Maintenance of Certification: AMA House of Delegates Wants Impact-Study of MOC on Patient Outcomes, Votes To Oppose MOC as Condition of Licensure

Meeting last week in Chicago, the American Medical Association (AMA) House of Delegates voiced their concern over the burdensome requirements of maintenance of certification (MOC). They voted on a number of important checks that could help rein in MOC, including recommending a “critical review” about the impact of MOC on physician practices and patient outcomes. While some delegates urged the AMA to call for a moratorium on MOC until the study was conducted, the delegates ultimately voted to oppose mandatory participation in MOC as a condition of licensure.

The House of Delegates is concerned that MOC, maintenance of licensure (MOL), and osteopathic continuous certification (OCC) initiatives create barriers to practice, are administratively unfeasible, and are routinely inflexible with regard to how physicians practice (clinically or not). Many also question whether the burdensome process actually has any benefits to physician practices or patient outcomes.

Furthermore, delegates are concerned that these certification procedures do not protect physician privacy, and are used to promote policy initiatives (rather than physician competence) such as participation in health plans, subscription to data exchanges, and specialty board certification.

The delegates adopted policy surrounding MOC, OCC and MOL that directs the AMA to:

• Explore the feasibility of conducting a study to assess the impact that MOC requirements and MOL principles have on workforce, practice costs, patient outcomes, patient safety and patient access;
• Work with the American Board of Medical Specialties (ABMS) and its member boards to collect data on why physicians choose to maintain or discontinue their board certification;
• Work with the ABMS and the Federation of State Medical Boards (FSMB) to study whether MOC and the principles of MOL are important factors to physicians when deciding whether to retire and whether they have a direct impact on workforce;
• Oppose making MOC mandatory as a condition of licensure. The delegates directed AMA to “oppose mandatory MOC as a condition of medical licensure, and encourage physicians to strive to constantly improve their care of patients by the means they find most effective.””

Maintenance of certification has come under extra scrutiny recently as the ABMS has attempted to make MOC a continuous process, whereby physicians would need to take time-consuming tests every two years. AMA House of Delegates appear to have listened to the rally against MOC. They criticized the programs as overly time consuming, expensive, and having too little value.

Delegates appear willing to challenged long-standing aspects of professional education. In addition to the MOC, MOL, and OCC impact studies, AMA Wire notes that AMA also updated its policies to ensure the association strongly and effectively advocates for evidence-based changes to resident duty hours, pending the outcomes of two new studies and other research.