Recently, the American Board of Internal Medicine (ABIM) announced a significant change in their requirements for maintenance of certification (MOC). This came in response to long-standing dissatisfaction expressed by MOC candidates.
Feedback from physicians indicate they felt that requirements were confusing, irrelevant, and borderline punitive. They asked for more relevant exam content that would portray a more reliable standard of physician knowledge, as well as options that would work within their practice, rather than take time away from it.
In response to what they heard through surveys, focus groups, and other discussions, ABIM began looking at the options available for MOC, with an eye to revising the requirements and presenting a recertification program that would assure that doctors would stay current with relevant medical information and integrate it into their daily practice of medicine. To come up with a solution that would work for practicing physicians, the ABIM council spent over a year and a half consulting 200,000 ABIM board-certified physicians as well as 27 medical societies. According to ABIM, capturing input from the internal medicine community is an essential part of developing an updated MOC process that would truly meet the needs of doctors (and, by extension, patients).
Short Assessments Unveiled as a Possible Solution
Last month, ABIM announced that they were taking steps to address these issues in their Spring 2017 update: they introduced the ABIM Knowledge Check-In. This new assessment option will allow physicians to take an assessment in their home, office, or testing center every 2 years, rather than one 10-hour exam every 10 years. And rather than waiting for exam results to come in the mail, most MOC candidates will receive their results upon completing the assessment. The requirements would let physicians forego the the long-form exam as long as they passed the assessments.
The ABIM Knowledge Check-In will be available as a pilot program beginning in 2018 for internal medicine and nephrology diplomates. Expansion into all subspecialties will be ongoing through 2020; the tentative rollout schedule can be found on the ABIM website. At this time, physicians whose certification expires in 2017 must continue with the current requirement (the long-form exam) in order to maintain their certification status.
ABIM has a tentative rollout timeline for the Knowledge Check-In as follows:
| 2018 (Pilot) | 2019 | 2020 |
| Internal Medicine Nephrology | Cardiovascular Disease Geriatric Medicine Endocrinology, Diabetes, and Metabolism Gastroenterology Hematology Pulmonary Disease Rheumatology | Advanced Heart Failure & Transplant Cardiology Clinical Cardiac Electrophysiology Critical Care Medicine Hospice & Palliative Medicine Interventional Cardiology Medical Oncology Sleep Medicine Transplant Hepatology |
*Adult Congenital Heart Disease will be available the first year the MOC assessment is offered in 2023.
How the ABIM Knowledge Check-In Works
The ABIM Knowledge Check-In will follow a 2-year cycle, and MOC candidates can choose from a selection of dates to schedule a time that is convenient for them. It is a shorter assessment that will take approximately 3 hours to complete as opposed to the full day of testing required for the long-form exam, and it will be offered 4 to 6 times a year. ABIM’s goal is that with more frequent exams, physicians can be confident that they are staying up to date with the most current, relevant medical information for their practice. The Knowledge Check-In will have more of a continuous learning component, providing information for improvement and remediation following the assessment. To maintain certification, physicians can choose to take the Knowledge Check-In every 2 years, or continue taking the long-form exam every 10 years.
The Knowledge Check-In is also a lower-stakes assessment experience. Physicians do not need to pass every Knowledge Check-In to maintain certification. However, if they fail the assessment twice in a row or do not take the assessment every 2 years, they will need to take and pass the 10-year exam to maintain their certification.
The cost of the MOC process for diplomates has been another major concern for candidates, and ABIM has responded with revisions to the MOC model. Although the costs for the 10-year assessment will likely stay consistent with current levels, ABIM will be introducing additional payment options to lessen the burden on candidates. ABIM has not finalized the fee for participating in the Knowledge Check-In program, but it announced that it will release details in fall 2017 so that candidates have time to plan for the rollout of the assessment pilot program.
For the initial rollout in 2018, there will be no consequences for physicians who do not pass the assessment. This means that if physicians pass the 2018 ABIM Knowledge Check-In, it will be considered a pass, but if they fail, this round will not count and they will have a clean slate to retake the assessment in 2020. The pilot program will enable physicians to try this new option free of penalty, so that they have an opportunity to adapt to the revised process. ABIM hopes that presenting the initial assessments free of consequence will prompt more physicians to take them as practice, which will provide information that ABIM can use to evaluate the process and make adjustments for future assessments if necessary.
