If you’re board-certified in internal medicine, you may be surprised to find that after April 30, 2014, you could be listed at American Board of Internal Medicine (ABIM) and American Board of Medical Specialties public websites as “Certified, Not Meeting MOC Requirements.” This reporting status reflects the recent change in ABIM requirements for Maintenance of Certification (MOC). You probably heard that change was afoot but perhaps did not realize how it would affect you.

The key thing to know is that new requirements move ABIM Maintenance of Certification toward a continuous learning cycle. This means that your participation in education activities is required with greater frequency and that you must accrue twice as many MOC points each decade as in the past.

Most physicians, though, should be reassured: Your board certification in internal medicine remains valid, assuming you hold a current and valid license. But in order to be listed as “Meeting MOC Requirements” as of April 30, 2014, certified physicians must be enrolled in the MOC program and pay the enrollment fee (if they have not done so previously). Enrollment automatically changes your reporting status to “Meeting MOC Requirements.” Requirements vary based on your year of certification. To learn specifically how the changes apply to your certification year, see the ABIM website. (ABIM is asking physicians, even those already enrolled, to log in to state which certification(s) they wish to maintain if they haven’t done so in 2014.)

From there, the next important deadline is December 31, 2015. To continue being listed as “Meeting MOC Requirements,” you must complete any ABIM-approved activity by the end of 2015. Each of these activities (which we address more below) starts you earning the necessary MOC points.

Now that you know these two key steps for the near term, let’s look at the bigger picture of what has changed, and why, in requirements for maintaining ABIM board certification.

What Are the Latest Changes in MOC Requirements?

Time-limited certificates in internal medicine began in 1990 and subsequent Maintenance of Certification requirements included holding a current and valid license, self-assessment and practice evaluation, and passing an exam every decade. Until this year, physicians could fulfill all requirements anytime within a span of 10 years. In the past, you were required to pass the recertification exam, and earn 100 MOC points anytime within that 10 years, including at least 20 points in medical knowledge and at least 20 points in practice performance.

Starting in 2014, requirements have expanded for maintaining certification and for being listed as “meeting MOC requirements.” The new requirements shown in red:

  • Earn 100 MOC points every 5 years (instead of every 10 years), the first 5-year period ending in 2018.  The point distribution is the same as before:
    • at least 20 points in medical knowledge and
    • at least 20 points in practice assessment;
  • Earn some points within every 2-year increment
  • Fulfill requirements in patient safety and patient survey by December 31, 2018, and  every 5 years thereafter.

Another change is the public nature of your status:  Whether or not you are “Meeting MOC Requirements” can now be viewed by the public on both the ABIM website and at CertificationMatters.org.

One ABIM board certification requirement that hasn’t changed is the exam. You must pass ABIM’s MOC exam within 10 years from the date of your last successful certification exam. (For those who received a time-unlimited certification prior to 1990, see below.)

Why Did ABIM Change Its Requirements for Board Recertification?

The change in ABIM maintenance of certification reflects an evolution in the medical profession’s approach to lifelong learning: ABIM is seeking to encourage continuous learning and self-improvement, as are other organizations. The change is intended to send a message that reinforcing knowledge only during years 9 and 10 of each decade is not adequate — and emphasizes the importance of setting aside time to learn and review on an ongoing basis as part of practicing medicine.

This shift is partly a response to concerns that prior self-regulation by physicians was inadequate and partly to encourage keeping up with medicine’s ever-expanding knowledge base. It is also an attempt to increase the utility of ABIM certification by aligning it with reporting requirements from payers, insurers, and employers. Although some physicians bristle at the increased effort required by these changes — and evermore oversight — medical leaders have chosen this path to prove that the profession can regulate itself and set its own standards for quality. Read what went into NEJM Knowledge+ Editor Graham McMahon’s decision to recertify in his blog post: To Recertify or Not? Making a Decision about ABIM Recertification.

How Do I Earn Points to Maintain ABIM Certification?

