Marshall Land, Jr., MD, FAAP, presented at the May 3 Hot Topics in Pediatrics Conference about innovations and improvements in maintenance of certification. He asked conference attendees to use notecards to leave him follow-up questions about MOC4. Below are the questions that were posed, and the answers from Dr. Land. (A video of Dr. Land’s presentation is available below the Q and A section.)
Q: MOC is stated as voluntary, yet it is now required for us to continue caring for patients – it’s tied to hospital credentialing and to insurance reimbursement. If we don’t pay it, we can’t practice. Isn’t that extortion?
A: Certification and ongoing certification (MOC) are voluntary. Like all other medical specialties and virtually all other professions, a certification process is in place based on standards of excellence for that profession. Almost all professions have a continuing certification process (such as MOC). As an example, American Airlines pilots are required to maintain their “certification” by traveling to Dallas and participating in 3-day learning and testing activities every 6 months. My cousin, a very experienced American Airlines pilot, needed a medical leave of absence for 12 months for cancer treatment, and now must go back for one month of “re-training” before he’s allowed to fly again. The ABP does not ask hospitals or insurers to require certification (or ongoing certification); that is up to them.
Q: Why must MDs continue to pay to practice medicine? Non-physician providers have no regulatory MOC and are able to practice independently with less than 3 percent of our training. In no other field does this happen.
A: Again, virtually every profession requires maintaining certification within that field. Physicians Assistants, for example, have requirements to maintain their certification every 2 years. Nurse practitioners must renew their certification every 5 years.
Q: Are you grandfathered in and not participating in MOC?
A: Yes, I do qualify for being grandfathered in, but I actively participate in MOC, because I think it is the right thing to do. This winter, I completed my second Part 4 practice improvement project within my current cycle. My cycle does not end until December of this year, but because I have completed my requirements for this cycle, I have already signed up for my next cycle which will end in 2024.
Q: Why are physicians prior to 1988-1993 grandfathered in?
A: The issue of “grandfathering” is a tough one. We do have an awkward situation in this regard, but we are honoring a promise made to those physicians when they were initially certified. We are proud that a large percentage of those pediatricians have voluntarily chosen to maintain their certification; although the number of grandfathered pediatricians is decreasing, the number signing on to participate in MOC is increasing, partly due to the improvements and innovations in the process. All of the over 250 pediatricians who do the work of the ABP, full time or volunteer (around 240 of the total are volunteers), and regardless of whether they are eligible for “grandfathering”, must be maintaining their certification by the same process as all other diplomates; there are no exceptions.
Q: What makes the ABP think that pediatricians will stop “lifelong learning” and why must we continue to pay to be able to practice medicine?
A: The ABP does not think that pediatricians would ever stop lifelong learning; they are the most dedicated group of individuals anywhere. As a certifying organization, the ABP is trying to show the public that pediatricians are keeping up with lifelong learning and practice improvement.
As I answered in a previous question, virtually every profession, medical and non-medical (physicians, physician assistants, nurses, pilots, lawyers, electricians, etc.) requires maintaining certification within that field. The ABP enrollment fee includes participation in MOCA-Peds, as well as access to all ABP activities needed to complete Parts 2 and 4 of MOC at no additional cost.
A word about the cost. The ABP is nonprofit and works very hard to steward the resources we have. MOC is not a “money maker” for the ABP; it actually loses money. The ABP produces over 50 separate examinations as well as many Part 2 and Part 4 activities that can be used to complete MOC for both generalists and sub-specialists. Unfortunately, most of the sub-specialty examinations cannot cover their expenses given the small numbers involved (just 20 or so rheumatology fellows exit training each year for example, but the costs remain the same). Although most people tend to equate the cost of certification and maintenance of certification with the perceived costs of exam development and administration, the fees for certification and maintenance of certification must support all of the Board’s operations of which development of multiple examinations is only one part. These include, but are not limited to development of initial and recertifying examinations in general pediatrics and for each of the 16 sub-specialties; the staff who review eligibility requirements, work with residency and fellowship program directors on details related to resident and fellow tracking, and develop and administer in-training examinations; development of instruments to assess the general competencies of trainees in both general pediatrics and its sub-specialties; examination psychometric analysis; participation in national efforts related to competence, quality improvement, and standard setting; participation in all functions of the Residency Review Committee in Pediatrics of the Accreditation Council for Graduate Medical Education; and membership in the American Board of Medical Specialties (ABMS) just to name a few of the less visible activities.