Other Changes to the ABIM MOC Process
In addition to rolling out the shorter assessments every 2 years, ABIM is considering several other changes to MOC to make it a more flexible, relevant process for physicians. For example, ABIM is revising the 10-year exam to ensure that it will be more applicable to physicians’ daily practice of medicine. Some other changes include:
- Introducing an open-book element to the ABIM exam that occurs every 10 years
- Introducing an open-book element to the 2-year Knowledge Check-In assessments
- Making assessments more focused, with deeper, practice-related topics rather than wide, general knowledge in each discipline
Has ABIM addressed physicians’ concerns with a process that maintains high standards while providing a learning and assessment process that is less burdensome, yet more effective?
A day late and a dollar short! Whole MOC business is a political get rich scam. Nobody pays attention to it anymore. American College of Physicians has become totally irrelevant.
Agree completely with Jack Shapiro’s comment. You can try and put lipstick on a pig, but it’s still a pig.
The ABMS Maintenance of Certification (MOC) program lost all credibility with practicing US physicians in late 2014 with the revelation that the ABIM Foundation, created (we were told) to “define medical professionalism,” purchased a $2.3 Million condominium complete with a chauffeur-driven Mercedes S-class town car for itself with our testing fees in December 2007. From there the money trail was followed and the multiple conflicts of interest of the MOC program exposed. No longer will physicians roll over to the endless propaganda used to assure the handsome salaries, condos, spousal travel , health club memberships, and multi-million dollar golden parachutes by the ABMS, their member boards, and our professional specialty societies in the name of “public good” masquerading as “professionalism.”
MOC has never been independently proven to improve patient care safety or quality above and beyond lifetime certification. Furthermore, MOC’s adverse financial and psychological effects on capable practicing physicians who fail recertification have never been studied. Do we care less about physicians and their patients than an altruistic educational vision?
It seems so.
MOC’s far-reaching and extensive financial conflicts of interest as our ever-changing “certification status” data are sold to third parties is self-serving by the ABMS and their member boards and exploits hard-working physicians. ABMS Solutions, LLC in Atlanta, GA – a wholly-owned subsidiary of the ABMS – has never been disclosed as a conflict in the literature that supports MOC, including articles published in the New England Journal of Medicine. Instead, physicians who bring this conflict to the attention of the editors receive emails stating “we have no comment at this time.”
The ongoing conflicts of interest between the ABIM, ABMS, National Quality Forum, and National Committee on Quality Assurance are too large to ignore any longer. IRS tax form discrepancies, Cayman Island investments of the ABIM Foundation, and the use of a convicted felon from 2008-2017 to serve as “Director of Investigations” by the ABIM/ABMS to protect their educational monopoly, to name a just few more conflicts, are now common knowledge.
For all these reasons and the integrity of medical education in the US, it’s time to end MOC, not modify it. The Massachusetts Medical Society should end their expensive Knowledge+ product for these reasons as well.
Well said
Thank you to DrWestby Fisher for his excellent summary of why the MOC is just simply a farce and unproven to show any benefits and instead it is an absolute unnecessary financial scam perpetuated on physicians ! After I was forced into my first MOC I resigned from all the useless medical societies that I had been paying yearly dues because none of them stood up for us doctors and instead were simply in cahoots with the ABIM and charging fees in the name of MOC modules. In all the years before MOC us physicians in USA have provided excellent care with CME requirements alone and suddenly has the standard of care gone up since cumpulsory MOC ? I don’t see any difference ! I am sure they can show some idiotic studies they want us to believe just like all the wonderful studies in journals that have been convieniently skewed to leave out any undesirable data . STOP THE MOC – Physicians will continue to provide excellent care as we have always in all the years without it !
Agree with Dr W Fisher’s comment regarding knowledge + outrageous fees thats why less n less physicians participating. Very unfortunate.
I agree MOC should end for reasons stated and more.
Medicine has too many hurdles that distract from our work and this shameful effort of physicians unscientifically creating false certifications MUST end.
I agree. No to MOC; Unnecessary, redundant, too expensive, taking away just the very small amount of time left for a rest/stay with family.
CME is totally sufficient.
Abim is a scam. All You need to practice medicine is a residency certificate, state license and dedication. Everything else is bogus. Not a single study confirms a benefits of MOC. Abim should be sued.
Agree with all the above comments. I have earned my license to practice medicine, by the tests and the training, and earned my Board Certification as well. I keep up to date with Continuing Medical Education. My Patients are well taken care of, and they are almost always appreciative and some even say, Dr. Ali you are so thorough, in fact you are the only doctor that is so through that I have been examined by. Some even say Dr. Ali the way you talk to the patients, is so therapeutic in and of itself. Many of my diabetic patients start have not only good control but also reduction in medication. YET ABIM lists me as Board Certification : No. This is just a ploy to charge all the doctors, Forcing us to take the Recertification. CME should be good enough for us, and our dedication to excellence in patient care. That is the reason I took the ABIM exam in the first place. If I knew I would be listed as non certified, then I would never have taken the Boards in the first place.
