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Research & Commentary: Michigan Should Reject Maintenance of Certification

June 14, 2017

In this Research & Commentary, Matthew Glans discusses two proposals now being considered in the Michigan Legislature that would limit the influence of maintenance of certification in the state.

Certification has changed significantly since the early 1990s. For decades, doctors were required to take one exam, generally administered immediately after completing their training and education, to prove they were knowledgeable to treat patients. Doctors choosing a specialty field were required to follow this test with another in their chosen field. Physicians maintained their certification by participating in classes and seminars, known as continuing medical education, which provided doctors with up-to-date information on any new developments in their chosen field.

Providing certification for doctors has become a profitable industry for the medical boards administering the certifications. Due to the increased cost of certification, many doctors have chosen to relocate to other states or retire early. Because of these problems, State Rep. Ed Canfield (R-Huron County), a family physician practicing in Michigan, has introduced two pieces of legislation that limits the ability of hospitals and insurers to use maintenance of certification as a reason to place limits on physicians. The first bill would ensure physicians would not need a national or regional certification to get a medical license. The second bill would block insurance companies from refusing to pay or reimburse a claim based on a lack of certification.

Some critics of MOC reform argue hospitals should be allowed to require MOCs if they so choose and that disallowing them to do so is an unnecessary mandate. In a statement to Health Care News, Michigan physician Dr. Chad Savage disagreed with this argument, contending the groups administering the MOCS are not a representative body of a medical specialty. “They are a private corporation that has appointed itself a monopolistic authority over physician board certification.”

In an article appearing in Health Care News, Dr. Meg Edison, a private practitioner in Grand Rapids, Michigan, argues MOCs are now predominantly a money-raising scheme. Many older physicians have even chosen early retirement over the expensive MOCs, Edison reports.

“Realizing they’d make more money if doctors had to maintain certification, some boards introduced the MOC program, which grandfathered certain age classes of doctors and required the younger doctors to keep taking tests, paying more money, and completing research projects,” Edison said. “For those of us who are not grandfathered, if we do not participate in any portion of MOC, we are completely stripped of all board certification, regardless of how many times we have passed the exams, and we are erased from their websites.”

Groups administering MOC programs say they improve health care outcomes, but Dr. Paul S. Teirstein argues in an article published in The New England Journal of Medicine these results are far from clear. “In fact, close examination of the reports cited by the American Board of Internal Medicine reveals that the data are ambiguous at best: in a meta-analysis of 33 studies, 16 described a significant association between certification status and positive clinical outcomes, 14 found no association, and 3 found a negative association,” wrote Teirstein. The National Board of Physicians and Surgeons has emerged as a result of the American Board of Internal Medicine’s excessive MOC requirements.

MOC certifications were designed with the intention of ensuring physicians are educated on the latest health research and methods, not to act as a profit center for medical board organizations. While a certain degree of certification will always be necessary, physicians should not be required to pass through a quagmire of costly and expensive tests that may be unnecessary. physicians.

The following documents examine maintenance of certification in greater detail.
 

It's Time for Change! Conversations About Maintenance of Certification
https://www.msms.org/About-MSMS/News-Media/Michigan-Medicine-Magazine/January-February-2016/Its-Time-for-Change-Conversations-About-Maintenance-of-Certification
In this issue of Michigan Medicine, the authors talk to three physicians about their frustrations with MOC and how this bureaucratic requirement is affecting their practice and patients.

More States Consider Outlawing Forced Maintenance of Certification
https://www.heartland.org/news-opinion/news/more-states-consider-outlawing-forced-maintenance-of-certification
Michael Hamilton writes in Health Care News about the growing trend in many states to prohibit maintenance of certification from being used as a condition of medical licensure or hospital-admitting privileges.

