Contrary to the views expressed by Niran Al-Agba and Meg Edison in their recent Coins2Day commentary, Maintenance of Certification (MOC) is important for physicians. It is an external, objective indication to patients, their families, hospitals, health systems, insurers, and other physicians that Board Certified physicians are up to date in their area of specialty medicine. With the explosion of medical knowledge and an estimated 10,000 new studies published each month, keeping current in specialty medicine is essential.
For more than 80 years, patients have relied upon Board Certification as an indicator that their physician is current in their expertise and prioritizes quality care. The American Board of Medical Specialties (ABMS) and its 24 Member Boards certify that their Board Certified physicians have demonstrated the knowledge, clinical judgment, and professionalism to practice in a medical specialty.
Studies indicate that physicians’ skills and knowledge retention decline over time. Like everyone else, physicians do not always accurately self-assess the areas of practice in which they may need improvement. While necessary, continuing medical education is self-directed; there is no way of knowing whether physicians are remaining current with the knowledge and skills needed to care for patients. A system of independent, objective assessment is essential to assist physicians in identifying gaps in their skills and knowledge, guide subsequent education and improvements in practice, and verify that these gaps have been addressed.
There is a substantial amount of evidence indicating that participation in a continuing certification process improves patient care. Following are a sample of studies published in peer-reviewed journals showing that as a result of participating in MOC activities, physicians have:
- Improved asthma action plans and asthma control tests resulting in a decline of asthma exacerbations in children
- Improved HPV vaccination rates
- Improved blood sugar levels and process measures
- Improved care of patients with hypertension
- Improved processes of care for diabetes and mammography screening in Medicare patients
There is no evidence that the cost of participating in MOC is raising consumer health care costs, but there is evidence that it reduces them. One study noted a 2.5% reduction in the total cost of care for Medicare beneficiaries treated by physicians participating in MOC. This represents an average savings of $167 per Medicare patient per year compared with patients treated by physicians not participating in MOC, amounting to a total cost reduction of approximately $5 billion annually. Furthermore, this cost reduction was not associated with any decline in quality outcomes.
ABMS has a longstanding policy that Board Certification and MOC should not be a requirement for licensure. The implication in Al-Agba and Edison’s commentary that licensure can be revoked by not participating in MOC is false. Board Certification is voluntary and physicians have alternatives to ABMS Board Certification.
ABMS and its Member Boards rely on a highly trained and specialized workforce including psychometricians, assessment professionals, and medical educators to develop, evaluate, validate, and administer Board Certification programs for more than 880,000 physicians. It stands to reason that the greatest expenditure is in staff compensation, and its executive compensation is aligned with like non-profit organizations. ABMS is fully compliant with all financial standards and conducts its operations efficiently and ethically.
Participation by specialty physicians in an ABMS Member Board MOC program has a positive impact on patient care, improves outcomes, and serves as an important tool for consumers, hospitals, and physicians. Their participation helps promote healthier communities, improve patient outcomes, and decrease health care costs.
Richard E. Hawkins is the president and CEO of the American Board of Medical Specialties.