Certification Concerns Persist

The ongoing debate about maintenance of certification (MOC) among internists, nephrologists, and other subspecialists continued unabated after the American Board of Internal Medicine (ABIM) announced on May 5, 2016, that it would provide more details about the changes it is considering to its MOC program or “alternative assessment options” by the end of the year.

In the meantime, an alternative certifying body, the San Diego-based National Board of Physicians and Surgeons (NBPAS), has issued board certifications to more than 3300 practitioners in 39 states. A nonprofit launched in early 2015, NBPAS requires initial certification by an American Board of Medical Specialties (ABMS) board and 50 hours of continuing medical education every 2 years. The cost? $169 for two years at NBPAS, compared with thousands of dollars for ABIM initial and continuing certification.

Also, Oklahoma became the first state to enact legislation that aims to remove MOC as a requirement for physicians to obtain a license or secure hospital admitting privileges. Passed with bipartisan support, the law frees physicians to certify through alternative boards like NBPAS or not at all. Other states may follow suit: 19 state medical societies have passed resolutions opposing compulsory MOC, and some are working to turn those resolutions into legislation.

The Oklahoma move may be a big deal if other states follow suit because now “insurance companies [in Oklahoma] cannot use MOC as a criterion for payment,” said NBPAS President Paul Teirstein, MD. “Insurance companies often have contracts that require providers be ABMS-certified,” and that has been one of the biggest impediments to more institutions accepting NBPAS certification.

Several nephrologists took their concerns about the need for recertification every 10 years—or at all—to a recent thread on the ASN Communities website.

“Whereas there is unison in the opinion of the entire medical field that an initial Board Certification upon completion of a residency/fellowship training program is a must (although not required to practice medicine in the US), whether or not we as physicians need to take a “recertification exam” every 10 years is highly debatable,” noted Mukesh Sharma, MD, of the Arkansas Renal Group on the ASN Communities discussion, “MOC Debate and Where Do We Stand?”

In a follow-up interview, Sharma stated: “NBPAS is trying not to mitigate ABIM regarding initial certification. Instead, many physicians are against having to take an exam every 10 years and with having to pay so much for an exam that’s out of touch with practice. I am all for initial certification, but I want choice when it comes to recertification—exam, CME, MOC, open book.

“There are so many resources a physician uses today,” Sharma said. “If they come across something they don’t understand in a publication, they may use UptoDate—doing so makes them a better physician. With [recertification] exams, you should have similar resources.”

The medical knowledge tested on the recertification exams continues to be a sticking point with practitioners.

“The aim should be to keep up with fresh medical knowledge, not a punishment-like system that threatens livelihood, because at 50-plus age, some people might not be in the habit of taking hourlong tests but are excellent physicians and provide good care, but may lose their board status and have trouble in jobs,” said Farhan Ali MD, MBBS, of the University of Maryland. “Board questions are mostly research-based and add to knowledge, not treatment paradigms per se, so they do not impart much to clinical practice on a large scale. In addition, my argument always is . . . that if recertification is such a good thing, it should be for all physicians. Why are some physicians (who graduated before 1991) exempt?”