Physician survey: The clinical value and future of MOC
Key Takeaways
This article was updated on October 22, 2018.
When it comes to Maintenance of Certification (MOC), there is a great divide within the medical community.
While some may feel very strongly that recertification is a time-consuming, tedious process that adds no clinical value to practice, there are those who believe that recertification is imperative in verifying that one is current on the latest advancements and guideline updates in medicine. However, many of those who argue for recertification still believe that the current MOC process leaves much room for improvement according to a recent survey we conducted here at MDLinx.
On October 9, the American Board of Family Medicine announced the launch of a pilot program as an alternate to the 10-year MOC exam. The longitudinal assessment option, set to launch in January 2019, allows eligible Diplomates to answer questions online quarterly, over a 3-4 year period, at no additional cost.
To assess the impact of the currently available MOC exams, we surveyed 515 US physicians on the MOC process and asked them to share their feedback. . Of these participants, 93% held MD degrees, while the remaining 7% were DOs. Participants included both primary care physicians and specialists.
There was no correlation between degrees, specialties, or membership and how physicians responded to the survey questions.
Here are the full survey results, including some comments from our survey participants.
Surveyed Audience (%)
- Cardiology (6%)
- Dermatology (4%)
- Family Medicine (14%)
- Internal Medicine (13%)
- Neurology (5%)
- Ob/Gyn (9%)
- Pediatrics (15%)
- Psychiatry (20%)
- Other (13%)
Who is taking MOC?
What is the most recent exam that you have taken?
Among survey participants, 73% have self-reported taking some form of MOC exam.
"Unlike a lot of docs, I think the MOC is a good idea since it basically makes us keep our clinical knowledge current."
"Do not grandfather MOC requirements. Why shouldn't older doctors demonstrate proficiency?"
"We have two groups in our practice: oldies like myself, with lifetime board certification, and youngsters who need to engage MOC. I don't find any difference in professionalism, practice, engagement of CME (continuing medical education), etc, between the two groups that would indicate that MOC accomplishes something. So why is MOC mandated? What ever happened to the elective…CDQ (continuing demonstration of qualification) to be used by those whose states required some form of retesting? MOC is overkill designed to create the appearance of doing something, without actually creating anything of value."
Are MOC requirements confusing?
56% of survey participants reported being uninformed about current MOC requirements in their state of practice.
As of May 2018, the 7 states highlighted above require that insurance companies, licensing boards, hospitals, or health-care systems not penalize physicians who have decided to forego taking MOC.
Is MOC required in your state?
23% of survey participants practice in 1 of these 7 states.
- 70% of them know that their state doesn't require MOC
- 30% believe that they need to take MOC in order to practice freely within their state
77% of survey participants practice in states that require MOC.
- 36% of these participants know that their state requires MOC
- 64% believe that their state does not; however, there may be some confusion as to whether MOC is required by the state or if it is required for other reasons (such as insurance or health-care system)
"I found the whole exercise devoid of value, tedious, emotionally taxing and disruptive. I am a rural physician and travel was required for this exam. The online requirements were useless. MOC significantly contributes to physician burn out and office interruption."
"Very confusing; I may just retire."
"Make the requirements less confusing. So many hoops to jump through and you're never sure if you've done everything. Go back to 10-year recertification with X number of hours of CME every year. That will provide enough flexibility for everyone in practice to keep up-to-date with information without undue burden on their patients and their livelihood."
Time spent on MOC
How long does it take you to prepare?
Traditional 10-year MOC Exam
Knowledge Check-In Exam
Of the survey participants, 62% have taken the traditional 10-year MOC exam spent more than 3 months preparing for it.
In contrast, 33% of participants have taken the Knowledge Check-In 2-year MOC exam spent more than 3 months in preparation.
"It's a good review but adds little to my current practice and certainly takes away time from what I value."
"The current process is not consistent with adult learning, the way we practice, and is a complete waste of time."
"I gave up when the MOC requirements included practice improvement modules, which meant either extracting data from practice patient charts or surveying patients. It's just too time-consuming and meaningless in my opinion."
How do you allocate your time to study for the MOC exams?
The majority of the time spent preparing for MOC exams is reallocated from physicians' free time, followed closely by their family time.
