Editor’s note: The Editor received two letters regarding a “Looking forward” column in the August 2017 issue of the Bulletin, which centered on the American Board of Surgery (ABS) requirements for Maintenance of Certification. The letters and a response from the associate executive director of the ABS follow.
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In the August 2017 Bulletin,* American College of Surgeons (ACS) Executive Director David B. Hoyt, MD, FACS, opined that it is unfortunate that physicians have taken to state legislatures to protect the rights of physicians with regard to Maintenance of Certification (MOC) mandates. I wholeheartedly agree that it truly is unfortunate that physicians have had to resort to that tactic instead of getting the support we need from organized medicine, including the ACS.
Clearly, I hope that everyone agrees that physicians of every specialty should remain current in their fields to ensure the best care for our patients. But the explosion of requirements for Continuing Medical Education (CME) credits for a variety of needs (state medical licensure, specialty certificates, insurance requirements, and so on) has occurred without any coordinated attempt on anyone’s part, and frequently the required CME credits don’t count for other requirements. The increased MOC requirements on the part of some boards (not to mention the threat of Maintenance of Licensure requirements from the Federation of State Medical Boards) have led to the predictable backlash and, thus, the pursuit of legislative relief when our own professional organizations fail us.
Although the American Board of Surgery (ABS) has not been the most absurd of the boards, the requirements have had no evidence to support their necessity, and the ABS has been far too slow to react to the pain and suffering of the practicing surgeon. Because the ABS is not a professional organization that has true membership and has been very slow to react to objections, the ACS should be the organization to help balance the needs of the surgeons and the needs of the public. I, for one, have let one of my three certificates with the ABS expire because I am tired of their requirements.
I would suggest that with the current legislative activity on this topic it would behoove the ACS to work with others to move faster to protect the needs of the surgeons and other physicians. Otherwise, we have little choice but to seek legislative relief. It is truly unfortunate when the ACS fails us.
Kevin D. Martin, MD, FACS
Too little too late
Dr. Hoyt’s column on MOC in the August issue of the Bulletin was too little too late. There has been generalized dissatisfaction with all medical disciplines with the MOC requirements. Unfortunately, the medical boards have been more responsive to the negative feedback than has the ABS. The ABS has doggedly stuck to its format over the last five years. Only after it became apparent that the local physicians were revolting against MOC status as criteria for granting hospital privileges did the ABS modify its stance, thus showing that the prior stance for MOC credentialing was more arbitrary than stated. The Texas legislature decided to not use MOC credentials for determining hospital privileges, thereby making the matter moot in this state.
The dissatisfaction with national leadership extends back to the time that the Affordable Care Act was being formulated. If the leadership of the ACS and the rest of medicine had taken a position in negotiating with the government, there is a good possibility we would not be saddled with dysfunctional electronic health records and a continuing flurry of nonsensical government regulations that have hampered rather than improved patient care. The hospital system was well represented. So were the pharmaceutical firms. Comparatively, the leadership in surgery was AWOL [absent without leave]. The rebellion against MOC standards was symptomatic, with dissatisfaction with surgical and medical leadership failing to represent what it should—excellent patient care.
Charles Van Buren, MD, FACS
Response from the ABS
It is evident that MOC has become a “hot button” issue for physicians in all specialties. This controversy has accelerated over the last three years, and more recently so-called anti-MOC legislation has been introduced in multiple states. Turning to political solutions to address certification standards threatens the privilege of professions to regulate themselves, undermines the value of board certification, and reflects poorly on the medical profession.
There are some misconceptions about the current requirements of the ABS MOC Program that need clarification. Unlike professional societies, boards are not membership organizations. The mission of the ABS is to serve the public by establishing standards for initial and ongoing certification. As a member board of the American Board of Medical Specialties, the ABS is required to use the MOC framework of professional standing and professionalism; lifelong learning and self-assessment; assessment of knowledge, judgment, and skills; and improvement in practice. Within this rubric, the directors of the ABS have sought for a number of years to shape MOC into a more meaningful and useful tool for our diplomates.
With this goal in mind, the ABS recently reduced the reporting frequency for MOC requirements from every three to every five years to make complying with MOC easier and less time-consuming. Likewise, we have decreased the required self-assessment CME credits from an average of 20 credits per year to 10 per year to give diplomates greater flexibility in selecting CME programs. Any CME activities required by state licensing boards count toward this requirement. Furthermore, a wide range of surgical outcomes registries developed by the ACS and other professional surgical societies are acceptable practice improvement activities for MOC, and some also satisfy requirements for participation in the Centers for Medicare & Medicaid Services Merit-based Incentive Payment System.
Beyond these changes, in 2018 the ABS will offer an alternative to our traditional broad-based secure 10-year MOC examination. Survey responses from nearly 10,000 ABS diplomates are guiding us in developing an assessment that is more practice-related, more convenient, and that has lower stakes, all of which were favored in the survey. The focus of this assessment will be on education with an emphasis on practice guidelines and recent changes in surgical practice, to assist diplomates in staying current in their area of practice. One section will emphasize core surgical principles, while diplomates will be able to choose from practice-related areas for the remainder of the assessment.
Our goal is a flexible, convenient program that supports diplomates in their pursuit of lifelong learning and high-quality patient care. We believe all of these changes reinforce our commitment to the public and respond to the voice of our diplomates.
Mark A. Malangoni, MD, FACS
Associate Executive Director, ABS
*Hoyt DB. Looking forward. Bull Am Coll Surg. 2017;102(8):10-11.