Oklahoma Frees Physicians from Forced Maintenance of Certification
https://www.heartland.org/news-opinion/news/oklahoma-frees-physicians-from-forced-maintenance-of-certification
Jenni White writes in Health Care News about Oklahoma’s recent passage of legislation limiting the power of maintenance of certification, how medical boards can use them, and how several states are considering similar protections. “Oklahoma will become the first state to protect physicians without maintenance of certification (MOC) from losing their licenses, reimbursement, employment, or hospital-admitting privileges,” wrote White.

First State Goes MOC-Free, Others May Follow
http://www.medscape.com/viewarticle/862331
Robert Lowes, reporting for Medscape Medical News, discusses the new anti-MOC laws being considered in several states and how the debate has progressed over time.

Oklahoma Bans Forced MOC, Becomes the First ‘Right to Care’ State
https://d4pcfoundation.org/oklahoma-bans-forced-moc-becomes-the-first-right-to-care-state/
Docs4PatientCare examines a recently passed bill in Oklahoma that ends the forced use of MOCs, a policy they call “Right to Care.”  “In a time when gridlock is a given, MOC is something that unites us all,” wrote authors for Docs4PatientCare. “The funny thing is, this law shouldn’t be revolutionary. It simply legislates exactly what ABMS says about board certification: that it is voluntary.”

Boarded to Death: Why Maintenance of Certification Is Bad for Doctors and Patients
http://www.nejm.org/doi/full/10.1056/NEJMp1407422 - t=article
Paul S. Teirstein argues in an article published in The New England Journal of Medicine against the expansion of MOCs. Teirstein explains how these unnecessary requirements negatively harm the health care industry. “More broadly, many physicians are waking up to the fact that our profession is increasingly controlled by people not directly involved in patient care who have lost contact with the realities of day-to-day clinical practice. Perhaps it's time for practicing physicians to take back the leadership of medicine.”

Negative Secular Trends in Medicine: The ABIM Maintenance of Certification and Over-Reaching Bureaucracy
https://www.heartland.org/publications-resources/publications/negative-secular-trends-in-medicine-the-abim-maintenance-of-certification-and-over-reaching-bureaucracy?source=policybot
Robert M. Doroghazi writes in the American Journal of Medicine about the negative effect of bureaucracy in the medical field. Doroghazi focuses on the many issues created by MOCs: “But I think there is no better example of this trend of ever-expanding, over-reaching, and arbitrary bureaucracy than the recently proposed changes in the Maintenance of Certification (MOC) requirements by the American Board of Internal Medicine (ABIM).”

Maintenance of Certification: Important and to Whom?
https://www.heartland.org/publications-resources/publications/maintenance-of-certification--important-and-to-whom?source=policybot
Paul M. Kempen writes in the Journal of Community Hospital Internal Medicine Perspectives about MOCs, how and why they emerge, and who they truly benefit. “Certification is at best a slight, or possibly false, promise, recently openly admitted by the ABMS: ‘FACT: ABMS recognizes that regardless of the profession – whether it is healthcare, law enforcement, education or accounting – there is no certification that guarantees performance or positive outcomes.’”

The Medical Monopoly: Protecting Consumers or Limiting Competition?
https://www.heartland.org/publications-resources/publications/the-medical-monopoly-protecting-consumers-or-limiting-competition?source=policybot
Sue A. Blevins of the Cato Institute examines the effect of government health care policies on the health care market. Blevins finds licensure laws appear to limit the supply of health care providers and restrict competition to physicians from non-physician practitioners. The primary result is an increase in physician fees and income, driving up health care costs. 

 

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Health Care News, The Heartland Institute’s website, and PolicyBot, Heartland’s free online research database. 

If you have any questions about this issue or The Heartland Institute’s website, contact John Nothdurft, The Heartland Institute’s government relations director, at john@heartland.org or 312/377-4000.

Author
Matthew Glans joined the staff of The Heartland Institute in November 2007 as legislative specialist for insurance and finance. In 2012 Glans was named senior policy analyst.
mglans@heartland.org