a real “snapshot” of my knowledge and practice performance as it exists today.

The ABIM medical knowledge modules offer a great learning tool to stay current on the recent advances that have changed our practice. In fact, ABIM introduces new “update” modules every year. The Practice Improvement Modules, known as PIMs, give you a heads-up as to how your practice is perceived by both peers and patients. Together, they provide a low-stakes self-assessment and also give you an opportunity to engage in quality improvement.

Some of the cons we have heard include workload and cost, but if you plan ahead, you can spread the requirements over the 10-year period for just a few hours a year.

By the way, more than two-thirds of nephrologists also maintain their certification in internal medicine, even though this is not required. The MOC program lets you do this easily because the self-assessment applies to both certifications. You pay only an additional exam fee to recertify in internal medicine.

Some health plans and other quality groups acknowledge MOC and PIM completion in their reward and recognition programs, which helps reduce redundancy in your quality improvement reporting.

Please compare the ABIM process of recertification versus various individual states’ policies on renewing medical licenses.

ABIM MOC and individual state policies for renewing medical licenses are separate initiatives. Licensing is required of all physicians to practice medicine, and, today, physicians must be licensed in good standing to complete MOC. However, there is growing attention to how to better align licensing and MOC, and I believe there is a real possibility that in the future MOC will be a requirement for licensure.

Are you undergoing recertification yourself?

As a member of the ABIM Board of Directors, I was required to complete MOC even though I initially certified in nephrology before 1990. I will admit that at first I had my reservations about it, but once I enrolled and began to experience the program components, I knew that this would be a beneficial experience.

The process of completing the PIM was rewarding; it really helped me identify gaps in my practice operations. I also found that taking the MOC exam affected my related work as a member of the Nephrology subspecialty board at ABIM, where we develop questions used in the ABIM MOC Exam in Nephrology. My own experience with the exam helped me think about ways to make the exam questions more relevant to nephrologists and helped the committee develop what I believe is a better exam product.

A significant part of the recertification process is the “Self-Evaluation of Practice Performance.” A number of subspecialty organizations have partnered with the ABIM to create tools that can be used to fulfill this requirement. Do you know if the ASN is involved in any of these?

One of the areas that ABIM and ASN jointly acknowledge is that we need more relevant practice performance options, including PIMs specifically for nephrologists. So ABIM and ASN are now exploring some new options for practice improvement tools and products that will fill this gap. Examples could include topics such as transplant and acute kidney injury.

In the meantime, nephrologists have several choices. Many have chosen the patient and peer assessment and communication modules. The hypertension PIM is also popular with nephrologists. Another option is the self-directed PIM. Nephrologists who are already collecting data about their practice or are already engaged in quality improvement can use this PIM to complete their quality assessment. There is also a new clinical supervision PIM specifically designed for physicians, including nephrologists, who work in academic environments.

What would you advise those currently undergoing the recertification procedure?

The best advice I can give to nephrologists is to think of MOC as a continuous process. Ideally, it is best to enroll early in the 10-year cycle. You can begin by completing the medical knowledge modules. Later in the cycle you can focus on the PIM as a way to make meaningful changes and improvements in your practice. In the latter phase, you can also prepare to take the exam.

Remember that MOC is flexible. For example, you can choose to take the exam before you complete all of your self-assessment modules. It’s up to you.

And keep in mind that your new certificate begins when your current one expires, even if you complete the program before the end of your tenth year of certification.

Is there any particular reference material or Board Review Course you would recommend for use in preparing for the written examination?

How you did on your initial Certification Exam in Nephrology may help predict how you will do on the MOC exam. A resource is the Nephrology Exam Blueprint, located on the ABIM web site, which provides percentages of content by topic in the exam.

Because of their mission and unique role in setting practice guidelines, societies are well positioned to provide the broadly comprehensive educational reviews of important clinical topics that certified nephrologists should be up to date on, and which will help them prepare for the MOC exam.

Is there anything you would change in the whole process of current recertification?

On the whole, the principle behind MOC is terrific, and I believe that the benefits outweigh the time and costs involved. ABIM is focusing on improving MOC to make it more meaningful and relevant to nephrologists. This is why ABIM is working closely with ASN to find ways to provide new options, particularly in the area of practice performance.

Among nephrologists who have completed MOC, 74 percent have cited professional value. Whether you are just enrolling now or in your second MOC cycle, I encourage you to take part. You’ll learn about what you know, and more importantly, you’ll identify ways to improve.

For more information about MOC for nephrologists, including how to enroll, visit www.abim.org. Details and links can be found in the “Get Information by Subspecialty” section. Click on the dropdown and select “Nephrology.” For details, call ABIM’s Contact Center at 1-800-441-ABIM.