Signs of progress for MOC, but more work needed

The past year's worth of advocacy to improve the Maintenance of Certification process has succeeded, in part, but the issue will remain in front of ACP leadership in coming years.

My year as ACP President is coming to a close at the end of Internal Medicine Meeting 2016. I am reminded of the many challenges and successes that have occurred over the past 12 months. ACP has made progress on several fronts. We saw the end of the sustainable growth rate, a long battle finally won. We've welcomed new international ACP chapters, expanding our reach across the globe. We've begun preparing to transform the way we practice and adjusting from a volume-based system to one that is value-based. And, most important, we've seen our advocacy efforts on the Maintenance of Certification (MOC) program of the American Board of Internal Medicine (ABIM) result in positive progress.

During the past year, MOC has been “top of mind” and an area of consistent focused effort, not just for me but for ACP staff and those holding elected leadership positions in the College. We've heard from members loud and clear that the MOC process is burdensome, expensive, not always relevant to their current practice situation, overly difficult, and too “high stakes.” And we have been concerned about the relatively low passing rate on the secure exam.

These issues have occurred in an era when we are adjusting to enormous changes in the health care system, moving toward a value-based health care system, and grappling with less-than-nimble electronic health records. The continuing evolution in where and how we practice adds further complexity and challenge. Accordingly, we in ACP leadership have had intensive, frank, open, and constructive dialogue with ABIM over many months to address MOC issues.

Our consistent advocacy for significant reform has resulted in real and tangible improvements. The report from the ABIM Assessment 2020 Task Force recommends eliminating the every-10-year examination and replacing it with a series of low-stakes assessments that could be taken at home or in the workplace; increasing the relevancy of content based on the physician's area or areas of practice; and continuing to demonstrate noncognitive skills such as communication, teamwork, and quality improvement as part of primary certification, not MOC. ABIM announced it is eliminating its Practice Improvement Modules (PIMs) and suspending the Part 4 (Performance Improvement) component of MOC, which internists have considered particularly burdensome.

In addition, ABIM made changes to the internal medicine MOC examination administered in October 2015, addressing our concerns about the secure exam and low passing rate. The “blueprint” for this examination was modified based on feedback from ACP members and others. We have received comments from individuals who took the examination noting that the questions seemed much more relevant to practice than they had been in the past, and ABIM has reported a higher pass rate.

While I'm pleased that progress has been made, more work on MOC remains in front of us. Over the past several months, ACP asked for and received your input about MOC through a random-sample survey of members. The survey responses confirmed what we had heard anecdotally from many members and will help guide us as we continue to advocate on your behalf to ABIM for desired changes. ACP would like to see a process for physician accountability that is of value to both physicians and patients, that minimizes burden for physicians, and that is relevant to practice.

As I reflect on the past year, I am hopeful that internal medicine will flourish. Internists will continue to face challenges, whether responding to urgent public health issues or evolving with and adjusting to continuing governmental changes that impact physicians and patients. But meeting the needs of our members, as evident in the progress to date on ABIM MOC, is always a priority for ACP, and I am confident that ACP will work successfully on your behalf and continue to live up to its tagline: Leading Internal Medicine, Improving Lives.