PracticalDermatology

Dermatologists in 2015 stepped up their opposition to Maintenance of Certification (MOC) requirements, with a grassroots campaign at this year’s AAD Annual Meeting where dermatologists called on the Academy to halt MOC implementation. A subsequent campaign begun by H. L. Greenberg, MD this fall, seeks signatures from dermatologists in order to require the AAD to amend the AAD and AADA bylaws to end Maintenance of Certification (MOC) and recertification for dermatologists.

In the October edition of Practical Dermatology®, Dr. Greenberg penned a commentary about MOC in dermatology, and Chief Cosmetic Surgery Editor Joel Schlessinger, MD wrote about a need for greater transparency around the issue.

Their comments drew reactions from readers. Read on to see what respondents said.

I’d like to respond to the article titled “When is it enough?” in Practical Dermatology by Dr. Greenberg. I agree wholeheartedly with the opinion of Dr. Greenberg and was more than delighted to discover I am not the only doctor with a strong negative opinion of the requirement for MOC. I find this MOC requirement to be ludicrous; and yet another form of gross financial extortion from yet another non-medical governing body.

By no means is MOC a fair, accurate, or justified method of measuring physician quality of care. I would happily join forces with any group willing to protest and abolish the MOC.

The insurance companies and Medicare system, as well as our over-inflated litigious society, have already made practicing high quality medicine nearly impossible for physicians. So I beg these non-medical governing bodies to keep their greedy hands out of medicine and what you think is best for doctors. The one board certification we receive is more than sufficient to be career-long certification.

The MOC is not in the least an accurate measure of quality healthcare. Quality healthcare is measured in such a large variety of ways and is a matter of personal opinion from every patient out there. So leave it to the patients, and to the free market, to decide which doctors give good healthcare, and abolish the MOC completely! 


—Leslie Stapp, DO

In response to your October 2015 Practical Dermatology Viewpoints essay...You’ve got my vote!  Thanks for standing up to represent us in the MOC debate. From where I sit, it seems my colleagues are generally more than competent, and the MOC is a waste of our valuable time—time that we are desperately seeking to take care of patients who may be waiting months to see us. 

Can this really be in the best interests of the public?  I would certainly like to see objective evidence that MOC is linked to higher quality patient care if I’m going to spend all that time (and money) pursuing it. Again.

Too bad we aren’t instead directing our efforts to the real barriers to excellent patient care: the manpower shortage in our specialty, the shortcomings of EMR, avoidance of medical errors, tort reform, physician burnout, the misguided “meaningful use” regulations, medical education reform, health literacy, skin cancer screening, and treatment guidelines that make sense, etc. 

The demands that have been placed on dermatologists (and other physicians) over the past 20 years, including MOC, are numerous and outrageous, and frankly feel like harassment to me. It’s about time we speak out. By definition, a professional is someone who is highly trained, self-regulating, and ethical. Having us jump through a set of arbitrary and unproven hoops annually is demeaning, demoralizing, and infuriating.  

Kudos also to Joel Schlessinger for his editorial!

—Jennifer Goldwasser, MD, FAAD

I think board certification in dermatology should be for life. We paid our dues and to allow some to be grandfathered in isn’t fair. Who decided the cutoff date? Obviously, someone who doesn’t ever have to take exam again. Why do I have to worry about retaking the exam while trying to handle my busy practice that has been successful for 17 years?  It is totally unfair.

The MOC requirement is ludicrous and I haven’t had time to even do it.  I do meetings and get my required CME credits to maintain my license. That should be sufficient to maintain my board certification in derm. I have taken the recert exam once and passed for a second time. How many times do we need to take it to show expertise in dermatology?  

I read journals, attend meetings and talk with reps and read other materials to stay updated in dermatology.  Please continue to help fight the recertification exam. It is so unfair.  

—Sabrina Dowd, MD

It was nice to read two brief articles in support of changing MOC for dermatologists. I have always thought this to be an unnecessary burden with regards to time, money, and stress.  In what other profession do they require this?  We have to maintain CME for licensure...is that not enough?  I have to be a student my entire career?  This is just a way to get money and maintain the organizations that support these programs. It is time that we physicians band together to say enough is enough.  MOC should be eliminated altogether or made voluntary.  

—Lawrence A. Schiffman, DO

I can answer the survey on page 42 of Oct 2015 Practical Dermatology:

1. Yes

2. NO

3. NO

And I agree with the author that costly yearly maintenance fees are extortion. I would like to see a financial report of ABD and think I deserve to, since I pay into each year. What in the world are they doing with all this money?

—Elizabeth Rostan, M.D.

I agree completely with Dr. Schlessinger’s editorial about MOC. I had a similar experience when I responded to the ABD’s survey on the MOC exam. I found the survey questions confusing and very narrow. The survey in my opinion did not measure how I felt about MOC.

In my opinion trying to work with the ABD to reform MOC is not going to get us anywhere. The bottom line is we are all in a subordinate position in our relationship to the ABD, and they know it. The board also knows they do not have to be accountable to anyone and have demonstrated their satisfaction with the status quo.

I hope the AAD provides an alternative to the ABD so there will be a choice in how members can continue to be recognized as being component dermatologists. Thank you for listening. n

— Darnell Martin-Wimmer, MD, FAAD