The Doctors Who Defend MOC

How does a doctor defend maintenance of certification (MOC) when most of his colleagues dislike the program with a burning passion? Physicians Practice spoke to two doctors who count themselves as MOC supporters to get an idea of what they appreciate about the program.

Eric Green, MD

Eric Green, MD, general internist and director of the internal medicine residency program at Mercy Catholic Medical Center in Philadelphia, likens MOC to older drivers. "A number of states now require older drivers to have shorter interval licenses and to have some sort of testing to ensure they are safe to drive. Older drivers resent that. They say it's burdensome and intrusive and they're right. But it was a decision by those states that was done for the common good," he says.

In the same way, Green points out that having a checkpoint for physicians to ensure they are keeping up with changing standards benefits the greater public. "If there are physicians who are not keeping up, and I've seen evidence there are…we need to accept this minor burden as a tax on our time to help the public," he adds. When Green says, "minor," he says the direct cost isn't that much for a profession that is in the top 5 percent of income-earners in the U.S.

On other more indirect costs, such as having to close a practice to study, he defends the American Board of Internal Medicine's (ABIM) efforts to reduce the burden. Two examples of this, he cites, are when ABIM removed the quality and practice improvement parts from the program as well when it began to accept continuing medical education (CME) modules from other organizations as credit for MOC. Another effort to reduce burden, he says, was ABIM offering lower stakes, two-year online assessment options, rather than its more traditional 10-year assessment.

"My concern is if our boards don't do this, we're going to be relying on Yelp! and things like that for people to get reviews of physicians…If there is going to be some kind of verification of who I am and what I do, I want it to come from something I rely on," Green says.

As a member of the Society of General Internal Medicine (SGIM), Green was the organization's representative to all things ABIM and board re-certification. However, he clarifies that he is not employed by ABIM nor did he volunteer for them, just the SGIM. Green is adamant when he says many parts of MOC can be improved, but he doesn't buy the idea that it's a flawed concept.

"It implies that graduation from medical school is sufficient to say someone is good to practice medicine for their entire career. I don't believe that…I graduated medical school in 1998. If I practice medicine the way I was taught in 1998, I'd be killing people," Green says.

Yul Ejnes, MD

Green is not the only doctor that defends MOC. Yul Ejnes, MD, has a more direct tie to ABIM as a member of its board of directors and a member of its Internal Medicine Specialty Board. He is also a former chair of the American College of Physician's Board of Governors, where he was working on "the other side of the table" as it relates to board re-certification. He is also a private practice physician in North Scituate, R.I., and says his involvement with ABIM comes from an ideal that it's easier to enact change from the inside, rather than the outside.

Like Green, Ejnes says he understands where the frustrations toward MOC come from and how many physicians consider it an added burden with EHRs, prior authorizations, malpractice issues, and more. Like Green, he defends ABIM's actions in the last few years towards improving the program.

On the state-level efforts to remove MOC as credentialing requirements in hospitals, insurance panels, and on licensing boards, Ejnes says, it's antithetical to what doctors are complaining about. "We're trying to get the government out of our business and here we are giving the government some of our business," he says.

Ejnes also says he doesn't think alternatives have been exhausted concerning the role of MOC in credentialing. "There are enough mechanisms for physician peers that are doing credentialing to do it the way they see fit. If they run into interference from [hospital or insurance administrations], there are mechanisms…to adjudicate it. Even to the point of legal action. Why get the state legislator involved in something that doesn’t require their attention?" he says.