Raising Issues with MOC

At the recent American Academy of Dermatology (AAD) meeting in San Francisco, Maintenance of Certification (MOC) was a hot topic. According to the AAD website, “Maintenance of Certification (MOC) shifts emphasis away from simply acquiring knowledge to proving competency. In today’s world, learning new information alone is no longer enough—you need to demonstrate that you understand how to apply the knowledge and skills in real-world situations… MOC was also adopted as a professional response to the need for public accountability and transparency in health care. By maintaining ever-evolving high standards for performance and quality care, we increase the level of confidence in patients, other health care professionals, employers, insurers, and government representatives have in our ability to deliver the best care possible.”

Dermatologists Speak Out Against MOC

But not all physicians agree with said benefits. Heidi Waldorf, MD, Associate Clinical Professor of Dermatology, Mount Sinai Hospital, was involved in a grassroots campaign to fight what she describes as “onerous MOC requirements.”

While medicine has been confronted by increasing hoops through which to jump in every area of business, aesthetic specialties have been protected from many limitations from insurance companies and Medicare reimbursement, explains Dr. Waldorf. “One of the benefits of aesthetic medicine, and one of the reasons that so many untrained, non-core physicians and non physicians flock to it, has been its ability to remain partially shielded because these are non-reimbursable, market-driven luxury items. However, we need to realize that we are not safe behind the fortress walls.”

Prior to 1991, board certification was awarded after completing an accredited residency program and passing an exam—similar to a college degree or bar exam for lawyers. Then, a change was made requiring all taking American Board of Medical Specialties board certified physicians to retake the test at intervals to be determined. In dermatology, Dr. Waldorf says, it started as a take-home, open book test every 10 years that was then changed to a closed book exam taken at national testing center. Then requirements increased further with the addition of patient safety, peer review, and patient survey modules, among others. All of these requirements are burdensome in time and money, she says, adding that at the AAD meeting, the MOC courses took doctors away from therapeutic courses.

Dr. Waldorf also notes there is no evidence of any improvement in medical care as a result of MOC, and dermatologists are not the only ones protesting MOC. For example, the American Board of Internal Medicine was sued by its constituents and put new MOC requirements on hold. Meanwhile, an alternate board was created, Dr. Waldorf says, adding that a proliferation of alternative boards will dilute the meaning of ‘true’ board certification.

Dr. Waldorf notes that board certification already indicates that a physician has completed a residency and is specialized, and continuing medical education requirements continue that. In the aesthetic specialties, Dr. Waldorf explains, if the boards force physicians to leave the boards or say that physician specialists are no longer maintaining certification appropriately to be called board-certified, it will be difficult to separate true board-certified specialists from non-core physicians.

“The snowball is already rolling down the hill,” says Dr. Waldorf. “We need to slow its momentum now or never.” (Visit http://www.modernaesthetics.com/tv/ to watch Dr. Waldorf discuss MOC in the most recent episode of Heideas.)

The AAD’s Response

Since the annual meeting, the AAD has issued a statement in response to its members’ concerns: “On your behalf, the Academy Board of Directors sent a letter today, asking ABD to modify current MOC requirements in the following ways:

• Part 1: Evidence of Professional Standing: The Academy recommends no change. This is your state license.
• Part 2: Self-Assessment: Make most ACCME-approved CME count for Self-Assessment. Allow members to report it directly to the ABD through the new Academy online learning system. (CME as we have always done it satisfies Self-Assessment/Part 2 requirements.)
• Part 3: Examination: Change to an open book exam; reconfigure the exam to a “learn to competence model” rather than pass/fail. You can take the exam until you pass if you wish.
• Part 4: Practice Improvement, Patient Safety: Suspend immediately.“

The statement also provided a link to the letter that the AAD sent to the ABD on April 2, and asked that members who support these changes to MOC, contact the ABD and partner with the AAD to help change the MOC requirements.

To read the statement and access the letter, visit https://www.aad.org/education/moc/aad-president-s-message-on-moc. n