Is MOC Run Amok? Economic Impact on Physicians

Sandhu AT, Dudley RA, Kazi DS. A Cost Analysis of the American Board of Internal Medicine's Maintenance-of-Certification Program. Ann Intern Med. 2015 Sep 15;163(6):401-8. doi: 10.7326/M15-1011.

CONCLUSION: The ABIM MOC program will generate considerable costs, predominantly due to demands on physician time. A rigorous evaluation of its effect on clinical and economic outcomes is warranted to balance potential gains in health care quality and efficiency against the high costs identified in this study. PMID: 26216046

Comments: I am board certified in Internal Medicine, Pediatrics, and Emergency Medicine.  The time it takes to study for these is enormous.  Also, the direct cost is > $2400 each!  And this has occurred at a time where my institution has removed CME funding for such expenses.  Since I am faculty for all three departments, it seems important for job security to maintain all three certifications.  Many share a similar story, even if they have only one board certification.  This study found that a general internist spends almost $24,000 in MOC costs (time and direct) over 10 years.  For many of us, this isn't "funny money" that we can pull from CME funds.  This is cash out of our pockets in time and direct costs.  Is it worth it?  Probably not.  Although I learned a lot studying for IM and Peds recertification 2 years ago, I didn't see much impact on my daily practice from the knowledge gained.  Yes, I can recite colon cancer screening guidelines and what age child can draw a cube, but is this really important?  Certainly the learning for MOC is nothing like the impact curating this website has on my practice and teaching.  For EM, LLSA articles are a mixed bag - some good and some awful.  I guess I could say it is the cost of doing business.  Except the certifying boards have a monopoly and make tons of money on the backs of doctors who must have the board certification to practice.  Small wonder question writing is so expensive when it includes posh flights, hotels, and dinners for question authors.  Is that really necessary in 2015-2016 in the era of instant electronic communication, Skype, and FaceTime?  For now, we are stuck paying whatever they demand.  But just as ABIM backed down when massive numbers of internists put their foot down, maybe other boards will listen to the numbers above and make MOC less onerous on the wallet by reducing time and monetary costs.

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