“We got it wrong and we’re sorry.”

Yesterday, the American Board of Internal Medicine (ABIM) announced on their website and via an email to their diplomates that they are making immediate and substantial changes to their MOC requirements, including the suspension of Part 4 (practice assessment requirement), a coming expansion of Part 2 (self-assessment options), and changes to the MOC exam this fall. Here are the highlights:

Suspension of Practice Assessment, Patient Voice and Patient Safety Requirements for at Least 2 Years

Effective immediately, ABIM is suspending the Practice Assessment, Patient Voice, and Patient Safety requirements for at least two years. This means 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.

“Practice assessment” is also known as “practice improvement,” and typically makes up the bulk of Part 4 activities. If you are currently not certified only because you have not completed the practice assessment requirement – but have met all other Maintenance of Certification requirements (enrolled in MOC, completed 100 points with at least 20 medical knowledge points, passed your certification exam in the past 10 years), you will be issued a new certificate this year.

Change of Language Around “Meeting MOC Requirements”

The much-criticized language used by ABIM on their website to publicly report a physician’s MOC certification status is being changed; this change will take effect within the next 6 months. Rather than reporting a diplomate’s MOC status as “meeting MOC requirements,” ABIM will report the physician as “participating in MOC.”

Updates to the Internal Medicine MOC Exam

According to ABIM, the updates to the exam will take effect in the fall of 2015 and “will focus on making the exam more reflective of what physicians in practice are doing.” ABIM is reviewing the internal medicine MOC exam blueprint and will seek ongoing feedback from ABIM board-certified internal medicine practitioners via a structured review process. Changes to additional subspecialty exams will follow.

MOC Enrollment Fees

MOC enrollment fees will not increase beyond 2014 levels through at least 2017. This applies to both annual and 10-year fees.

More Flexibility in Demonstrating Self-assessment of Medical Knowledge

ABIM states that they will expand the pool of Part 2 options by recognizing most forms of ACCME-approved Continuing Medical Education by the end of 2015.

ABIM is working toward recognizing most forms of CME as fulfilling ABIM’s MOC expectations for knowledge self-assessment and we expect much more of what you are doing to be recognized for MOC later this year. We are absolutely interested in finding ways to recognize meaningful clinical work that you do in your practices to earn CME points, and we’re particularly interested in recognizing CME activities for which there is evidence that they drive learning and/or change practice. Many forms of “passive” CME do not meet this standard.

This opens the door for a marketplace of more broadly available opportunities to meet MOC requirements. These offerings, however, will need to conform to quality standards that are yet to be defined.

Leading Up to Changes in MOC Requirements

At the beginning of 2014, ABIM expanded the MOC requirements for internal medicine physicians. These new requirements were met with increasing and vocal opposition from physicians, including the launch of a petition in March 2014 calling for a rollback of the changes.

Throughout 2014, ABIM worked to respond to internists’ concerns. They released a statement in April in response to the anti-MOC petition; issued an open letter to medical societies on July 10 to further respond to concerns; convened a meeting in mid-July at which representatives from 26 medical societies gathered to share their thoughts regarding MOC; and followed this up with an additional open letter, as a formal response to concerns about MOC requirements that came out of the meeting.

ABIM’s proposed steps toward change and its responses to organized opposition during the past year did little to quiet the storm of objections, which led to their announcement of changes to the Maintenance of Certification program.

The Long View

It’s not clear what will happen with the now-suspended practice assessment, patient voice, and patient safety requirements. In addition, exactly how the self-assessment options will expand and the exam will evolve remain to be determined. But ABIM appears determined to engage its diplomates more in the shaping of MOC:

ABIM is changing the way it does its work so that it is guided by, and integrated fully with, the medical community that created it. However, I know that actions will speak louder than words. Therefore, ABIM will work with medical societies and directly with diplomates to seek input regarding the MOC program through meetings, webinars, forums, online communications channels, surveys and more. The goal is to co-create an MOC program that reflects the medical communities’ shared values about the practice of medicine today and provides a professionally created and publicly recognizable framework for keeping up in our discipline.

What are your thoughts about ABIM’s announced changes to MOC requirements? Will it alleviate some of the stated concerns of physicians? Is it a step in the right direction? Let us know by commenting below.

ABIM Changes MOC Requirements — More Information

For more information about ABIM’s changes to MOC requirements, read the ABIM announcement. You can also check out the MOC FAQ on ABIM’s website.

More from NEJM Knowledge+ and the Learning+ Blog:
We’ve been bringing you updates throughout the year about ABIM’s changes to MOC requirements, responses from the medical community, and related stories:
ABIM MOC Petition Reveals Escalating Debate Among Physicians
ABIM Responds to Concerns About Maintenance of Certification Requirements
ABIM Pass Rates: Behind the Declines
ABIM Results Decoded
JAMA Webcast Discusses New Research into Relationships between MOC, Health Care Quality, and Costs

From the New England Journal of Medicine:
Two Perspectives were published on January 8, 2015:
Maintenance of Certification 2.0 — Strong Start, Continued Evolution
Boarded to Death — Why Maintenance of Certification Is Bad for Doctors and Patients