Policy Diagnosis: ‘Maintenance of Certification’ Bleeds Doctors and Patients
Dr. Paul Teirstein explains why doctors are rejecting 'maintenance of certification' in a dozen states and trying to get lawmakers to do the same.
Editor’s Note: At least 12 state legislatures have pending legislation to prohibit state medical boards from requiring physicians, as a condition of medical licensure, to fulfill maintenance of certification (MOC) requirements set by the American Board of Medical Specialties (ABMS) and its affiliates, the largest of which is the American Board of Internal Medicine. Some of the bills also would prohibit insurers and hospitals from requiring MOC from doctors under contract.
Health Care News Managing Editor Michael Hamilton asked Dr. Paul Teirstein, president of the National Board of Physicians and Surgeons, which offers a certification alternative to ABMS’ MOC, why doctors are asking lawmakers for help.
Hamilton: How did medical board certification arise, and why don’t doctors object to initial certification?
Teirstein: Most people don’t realize board certification has nothing to do with licensing and nothing to do with the government. Board certification is an add-on to your medical license. All doctors go to medical school, take a few tests, and get licensed by the state, not the federal government.
About 90 years ago, the first board certifications came along because some physicians felt the public needed more than a medical license to distinguish a good physician from an average, or maybe even poor, physician. That’s how the idea of being certified, particularly in a specialty, came to exist. The biggest part of certification is extra training. There’s nothing wrong with that. Most of the doctors think that’s a pretty good process.
Hamilton: How has MOC, unlike initial certification, grown cumbersome?
Teirstein: In 1990, the boards decided not to issue one-time certification. You have to prove you’re keeping up with changes in medicine by taking a test every 10 years, which really doesn’t mean a lot to the physicians or to their patients. After practicing for 10 years, doctors tend to be very specialized. The boards give a generalized test, which requires spending a lot of time away from your practice, studying things you don’t do and that aren’t relevant.
Doctors don’t feel this recertification, this repeat test, has any impact. It doesn’t make them better doctors or prove they remain competent, because the test is testing the physician on aspects of medicine they no longer participate in. Two years ago, the boards decided they want us to take tests every two years.
Hamilton: What does MOC cost doctors, and where does the money go?
Teirstein: I personally objected to the time [required], and that’s how I got involved with this. I sat down to do the new strategy of maintenance of certification and thought, “This is a ton of time they want from me. I can’t just knock this out in two hours. I’ll have to spend 10, 20 hours every year doing this.” For someone like me—I’ve got three boards—they would cost about $400 to $500 a year in direct costs to take the tests.
When I looked a little closer, I found out the organization offering the test is bringing in nearly $60 million a year, and of that, $26 million in 2014 came from these repeat tests. The last president of the organization made more than $1 million a year. The current president makes more than $800,000 a year. There’s many other highly paid folks with nice jobs, and the doctors are running around like rats on a treadmill, trying to bone up on subjects they don’t use or need to use, to satisfy this test.
Ultimately, it’s hard not to believe that the main motivation is to continue to feed these private companies revenue. That’s what’s really got the doctors upset.
Hamilton: Why does your organization support state continuing education requirements for medical licensure but oppose ABMS’ MOC process?
Teirstein: Several studies have looked at MOC and patient outcomes, and they do not find any difference in patient outcomes. That makes a lot of sense to those of us who have to actually do the MOC.
Physicians in every state are required to do continuing medical education, which we believe is the right way to do this. That’s how you stay abreast of current knowledge. You pick the continuing medical education courses that relate to your practice.
Hamilton: What recourse do doctors have in states without legislation protecting doctors who forego MOC from discrimination by insurers and hospitals?
Teirstein: They can just not take them, and they can also remain certified by the board we started, the National Board of Physicians and Surgeons. All you need is to have done the initial certification and do continuing education. But the problem they will have is many insurance companies and hospitals require the physicians under contract with them to be certified by this older board, ABMS.
That will impair their ability to take care of patients, if they don’t jump through the hoops and do what we consider to be “make-work,” meaningless work that these certification boards require.
Michael T. Hamilton (firstname.lastname@example.org) is a Heartland Institute research fellow and managing editor of Health Care News, author of the weekly Consumer Power Report, and host of the Health Care News Podcast.
Matthew Glans, “Research & Commentary: Tennessee Should Reject Maintenance of Certification,” Research & Commentary, The Heartland Institute, March 22, 2017: https://www.heartland.org/publications-resources/publications/research--commentary-tennessee-should-reject-maintenance-of-certification
Jenni White, “Oklahoma Frees Physicians from Forced Maintenance of Certification,” Health Care News, The Heartland Institute, June 6, 2016: https://www.heartland.org/news-opinion/news/oklahoma-frees-physicians-from-forced-maintenance-of-certification
“Organized Opposition to Maintenance of Certification Is Expanding,” Docs4PatientCare Foundation, September 4, 2015: https://d4pcfoundation.org/organized-opposition-to-maintenance-of-certification-is-expanding/
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