Frustrated by current maintenance of certification (MOC) programs, a growing number of physicians are turning to an alternative they say is less burdensome, more relevant, and far cheaper. The newly formed National Board of Physicians and Surgeons (NBPAS) launched its continuous certification program in late January and now boasts 500 applicants and thousands of supporters.
The NBPAS offers an alternative to current MOC programs that require labor-intensive, expensive activities that do not advance physicians’ professional development, said California cardiologist Paul Teirstein , NBPAS president and founder.
“Lifelong learning does not come in a one-size-fits-all package,” said Dr. Teirstein of Scripps Health in La Jolla, Calif. “No single program will ever meet everyone’s needs. NBPAS provides physicians with a much-needed alternative.”
But some physician leaders are skeptical about the new board and whether its requirements meet quality and safety expectations by patients and health systems. The NBPAS is not recognized by the American Board of Medical Specialties, nor do its requirements appear to align with the well-recognized standards of ABMS member boards, Dr. Lois Margaret Nora , ABMS president and CEO, said in an interview.
“The truth is that this is a fundamentally different organization,” Dr. Nora said. “My understanding is there are a number of states (that) have higher requirements for continuing medical education to maintain their licensure than the requirements [the NBPAS] is asking” for.
The NBPAS’ certification program is open to most physicians in ABMS nonsurgical specialties, and the board is in the process of adding more specialties, according to its website. Criteria for NBPAS certification include previous certification by an ABMS member board, a valid license to practice medicine, at least 50 hours of Accreditation Council for Continuing Medical Education ( ACCME ) accredited CME within the past 24 months and active hospital privileges for selected specialties, among other requirements. Cost of the program is $84.50 a year.
Organizers say the board is committed to providing certification that ensures physician compliance with national standards and promotes lifelong learning. Board leaders are working to gain acceptance by hospitals and payers, Dr. Teirstein said, including lobbying hospital executive committees for recognition of NBPAS as an alternative form of continuing certification. The NBPAS Young Physicians Alliance, led by Dr. Ricardo Correa , is also striving to create a dialogue and share news with recent graduates and trainees about the group.
The launch of the NBPAS’ program occurred just weeks before the American Board of Internal Medicine ( ABIM ) announced drastic changes to its MOC process. In a frank announcement , ABIM apologized to doctors for an MOC program that “clearly got it wrong,” and pledged to make the program more consistent with physicians’ practice and values. Among the immediate changes are updates to its internal medicine exam, suspension of the practice assessment, patient voice, and patient safety requirements for at least 2 years, and setting MOC enrollment fees at or below 2014 levels through at least 2017.
The changes followed harsh criticism by doctors that ABIM’s MOC requirements had become too onerous and expensive. By January 2015, a Web-based petition against the program had garnered more than 19,000 signatures and drawn thousands of comments in protest of the new requirements. Physician organizations, including ABMS and the American College of Physicians, applauded ABIM’s Feb. 3 program modifications, calling the move monumental and praising ABIM for addressing physician concerns.
“Continuous quality improvement of MOC programs is very important, and we support the listening to their diplomates and continuing the quality improvement of these aspects of the program,” Dr. Nora said in an interview.
However, not all doctors were satisfied with ABIM’s announcement. New York interventional cardiologist Gregg W. Stone of Columbia University Medical Center, New York, said the modifications failed to address all of doctors’ MOC concerns, such as cost. He believes it was NBPAS that drove ABIM to issue the changes.
“I see [the changes] as a desperation act in response to the fact that now there is an alternative where physicians will be able to go,” said Dr. Stone, a member of the NBPAS advisory board. “They’ve realized physicians really are serious and are not going to take what [they’re] selling anymore.”
Dr. Teirstein noted that interest and responses to NBPAS tripled after ABIM’s apology.
ABIM is not concerned with NBPAS, nor is it worried that the new program could draw physicians away from its MOC process, said ABIM President and CEO Richard J. Baron . ABIM’s recent MOC changes have been met with widespread gratitude and optimism by many doctors and a strong desire by physician organizations to work with ABIM on advancing the program, Dr. Baron said in an interview.
“There have always been alternative boards,” Dr. Baron said. “We know that for people to use the ABIM credential, they have to believe in the ABIM credential. When you look at what our credential is, and what other credentials are, there’s a reason that the ABMS credential is the one that most people use, and it has to do with rigor and standards. You can do a comparison of what the new board is asking and draw [your] own conclusion.”
The American Association of Clinical Endocrinologists ( AACE ) meanwhile, commended ABIM for listening to physicians and making the adjustments, but also expressed support for NBPAS. In a statement , AACE President R. Mack Harrell invited association members to visit the NBPAS website and consider its process.
“While AACE will continue to assist ABIM in whatever way we can to improve their MOC pathway, we will also advocate for other viable certification pathways that have relevance for our membership,” Dr. Harrell said in the statement. “At AACE, we believe that our individual members are the best judges of their own continuing educational needs, and our mission is to make sure that a variety of relevant options are available.”
Still other physicians would like to see the complete eradication of maintenance of certification. Ideally, MOC would be a voluntary process only, said Dr. Jonathan Weiss, an internist in private practice who specializes in critical care medicine and pulmonology in Monticello, N.Y. Dr. Weiss is part of an outspoken group of physicians against MOC that have published criticism of the process.
“It’s good there’s the possibility of an alternative,” he said of NBPAS. But “frankly, part of our feeling is we don’t want to be part of any recertification because we think the whole thing is a flawed, phony process. Lawyers don’t have to get “re-barred.” I would rather just be a doctor in good standing … do my self-directed CME. That should be sufficient.”
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