The Unnecessary Burden of Maintenance of Certification

Approximately 10 years ago, the America Board of Medical Specialties decided that the system for physician certification was insufficient and the new era of maintenance of certification dawned. Since that time, physicians have struggled to keep track of often changing requirements, point systems, and looming recertification exams. Although an undercurrent of despair with this process has been present throughout the country, it is often overshadowed by other threats to physicians such as MACRA, MIPS, and APMs. Recently, however, some specialty societies have begun to speak out against the current system, including the American Medical Association, as have states like Michigan and Oklahoma which have recently seen legislation regarding mandatory board certification for hospital privileges and medical licensure.

Why should physicians stand by while a private credentialing company forces physicians to undergo unreasonable, costly, time consuming, and sometimes irrelevant modules and an exam in order to maintain board certification? ABMS claims that physician recertification shows a commitment to lifelong learning and better patient outcomes; however, evidence showing an association with positive and meaningful patient outcomes is far from absolute. Studies showing physicians lose skills over the course of their career are used as an impetus to impose maintenance of certification, yet it is not clear that maintenance of certification helps with this at all. One author, reviewing the studies referenced on the ABMS website, found that of 33 articles cited, 16 were positive, 14 were inconclusive, and three were actually negative. Additionally, many studies in this area look at initial certification, not the recertification process so many physicians abhor.

Consumer surveys claim that most patients believe it is important for physicians to maintain certification; however, I suspect that the vast majority of patients have little to no understanding of the process of recertification or the lack of convincing evidence with regard to patient-care outcomes. What patients want is for their physicians to be competent and many believe that maintaining certification is synonymous with competency.

The guise of patient protection is alluring because physicians want our patients to receive safe, appropriate care and certainly do not want to appear apathetic to that crux of medicine. This is why we undergo intensive comprehensive training and an initial exam to ensure we are qualified to practice medicine. We obtain and maintain a medical license, which often requires ongoing continuing medical credits customizable according to the professional needs of individual physicians.

The ABMS has claimed that since such a large percentage of physicians participate in this voluntary certification they must be in favor of it. In reality, physicians understand that there is nothing voluntary about this and failing to maintain certification can lead to a loss of job, hospital privileges, and payer reimbursement. The ABMS may stipulate that maintenance of certification is not compulsory but any practicing physician understand the falseness of this statement.

Board certification may not be necessary to legally practice medicine, but we all know that it is absolutely essential to maintain such certification if we would want to find and keep an employed position or be reimbursed by insurance companies. Peruse the job listings for physicians; each and every one has BC/BE (board certified/board eligible) included in the job requirements. In many places, board certification has been linked to hospital privileges as well. The recent viral post of the pediatrician who opted not to pay yet again for ongoing certification and was quickly confronted with threats for loss of hospital privileges, being dropped from insurance rolls, and being told she was prohibited from seeing certain patients, epitomizes the apprehension at the heart of the high percentage of physicians bowing down to the ABMS MOC requirements. ABMS mistakes this fear for approval or agreement with MOC, when in fact at least one survey found that physicians actually found "the exercise was only marginally relevant to their day-to-day practice and that it took their time away from patients and other learning activities."

Physicians do not need to be force-fed irrelevant certification maintenance activities and it is insulting to require an overly broad comprehensive exam every 10 years as the best way to measure the capabilities of a physician. Hardly any physician is practicing every single aspect of their chosen specialty; we have found our individual niches. Physicians, as adult learners with an intimate understanding of their own practices and needs, are the best judges of the ongoing education and life-long learning they require. To assume that we are all identical cogs with a one-size-fits-all recertification process is ridiculous.

Like so many aspects in the changing systems of medicine, this recertification process parading as yet another value marker interferes with actual quality patient care. Physicians already overburdened with government metrics, ridiculous EHR check boxes, and payer demands do not need to jump through additional hoops every few years to keep their names on the hallowed rolls of "board certified physician."