How Maintenance of Certification Rule Changes Affect Rheumatologists

Dr. Flood

As I write this column, I see almost daily a new article on Maintenance of Certification (MOC) from various sources and organizations—PolicyMed, American College of Cardiology, Annals of Internal Medicine and, oh yes, from the American Board of Internal Medicine (ABIM) as well. An eye-catching story reported that 15,000 physicians have signed a petition requesting a recall of ABIM’s new MOC requirements, and in turn, the ABIM issued a press release defending the program.^1-3

With all of the controversy swirling around the subject, I’ll offer some of my perspectives about MOC and where the American College of Rheumatology stands on the matter.

Where Do I Fit into MOC?

As most of you are aware, the ABIM changed its MOC program this year. Along with doubling the number of points required (from 100 every 10 years to 100 every five years), physician participation is being reported in a new way. Physicians who have not yet enrolled are now publically reported as “Not Meeting MOC Requirements.” I am one of those physicians. Having certified in 1983 in internal medicine and 1984 in rheumatology I hold two, time-unlimited certificates and am considered grandparented. As such, I won’t lose my certification status by not participating in MOC, but now I am faced with the ABIM listing of “Certified, Not Meeting MOC Requirements,” leaving me and others (including perhaps my patients) questioning the meaning.

I am not the only rheumatologist grand­parented but not enrolled. In early May (just after the deadline to enroll closed), the ABIM reported that 24% of grandparented rheumatologists had enrolled. At the same time, ABIM reported 82% of rheumatologists with time-limited certifications had enrolled.

In a press release issued May 8, David H. Johnson, MD, chair of the ABIM Board of Directors, stated, “Although participation in MOC is a voluntary activity, ‘board certification’ has sufficient credibility and public acceptance that many hospitals, health systems and patients use it to help decide with whom they want to work.”⁴

Certification and MOC are voluntary, as Dr. Johnson points out, but in many cases it may not feel that way because many of us have experienced certification as a requirement by payers and hospitals. It remains to be seen what “meeting” or “not meeting” the MOC requirements will mean and how it will affect those grandparented. Currently, program directors must be certified in the specialty or subspecialty they lead; however, there is no requirement to be enrolled in MOC. Thus, “Certified, Not Meeting MOC Requirements” is currently acceptable to ACGME. Will this change? The answer is unclear.