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Research & Commentary: North Carolina Should Reject Onerous Maintenance of Certification

August 8, 2016

In this Research & Commentary, Matthew Glans examines the numerous problems maintenance of certification is causing in North Carolina and other states nationwide.

There are few who argue against the idea doctors should be required to stay current on all the latest medical developments. However, problems began to emerge when medical boards began requiring additional testing and programs, now known as “maintenance of certification” (MOC). Providing certification for doctors has become a profitable industry for the medical boards administering the certifications.

Many physicians across North Carolina have begun to question the new certification requirements. They argue certifications have become excessive, overpriced, and have become mandatory when they are supposed to be voluntary. In an article published in the News & Observer (Raleigh), Dr. Ghulam M. Shaikh criticizes the new MOC requirements and argues he is far from alone in his concerns: “In my email contacts and survey of more than 150 physicians in Research Triangle Area, not a single physician supports the new MOC requirements. Even the [American Board of Internal Medicine] task force has not supported its own MOC process.”

Several states are now considering legislation to limit or end the use of MOCs. In April, Oklahoma passed a bill that forbids the requirement of MOC as a condition of licensure, reimbursement, employment, or admitting privileges at a hospital in the state. Missouri legislators are now considering a similar but less expansive bill to the one approved in Oklahoma. If passed, it would prevent the state’s oversight board for allopathic and osteopathic physicians from requiring MOC for licensure. The bill also bars the state from requiring board certification or MOC as a prerequisite to practice medicine.

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.

Critics of MOCs argue the new requirements are excessive, costly, time-consuming, and unnecessary. 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.

Shaikh argues the new MOC requirements only seek to enrich organizations such as the American Board of Internal Medicine (ABIM). “On average, internists and [internal medicine] specialists each will spend $23,607 for recertification and, as a group, will spend $5.7 billion over 10 years,” wrote Shaikh. “The question is, will this inflow to ABIM improve quality of care for patients, the quality of life for physicians or just the quality of life of the ABIM staff? The answer is evident.”

The National Board of Physicians and Surgeons has emerged as a result of ABIM’s 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. Oklahoma provides a model other states can follow to end this unnecessary burden on practicing physicians.

The following documents examine maintenance of certification in greater detail.
 

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.

No More MOC: One State Bans the Controversial Credential Requirement—and Others May Follow
https://www.advisory.com/daily-briefing/2016/04/27/no-more-moc
Oklahoma legislators recently passed legislation that removes maintenance of certification (MOC) as a requirement for physicians to be hired, get paid, obtain a medical license, or secure hospital admitting privileges. The Advisory Board Company examines the new law and other similar laws being proposed in other states in this briefing.

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 health care, 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 at https://www.heartland.org/publications-resources/newsletters/health-care-news, The Heartland Institute’s website at http://heartland.org, and PolicyBot, Heartland’s free online research database, at www.policybot.org

If you have any questions about this issue or The Heartland Institute’s website, contact Nathan Makla, government relations manager at The Heartland Institute, at nmakla@heartland.org or 312/377-4000.

Article Tags
Health Care Regulation
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 @HeartlandGR