Editor’s Note: This post about one physician’s experience with ABIM maintenance of certification was previously published in CardioExchange, an online community hosted by the New England Journal of Medicine and NEJM Journal Watch. John E. Brush, MD, is a practicing cardiologist and professor of medicine at Eastern Virginia Medical School.
A petition to recall the American Board of Internal Medicine’s (ABIM) changes to Maintenance of Certification (MOC) has over 17,000 signatures. The petition calls for the ABIM to revert to the old method of simply certifying physicians using a test administered every 10 years.
I didn’t sign the petition, but I am also unhappy. I think the ABIM ought to eliminate the every-10-years secured exam and go with a more continuous testing approach. And I think the whole thing is way too expensive.
I am “grandfathered in” for internal medicine and general cardiology, but not for Interventional Cardiology. I could probably coast to retirement, but I decided to maintain my certification. At the last ACC (American College of Cardiology) meeting, I got started.
First, I went to an MOC session headed by Rick Nishimura and Pat O’Gara on valvular heart disease. I have to say that it was the best learning experience I have had in many years. The case-based format was engaging and the content was skillfully delivered. And I received 10 points of Medical Knowledge MOC credit, as well as CME credit.
Next, I sat down with an ABIM staff member who was available at the ACC meeting to ask about the Performance Improvement Module. I told her that I have worked on quality improvement at my hospital for over 20 years. I attend a monthly committee meeting where we go over a mountain of data pertaining to the quality of cardiac surgery and catheterization laboratory procedures. I said that it didn’t make sense for me to design a little performance improvement project when I was already involved in quality improvement, big time. She agreed and said that, for me, the “Completed Project Performance Improvement Module (PIM)” was the way to go.
I came home and designed my own Completed Project PIM. I had a head start because my hospital participates in the National Cardiovascular Data Registry (NCDR) and I had already signed up for the NCDR Physician Dashboard. So I had ready access to my own NCDR data to use for my PIM.
I went to the ABIM website and found my way to the Completed Project PIM. The website led me to the Measures Library, but also gave me the option to submit my own measures for approval.
If you don’t use measures in the Measures Library, you are required to submit three of your own measures, and these measures require ABIM approval. My measures were:
- Rate of radial access procedures among my patients undergoing diagnostic cardiac catheterization and percutaneous coronary intervention.
- Percentage of my patients undergoing percutaneous coronary intervention (PCI) procedures that were appropriate according to published appropriate use criteria.
- Percentage of my patients undergoing PCI who were discharged on a statin medication.
The NCDR dashboard gave me a ready data source for these measures. Others may want to design different measures, built around the data that are available on the NCDR dashboard or perhaps the PINNACLE Registry. The ABIM requires measurement from two time periods and a minimum of 25 patients.
On the ABIM website, I had to fill in the title and description of each measure and a reference to a guideline recommendation that justified each measure. I filled in the form and submitted my measures by hitting the submit button on the website. In less than 24 hours, I received an email from the ABIM approving them.
The website automatically knew that my measures were approved and it led me to the next step of reporting my results. It asked me a few additional questions, and that was it! All told, over 2 days, I probably put about 3 hours into the activity. With the Completed Project PIM, the ABIM acknowledged that I had already done the work. It was a matter of documenting what I had been doing already.
Let’s face it. The public will always demand that doctors are certified by an independent, objective certifying organization. None of us likes the added work that certification creates, but it is unavoidable. The changes in the ABIM requirements have created a lot of confusion, but the website helps you navigate through the changes, and for me, the ABIM staff was available and helpful.
I would rather have a series of small projects and learning modules, creating an atmosphere of continuous learning and improvement, rather than the big 10-year exam. To me, the petition asked for the wrong thing. I would eliminate the big exam and stick with the other stuff, which isn’t so bad after all.
We look forward to hearing about your own experiences with ABIM maintenance of certification. To find out everything you need to know about MOC, visit our ABIM MOC Requirements page.