ACP's ‘Mission: Not Impossible’

Changes to the Maintenance of Certification process advocated by College leadership are the beginning of meaningful reform of the process, not the end.

One of my favorite adventure shows in the late 1960s was “Mission: Impossible,” a television series about a team of secret government agents known as the Impossible Missions Force. Each show opened with the team leader receiving instructions on a recording device that self-destructed. The secret mission “should you choose to accept it” was always “impossible” and against insurmountable odds, but of course the team always successfully accomplished it in dramatic fashion. Recent events in the College will be chronicled as no less dramatic and will go down as monumental and historic for our profession.

The American Board of Internal Medicine (ABIM) announced in February changes in the Maintenance of Certification (MOC) process, for which ACP and other organizations have been advocating over the past 2 years. Richard J. Baron, MD, MACP, president and CEO of ABIM, announced that the Practice Assessment, Patient Voice, and Patient Safety requirements would be suspended for 2 years; that the ABIM website would now indicate whether diplomates are “participating” in MOC rather than “meeting requirements”; that the secure exam will be updated to reflect more of what physicians handle in their clinical practices; and that fees will remain the same for at least 2 years. This is an important step for ABIM; no doubt many thought this was “impossible” to consider, much less accomplish. Our job, however, is not finished and we have much more work to do to move MOC where we believe it should be. We will continue to advocate strongly for changes that increase the relevance of the MOC process and value to our members.

These changes occurred in the face of mounting pressure and discontent expressed by a growing number of U.S. internists concerned about the MOC process. ACP has been in regular discussions with ABIM for the past 2 years in an attempt to foster change to make MOC more meaningful and evidence based. Thankfully, ABIM heard the concerns of many internists around the country. Moving to make MOC both more meaningful and formative for what we do as internists was the right thing to do.

ACP leadership will continue working with ABIM leadership to advocate on behalf of our members. While we are optimistic about the potential changes, we recognize that this is a first step. ACP's CEO and Executive Vice President, Steven E. Weinberger, MD, FACP, has been most instrumental in working with Dr. Baron and articulating the concerns of our members. We owe him our gratitude.

ACP firmly believes that all physicians should participate in lifelong learning and maintain their skills and knowledge. We agree that this is a professional obligation. With these changes, internists are still accountable and responsible for maintaining professional competence. But by placing a moratorium on requirements that are not well supported by evidence, we go a long way in taking the pressure off busy physicians who already feel overwhelmed by layers of regulatory and administrative reporting that many view as burdensome and a barrier to our first duty of caring for patients.

This past year the College has been working to address the administrative burdens contributing to the discontent of physicians, many of whom are leaving practice early. Similar pressures often discourage students and residents from choosing internal medicine as a specialty. We are very concerned that these pressures will result in fewer internists being available to take care of an increasing number of elderly and complicated patients who need us. ABIM's decision relieves at least some of what many feel is administrative “make work,” allows greater flexibility in demonstrating self-assessment of medical knowledge, and designates publicly when physicians make an effort to maintain professional competency.

There is still a lot of work to do with MOC. Indeed, many feel the real work in developing this program has just begun, but we can now feel less distracted from the business of being good doctors and training future internists. I hope this move will help to revive the joy of practice so we can keep more internists in practice while encouraging more to join us.

As my year as President draws to a close, there is still much to do. The College will continue strong advocacy efforts in support of the Affordable Care Act, which is under attack on many fronts. The Sustainable Growth Rate must be repealed; enhanced Medicare payments for primary care and recapturing Medicaid parity with Medicare are still a priority to ensure access and care for everyone; and we now have even greater opportunities to promote high-value care by responding to the new CMS rule on the Medicare Shared Savings Program. Other issues include the future of graduate medical education funding and primary care; electronic medical records that enhance rather than detract from fluid and fulfilling patient care; firearms, global vaccination, and other public health concerns; and the professional needs of our growing and changing membership. These and other challenges await the next generation of ACP leadership. Meeting and overcoming tough challenges are part of our mission, but as recent history affirms, nothing is impossible if we link arms, remain calm, and mindfully focus on the objective.

I am fully confident that President-elect Wayne J. Riley, MD, MPH, MBA, MACP, and Board of Regents Chair-elect Tanveer P. Mir, MD, MACP, will take ACP leadership to the next level in 2015-2016. They are strong, smart, and capable. I am deeply grateful to my good friend and colleague in arms, outgoing Board of Regents Chair Robert M. Centor, MD, MACP, for standing by and supporting me this past year. He has been a great Chair and even better friend. I want to thank the many others with whom I have had the honor and privilege to work, but they are too numerous to name. You know who you are and have my admiration and sincere gratitude.

My year as President has been amazing and enriching. I can't thank you enough for giving me the opportunity to serve. It has been an experience I will never forget. I end by thanking the most important people in my life, my amazing wife, Karen Edison, MD, and my wonderful family. Thank you for hanging in there, supporting me along the way, and loving me enough to let me go for a while. It's been a long and lovely journey, but I'm coming home now.