Wednesday, January 16, 2013

Is Maintenance of Physician Board Certification a Sham?

Over the last few years, medical specialty boards have begun to compel physicians to maintain board certification by a number of means. This is an extension of recertification requirements which have been in existence since the mid-1970s.

Here is what the American Board of Surgery (ABS) mandates for Maintenance of Certification (MOC) every three years except where noted:

1. You must have an unrestricted medical license, hospital privileges in surgery, and references from the chief of surgery and the chair of the credentials committee of your hospital. It’s hard to argue with the need to have a license and practice in a hospital. However, if a surgeon had real quality issues, shouldn’t they have come to light before the end of a three-year cycle of MOC?

2. You must document 90 hours of CME credit, 60 of which must include some sort of Q & A testing which must be passed with an average score of at least 75%. I have previously blogged about the inadequacy of most CME programs. Even CMEs that require testing are often laughably simple. The American Board of Internal Medicine offers (for a price) open-book and Internet-based courses. Regarding self-assessed CMEs, the ABS website states, “[t]here is no required minimum number of questions and repeated attempts are permitted.”

3. You must successfully complete a written recertification examination every 10 years. Surely that must be an effective measure? Maybe not. For the last five years, the pass rate for recertification in general surgery is 94% or greater. The American Board of Internal Medicine (ABIM) recert exams must be a little tougher or those who take it may not be as smart as surgeons. The pass rates for the ABIM recert exams have been 88% to 92% for the last four years with similar rates for all of the medical subspecialties.

4. You must participate in a national, regional or local outcomes registry or quality assessment program. Participation in a national outcomes registry sounds great, but none of the available registries have policing powers and many rely on individual surgeon input to track outcomes. As mentioned in the critique of the first requirement, quality issues are far more likely to be discovered at the local level than by a registry that collects data submitted by the surgeon herself.

As if all of the above issues are not enough, how about this for a hot potato from the ABS? “Periodic communication skills assessment based on patient feedback may also be required in the future.” I can’t wait to see how that information is going to be collected. By what criteria will communication skills be judged? And what will happen to someone deemed a poor communicator?

I suppose the boards are doing all of this to forestall government or other regulatory bodies stepping in. Meanwhile, let’s everyone play along.

None of the MOC requirements address another issue, which is fitness for practice. A December 10th article in the Washington Post on aging physicians notes that some hospitals are setting age limits at which doctors are required to have physical and mental evaluations in order to maintain staff privileges. That’s great but not for just the elderly; every doctor needs to have period fitness testing.

Right now, all you have to do to stay on the staff of most hospitals is have a colleague attest to the fact that you are in good health, hardly a rigorous standard.

I’ve known a few physicians well under the age of 65 who could have used a checkup from the neck up.

To answer my own question, maintenance of certification is a sham.


Anonymous said...

For a practicing general surgeon it is a sham and a scam. The test was easy and it cost $1300 with registration fees. Registering for the exam involved several hours of computer time, also time getting letters of recommendation, making sure they are sent, compiling operative records, etc.

Skeptical Scalpel said...

You said it in a lot fewer words than I did.

Anonymous said...

yet another example of spending time and money for the appearance of doing something useful. Likely to forestall outside (aka government) intervention - which would likely be an even bigger "sham and scam".

artiger said...

I'm not board certified, and probably never will be. My hospital and my patients don't require it, so neither do I.

When it becomes a requirement to practice, I'll find something else to do. Otherwise, I'm not feeding the troll.

Skeptical Scalpel said...

Anonymous, thanks for agreeing with me.

Artiger, your situation is unusual. A lot of third-party payers require board certification for inclusion of a doctor on their panels.

artiger said...

Not in my neck of the woods, which is just another reason for me to stay out here in the sticks

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