I wonder why those so called honorable members of the board of Medicine do not say OK. well your licensing exam is not valid anymore, you need to take it every 10 yrs. And they might as well do it, learning from the ABIM. That is all so ridiculous.
Licensing Exam, Board Exam and then continuing medical education should be enough. So please now return my status to Board Certified again. Thank You Very Much.
ABIM MOC 2 year check in is shameful. So now I need to spend 3 hours every two years for ten years on examinations? 5 examinations in 10 years @ 3 hours = 15 hours vs one 10 hour examination. How is this less of a a time suck on my practice and family life? I know they need the S class chauffeured Mercedes but perhaps just let me pay $$$ and forget the bogus testing?
I took and passed the ABIM certifying exam in September 1991, As fate would have it, this was the inaugural year that the vaunted MOC would be imposed in 2001 (see Murphy’s Laws). The year 2001 came and went with absolutely no fanfare. Because none of my positions or affiliations required recertification, the MOC literally dropped off my radar. As the next 17 came to pass, I migrated from ambulatory care medicine to the hospitalist arena during which recertification evolved into a requirement for employment.
I purchased MKSAP 17 in December 2017 and began studying in earnest last summer in preparation for the fall 2018 MOC exam which I took on 26 October, During said preparation I left no stone unturned. Every MKSAP 17 product was gleaned with the proverbial fine tooth comb. In my opinion, the ABIM is the undisputed authority in evidence based medicine and current standards of care, I was pleased to find that my fund of knowledge was more than adequate albeit not entirely up to date. Overall MKSAP 17 was a superlative teaching and learning experience.
All this being said, the MOC exam itself, particularly its administration, was considerably less than satisfactory. During the week preceding the exam, I carefully perused every web site pertaining to the test taking process including the blueprints, formats, what to expect at the test center, etc
Much to my complete and utter dismay, I did not realize the exam was open to UpToDate until the long exhausting day of testing was 20 minutes short of its conclusion. The security at the testing site was so stringent I half expected a full cavity search. When I saw the UpToDate moniker appear before the very first question on the exam I was perplexed, to say the least. Was this some kind of stratagem designed to tempt and snare cheaters. Because I had thoroughly prepared for 3 months and had a very long day of testing in front of me, I gave the matter no more consideration until I was proofing the final 2 hour segment of the exam.
I was mystified about a question that was posed on the previous exam segment about a patient who presented with a plethora of neurologic abnormalities most notably a bilateral cranial nerve VII palsy. Out of shear curiosity I hit the UpToDate button. When no alarms sounded I proceeded to type in bilateral cranial nerve VII palsy and quickly found said palsy to be a late CNS manifestation of Lymes Disease. Talk about minutiae?
The realization that I had free access to UpToDate throughout the entire exam proved to be a powerful emetic! I was horrified! How could I not know this? Maintenance of what? Had I known this going in I would not have studied so diligently. As a result I would have learned next to nothing. I could go on and on…..Suffice it to say that this MOC was a travesty, a very expensive travesty.
Looking for anyone else who has had issues with the proctored exam from their home setting. Just today I was 14 minutes short of finishing (with 10 questions, yes I am slow), when screen went white with large Failed error message across including the PearsonVue website. Still had proctored box up. Typed for help. Waited 6 minutes. (Watched time as wasn’t sure if I was going to get time back). Advice from Pearsonvue was to log out of PV proctor and exam and log back in. Explained I wasn’t comfortable with that. They replied they had this logged and would be able to refer back to that. Ended up not being able to get back into exam. PearsonVue said exam marked complete. ABIM “investigating.” Not sure if others have heard of difficulties with taking this at home.
As an Oncologist NCCN guidelines have to be followed to get any chemotherapy approved by insurance. Every day tons of immunotherapies are coming. We have to be uptodate to practice . We do not want an exam on top of it. What about the grand fathered physicians? They don’t need exams. How are they practicing? If they are uptodate why not us? Where is the time for our families? Paper work, dictations, insurance peer to peer, phone calls, emergencies, tumor boards, on call Isn’t this enough? CME’s are enough. Every 2 yrs now? Please do a study on physician stress and Boards. We are also human don’t forget that. Excellence is second nature to become a physician. We don’t need an exam to evaluate us. We can not survive in practice if we don’t keep up with the subject. Please let us take care of our patients. Give us time for our personal life at least in our 5 th decade.Stop the MOC. CMES are the way to go. Help us do what we love. Don’t let us hate what we do by these exams so you can enjoy your vacations at our cost.
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