So in my last post, I touched upon Maintenance of Certification (MOC).

Now, in the recent news, information came out that the American Medical Association (AMA) has called for an immediate end to the MOC from the American Board of Medical Specialties (ABMS).

Their official stance, as it currently stands, is here on their site.

However, you may notice the language utilized in their official stance is more focused on partnership and improvement of MOC, rather than its immediate end.

After some detective work, it seems that there was a Resolution 39. In order to get that information you must create a log-in and password to access the AMA site and wade through a lot of other resolutions to find this particular (important) one. Credit goes to rebel.md for all of this information.  I am simply providing my own commentary on it.

Excerpt as follows:

“RESOLVED, That our American Medical Association call for the immediate end of any mandatory, recertifying examination by the American Board of Medical Specialties (ABMS) or other certifying organizations as part of the recertification process (Directive to Take Action);
and be it further

RESOLVED, That our AMA support a recertification process based on high quality, appropriate CME material directed by the AMA recognized specialty societies covering the physician’s practice area, in cooperation with other willing stakeholders, that would be completed on a regular basis as determined by the individual medical specialty, to ensure lifelong learning
(Directive to Take Action); and be it further

RESOLVED, That our AMA reaffirm Policies H-275.924 and D-275.954 (Reaffirm HOD Policy);
and be it further

RESOLVED, That the AMA voice this policy directly to the ABMS and other certifying organizations (Directive to Take Action); and be it further

RESOLVED, That there be a report back to the AMA HOD by the 2017 Annual Meeting. (Directive to Take Action)”

*BOLD emphasis is mine

Strong language here. “Immediate end” and “mandatory” are good strong words. “Voice this policy directly” demonstrates that the AMA will take a stand and then “report back to the AMA HOD” demonstrates that the AMA was going to hold itself accountable.

After reading this, I almost considered rejoining the AMA.

However, it was changed significantly to read – Resolution 39 Revised.

RESOLVED, That our American Medical Association call for the immediate end of any mandatory, recertifying examination by continue to work with the American Board of Medical Specialties (ABMS) to encourage the development by and the sharing between specialty boards of alternative ways to assess medical knowledge other than by a secure exam or other certifying organizations as part of the recertification process (Directive to Take Action);
and be it further

“RESOLVED, That our AMA support a recertification process based on high quality, appropriate CME material directed by the AMA recognized specialty societies covering the physician’s practice area, in cooperation with other willing stakeholders, that would be completed on a regular basis as determined by the individual medical specialty, to ensure lifelong learning
(Directive to Take Action); and be it further

RESOLVED, That our AMA reaffirm Policies H-275.924 and D-275.954 (Reaffirm HOD Policy);
and be it further

RESOLVED, That the AMA voice this policy directly to the ABMS and other certifying organizations (Directive to Take Action); and be it further

RESOLVED, That there be a report back to the AMA HOD by the 2017 Annual Meeting. (Directive to Take Action)”

This is a significant change. Instead of taking a stand against the MOC exams, the AMA has decided to “work with” the ABMS. Not very strong.

Fortunately, it was changed back to its initial language. As it stands the resolution states:

RESOLVED,That our American Medical Association call for the immediate end of any mandatory, secured recertifying examination by the American Board of Medical Specialties (ABMS) or other certifying organizations as part of the recertification process for all those specialties that still require a secure, high-stakes recertification examination.

So what does this mean?

Unfortunately, I don’t think it means much. As much as I would love for the AMA to pressure the ABMS and rally the physicians to end certain MOC exams as they currently stand, the fact of the matter is that the AMA just isn’t all that strong when it comes to the ABMS. Since the AMA isn’t a certifying body for any particular specialty, it doesn’t have much power in the the certification or recertification realm. However, this should signal to the ABMS that at the very least, a rather large physician organization opposes MOC exams very strongly. With pressure from multiple fronts including the NBPAS, changes to the Anesthesia Boards, upcoming changes to the Radiology Boards and now AMA opposing the MOC, I honestly think it is just a matter of time before the remainder of the ABMS follows suit.

Which specialty board will be next? When will the last specialty board drop the MOC exam?

Only time will tell.

The important part of all this information is that it shows something very simple:

Historically, physicians as a group have been VERY WEAK politically because of the inherent separation of the specialties. This fact, combined with the need to be competitive to get into and get through medical school, and then get into and survive residency has created a physician culture where we all compete amongst each other... because that is what we have done for the past 10+ years. For this reason, every time a new policy is handed down physicians are consistently “too weak” as a group to fight against any unfair or unsafe legislation.

For the first time in a long time, (maybe ever), physicians as a group have stood up, nearly unanimously against MOC exams… and what happened…?

Changes… Changes are happening… Let’s continue to make them happen.

Now… my question to all my fellow physicians is… WHAT TOOK US SO LONG?

TL;DR

AMA uses strong language against MOC exams, then removes it, then reinstates it again.

The AMA by itself would not be strong enough to stand against the ABMS.

However, with the advent of NBPAS, and other boards already making changes, I think there is sufficient pressure for all the ABMS specialties to get rid of MOC exams.

Which specialty board will be next? When will the last specialty board drop the MOC exam?

For the first time in a long time, (maybe ever), physicians as a group have stood up, nearly unanimously against MOC exams… and what happened…?

Changes… Changes are happening… Let’s continue to make them happen.

Now… my question to all my fellow physicians is… WHAT TOOK US SO LONG?

-Sensei

Agree? Disagree? Questions, Comments and Suggestions are welcome.

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