Since 2001, ASH has challenged the American Board of Internal Medicine (ABIM) on its Maintenance of Certification (MOC) program, citing a lack of evidence for the value of MOC. On February 3, the ABIM announced a number of changes to its MOC program in response to the wave of backlash it experienced from ASH and other groups in response to the changes announced last year. In a letter addressed to the internal medicine community, ABIM President and CEO Richard J. Baron, MD, opened with a straightforward apology: "ABIM clearly got it wrong. We launched programs that weren't ready and we didn't deliver an MOC program that physicians found meaningful. We want to change that."
"I am extremely proud of ASH's role in communicating our members' concerns to ABIM," ASH President David A. Williams, MD, told ASH Clinical News. "The Society took a principled position, raising a series of concerns in a letter to the ABIM 14 years ago, and we have continued to press for change."
The changes to the MOC program announced in 2014 included moving the once-every-10-years MOC program to a more continuous one, requiring physicians to complete some MOC activity every two years and accrue 100 MOC points every five years. Under the new program, physicians failing to do so would be reported as "not meeting MOC requirements."
Not surprisingly, those requirements were met with much controversy, as evidenced by an anti-MOC petition started in March 2014 (currently signed by more than 22,000 physicians) and another 7,000+ pledging "non-compliance" in protest of the MOC changes.
"This change generated legitimate criticism among internists and medical specialty societies," Dr. Baron wrote in the press release from ABIM. "Some believe ABIM has turned a deaf ear to practicing physicians and has not adequately developed a relevant, meaningful program for them as they strive to keep up to date in their fields."
What Do These Changes Mean for Clinicians?
In response to those concerns, ABIM announced the following changes to its MOC program on February 3:
- Effective immediately, ABIM is suspending the Practice Assessment, Patient Voice and Patient Safety requirements for at least two years – meaning that no internist will have his or her certification status changed for not having completed activities in these areas for at least the next two years.
- Within the next six months, ABIM will change the language used to publicly report a diplomate's MOC status on its website from "meeting
MOC requirements" to "participating in MOC." (Dr. Baron did note that, because the changes being made are significant, it will take time until providers' individual status pages to be updated on the ABIM website.)
- ABIM is updating the Internal Medicine MOC exam. The update will focus on making the exam more reflective of what physicians in
practice are doing, with any changes to be incorporated beginning fall 2015, with more subspecialties to follow.
- MOC enrollment fees will remain at or below the 2014 levels through at least 2017.
- By the end of 2015, ABIM will assure new and more flexible ways for internists to demonstrate self-assessment of medical knowledge
by recognizing most forms of ACCME-approved Continuing Medical Education.
"While ABIM's Board believes that a more-continuous certification helps all of us keep up with the rapidly changing nature of modern medical practice, it is clear that parts of the new program are not meeting the needs of physicians like yourself," Dr. Baron concluded. "We got it wrong and sincerely apologize. We are sorry."
The ABIM has also pledged to work more closely with medical societies and diplomates to open up the lines of communication regarding the MOC program, via meetings, webinars, forums, online communications channels, surveys, and more.
ASH Continues to Advocate for Its Members
When the sweeping changes to ABIM's MOC program were announced last year, ASH ramped up efforts to make sure its members' voices were heard.
In March 2014, the American College of Physicians (ACP) convened a meeting of internal medicine and subspecialty societies. The ACP then
presented the ABIM with a letter, co-signed by ASH, outlining concerns and recommendations discussed during that meeting, including:
- Proving the benefit of MOC
- Increasing financial transparency
- Streamlining the approval process for societies' Part II products
"While action taken by ABIM this week marks a critical first step toward addressing the concerns voiced by ASH, several additional steps
must be taken by ABIM and other Boards requiring MOC, including moving away from a closed-book examination delivered in a secured
location to an examination experience that reflects current access to medical information," Dr. Williams said in a statement. "ASH also
believes that steps must be taken that recognize the unique contributions and circumstances of physician scientists. ASH looks forward to working with ABIM as it makes these important changes to the recertification program."
MOC issues will continue to be a hotly debated issue, and ASH will continue to advocate on behalf of its ABIM-certified members through multiple channels.