Thursday, May 29, 2014

Growing resentment and misery over MOC

Dr. Robert M. Centor, the blog author at DB's Medical Rants, opines on this subject from time to time and did so again yesterday. He has a wide readership and his posts on topics such as this usually generate lively discussion. He talked around some questions in need of elaboration but unfortunately the comments on his site seem to be disabled at present, so I'll weigh in here. He raised the following issues:

Career long learning is essential.
All would agree with that premise, but Dr. Centor didn't address the real rub, which is the question of how best to promote and advance it and whose responsibility it is. Mature professionals realize that they as individuals know best how to direct their learning as opposed to some outsider such as the ABIM. That's inherent in the notion of self assessment. (Note that not even state licensing boards dictate the type of CME content doctors are required to learn).

MOC is not evidence based.
From his post:

These regulations have face validity to the regulators, but practicing physicians just see the time and hassle that each step creates. Regulators want us to practice “evidence-based medicine”, but they do not want to practice “evidence-based assessment”...
The ABMS goes much further than knowledge however. And these activities feel like busy work, and many physicians complain that these activities have no reasonable outcome data to support the hassles involved.

The process is counterproductive.
He wrote:

When the physician community loses faith in the process, then we should reconsider the process. Making physicians angry with the process seems counterproductive.

Dr. Centor is a good listener and feels the pain of the rank and file internist. But what does he plan to do about the situation? As Chair of the Board of Regents for ACP he is positioned to do a great deal. If ACP were to partner with AAPS in their effort it might tip the balance toward a favorable resolution of the struggle.

Meanwhile, as internists grow increasingly miserable the ABIM is digging in, holding fast to its policies and proposing even more hoops for docs to jump through such as this one:

ABIM could require candidates to achieve a perfect score on questions related to costs and redundant care as a requirement for admission to secure exams for initial certification or MOC.

More concerning than the latest requirements from the Board are the general trends. See where things are headed?

Paul Kempen responded here.

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