"MOC is just another burden oppressing physicians in the current climate of burnout and negativity. It doesn't improve patient care because it cannot be tailored to your own practice. It makes more money for administrators, who are the real problem contributing to health-care costs. With paperwork requirements, licensing requirements, prescribing requirements, mistrust of physicians, coding changes, prior authorizations, etc, there is too much pressure on doctors. I will probably retire early because of this."
"Some requirements are irrelevant to active practitioners and takes time away from patient care."
"Physician wellness is a growing concern. The multiple requirements placed on physicians only worsens this. MOC is one of many requirements in my specialty. Making a very simple process that is low stress (no exam, ONLY articles, or ONLY chart reviews, or ONLY CME) would be so much better."
"It seems to get more esoteric. Clinical scenarios are prevalent. Costs in time, money, practice losses, and other are great."
MOC: Is there clinical value?
Do you feel that the MOC process adds clinical value to your practice of medicine?
We previously spoke with the American Board of Internal Medicine (ABIM) President and CEO, Richard Baron, MD, in an exclusive interview regarding the clinical value of MOC. He said, "In the same way that you would want an in-depth validation and verification that somebody at the beginning of their career successfully completed training, you would want some way to say that this person is still practicing [current] medicine 20 or 30 years out, and that they are not practicing what they learned 30 years ago."
However, the value is not as apparent to the majority of survey respondents: Only 4% felt that the current MOC process adds significant clinical value to their practice of medicine.
"They are a good idea, and I have always participated in continuing education throughout my career, irrespective of needing to prepare for an exam."
"The MOC does not add to my knowledge, and my patients have no knowledge of it."
"Wasteful extortion."
"Boards should show how MOC has improved the practice of medicine prior to requiring it."
"The current practicing environment allows for ample educational and oversight opportunities to allow a well-trained physician to deliver quality current care. Such testing as the MOC has no proven benefit as to the quality of healthcare delivery in today's highly regulated environment. Those who have no vested interest in the Hippocratic oath should be examined, not the care providers who devote their lives to the health of our fellow citizens. The MOC is a facade to create another phony business out of medicine and penalize those who keep Americans healthy."
"It's a money-making enterprise that has never been shown to assure quality of practicing physicians. Waste of time."
10% of survey participants have let their MOC expire.
- 41% of these physicians have been without that certification for more than 1 year
- 16% of those who let their MOC expire are certified through the National Board of Physicians and Surgeons (NBPAS) and say that MOC expiration hasn't impacted how they practice medicine
- 22% of this population are limited or can no longer practice medicine because of this
- Some physicians indicated that they planned to retire early because of this requirement
"This is a ridiculous, time-consuming, family-wrecking, practice-interfering, sleep-depriving activity that leads me to want to quit neurology. I am burdened by insurance regulations, board regulations, DEA regulation, hospital regulation, and all of this has really taken a lot of joy out of practicing medicine; much of it, like MOC, has no significant value toward making us better physicians."
"This is clearly a requirement made to take money and time from practicing physicians and give it to well-paid, disconnected bureaucratic physicians. Scrap the ABMS MOC and look at how we practice now to assure quality and accountability."
MOC: A proposed future
What would be your preference for the future of MOC?
Approximately 55% of participants would prefer that MOC requirements be revoked altogether. Following closely, 48.5% would prefer more continuing medical education (CME) hours replace current MOC requirements.
"There does need to be some demonstration of continued competence. Options should be available. ABFP currently offers one path with equally unhelpful activities in each option. I do learn during my exam prep, but 10 years is too long. The annual MOC is garbage! So maybe a 5-year exam-only option at the same 10-year cost could be an alternative."
"CME requirements for license renewal and MOC are redundant. It should be one or the other. If MOC, then the exam should not be more than $250. If CME is the chosen route, and some argue it varies from state to state, then create a uniform national CME requirement for license renewal."
"CME with small tests yearly, with flexible dates, would be most balanced for many"
"Have multiple, thoughtful paths. I understand that there are logistical issues, but the current process is a farce and a money-making scheme. The prior ABP leaders got in trouble for this and still made out like bandits. They also have a misguided view of MOC, viewing it as punitive rather than a method to benefit both physicians and the public. We just need a new change that isn't developed by greedy cronies."