The need for lifelong learning is inherent to the medical profession. Historically, there was limited oversight on physician training and no clear way to distinguish whether a physician had achieved proficiency in medical assessments and treatments. In the early 20th century, groups of physicians came together to promote advancements in medical science and to identify the boundaries that define specific specialties. In 1917, ophthalmology became the first officially incorporated board, followed by the American Board of Medical Specialties (ABMS) in 1933 and the Bureau of Osteopathic Specialists (BOS) in 1939.
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Board certification has long been held as the traditional measure of professionalism, the highest standard of care, and an indicator that a physician is committed to excellence. However, over the past 30 years, increased supervision, regulation, and mandates from medical certification bodies have grown in scope and intensity. For example, the ABMS developed Maintenance of Certification (MOC) modules along with standardized testing in 1990. The American Board of Internal Medicine (ABIM) replaced lifelong board certification with a 10-year MOC in 2000. But as the requirements for certification and associated costs have continued to rise, have these requirements been proven to be beneficial to overall quality of patient care?
Despite limited data on improved quality of care associated with periodic testing for board recertification and MOC or Osteopathic Continuing Certification (OCC), board certification or board eligibility is now the standard for employment. Their requirement contributes to increased costs associated with medical care and decreased time physicians are available to care for patients.
2 Physicians are concerned that the modules are costly and cumbersome, and they are burdened by data entry sets.
3 Furthermore, as national and state continuing medical education (CME) requirements meet or exceed those of the MOC and OCC modules, the modules have become redundant. The fact that these modules are tied to board certification also allows them to potentially be tied to licensure, hospital privileges, and insurance payments.
Other specialty boards, such as the National Board of Physicians and Surgeons (NBPAS), the National Board of Osteopathic Physicians and Surgeons, the Association of American Physicians and Surgeons, and the American Board of Physician Specialties (ABPS), arose in response to or have pushed against these added requirements. The discourse and competition from these entities has led to closer scrutiny of existing medical examination boards and has spurred greater scrutiny from the certifying boards themselves.
This article examines the process of MOC and OCC, the impact of MOC/OCC on physician performance and patient care, potential changes to MOC/OCC, and the impact of emerging boards on the process of certifying professional excellence and improving patient care.
While the regulatory boards are contemplating changes, recommendations should be made to continue with certification examination for initial board certification, end the 6- to 10-year mandated examinations in favor of more frequent and more focused online testing, and have physicians complete mandatory hours of specialty-specific CME.
Specialty colleges should require online lectures and posttesting in dedicated topics as determined by each college in addition to broad-based CME. Because requiring MOC and OCC with CME hours is redundant, the fourth component, quality metric modules, should be eliminated. By doing so, this will better use physician time while promoting continued improvement in patient care and outcomes.