Many options exist for you to fulfill the required 100 MOC points within the next 5 years, with the 20-point minimum each in medical knowledge and in practice assessment and an additional 60 points in either. Although you are being required to earn more points each decade than in the past, opportunities to earn points are increasing. For example, you will accrue 20 points for the first exam you take in a certification area. Other point-earning activities include:

Medical knowledge: You can earn points through self-assessment question modules that are intended to help you understand your own strengths and weaknesses. These are produced by ABIM and increasingly by other organizations (and approved by ABIM). Typically, each module is worth 10 to 20 points, although some large MKSAP modules accrue more points. With NEJM Knowledge+, it is possible to earn up to 80 points, which are automatically submitted to ABIM. New products are being added for new types of learning, including the bite-sized New England Journal of Medicine Interactive Medical Cases, which offer 2 points for each completed case.  

Medical knowledge points can also be earned by attending ABIM-approved learning sessions run by various medical societies, hospitals, and health systems. The ABIM website lists approved modules and a calendar of upcoming sessions. To receive MOC points for non-ABIM products and programs, you must first enroll in MOC.

Practice assessment: This requirement, previously called “practice performance” has intriguing potential benefits but has sometimes been challenging to implement. It aims to engage physicians with continuous improvement of practice. This is done primarily through ABIM Practice Improvement Modules [PIMs] in specific clinical areas and in patient communication. Each module, worth 20 or 40 points, involves physician submission of patient surveys and chart reviews. Typically, these web-based tools guide you through a review of your own patient data and support a quality improvement plan for your practice. An alternative is to participate in quality improvement activities with an external organization that meets ABIM standards for measuring and improving care, listed on the ABIM Practice Assessment Selector Tool.

Notably, MOC points earned through these activities apply to all ABIM certificates that you are maintaining.

How Can I Fit in New Patient Safety and Survey Requirements?

Patient safety: This requirement, which is new in 2014, must be completed by the end of 2018 and again for every 5 years thereafter. Current options to fulfill the requirement are primarily through medical knowledge and practice assessment activities that are also designated for patient safety. You can meet this patient safety requirement while simultaneously earning MOC points. More activities to satisfy the requirement are expected in the next couple of years, according to ABIM.

Patient survey: This requirement, new in 2014, must be completed by the end of 2018 and again for every 5 years thereafter. You can meet the requirement (while also earning MOC points) via any practice assessment activity that includes a patient survey, including most PIMs. ABIM is working on options to survey patients without a full PIM and to include patient surveys already in use in your practice.

What Will It Cost to Maintain ABIM Board Certification?

The MOC program fee for internal medicine increased beginning in January of 2014 to $1,940 for 10 years with an option to pay $194 annually. The new fee covers the cost of one Internal Medicine recertification exam, access to ABIM self-evaluation products, and the cost of any CME credit you claim by using these modules. Physicians enrolled prior to 2014 owe no additional fees until their ongoing 10-year enrollment expires. For most subspecialties, the fee is $2,560; if you are seeking more than one recertification, the full fee is charged for the most expensive certification, and half the fee is charged for each subsequent one.

Additional costs are what you might spend on point-earning MOC activities beyond ABIM’s free modules and the time spent away from practice to participate in these. The cumulative cost of maintaining certification also includes test preparation products and courses and the time spent studying and preparing.

A Note for Fellows

The 2014 changes to ABIM requirements allow current fellows to accrue 20 points automatically for each year of fellowship training and to participate in additional point-earning activities during fellowship. If you are already certified, you can receive a fee credit for each fellowship year. 

A Note for “Grandfathered” Physicians

If you were certified before 1990, your certification continues to be valid indefinitely, as long as you maintain a current, valid license. But as of April 30, 2014, such “grandfathered” physicians are being listed publicly as “Certified, Not Meeting MOC Requirements” unless they complete MOC requirements. These include enrolling in MOC, participating in some MOC point-earning activity every 2 years, earning 100 points every 5 years (with the first 5-year period ending in 2018), and passing the MOC exam by the end of 2023.

Find Out Your Status in Maintaining ABIM Board Certification

To find out where you stand in the MOC program, log in to the ABIM website and view your MOC Status Report, which provides personalized information about what you must do to maintain your certification(s).

While you’re in the mode, put your toe in the water and start earning points with a New England Journal of Medicine Interactive Medical Case.

Further information on changes to the ABIM’s MOC program is available on the ABIM website and on an ABIM summary page created for the 2014 changes.