Published 3/1/2007
Jennie McKee

Symposium addressed member questions about Maintenance of Certification

Although many orthopaedists have heard of Maintenance of Certification© (MOC), few can explain it in detail. Yet well over half of all practicing orthopaedic surgeons in the United States who are certified by the American Board of Orthopaedic Surgery (ABOS) will be involved in MOC in the coming years.

At a symposium during the 2007 Annual Meeting, ABOS and AAOS representatives answered questions about the MOC process, which affects all AAOS members who earned their board certification after 1985 and surgeons with lifetime certificates who have chosen to recertify. The speakers addressed the changes in the recertification process and detailed the collaboration between the ABOS and the AAOS during the development of the MOC program.

On the panel were Marybeth Ezaki, MD, chair of ABOS’ MOC committee and the ABOS chair of the Joint ABOS/AAOS MOC task force; Gordon M. Aamoth, MD, former ABOS president; David G. Lewallen, MD, a member of the Academy’s Council on Education and the AAOS chair of the Joint ABOS/AAOS MOC task force; and G. Paul DeRosa, MD, executive director of ABOS and member of the Joint ABOS/AAOS MOC task force.

The speakers discussed the MOC program’s timelines and requirements and offered suggestions for incorporating mandatory self-assessment programs, continuing medical education (CME), and patient surveys into an orthopaedist’s planning for MOC. Some of the program’s requirements—such as review of an applicant’s credentials and standing in the community, a CME requirement, and a secure cognitive examination—are similar to the current recertification program. Other features, such as self-assessment and demonstration of performance in practice, are new.

Members’ questions about MOC

Diplomates whose certificates will expire in 2010—the first class to recertify under the MOC program—asked several questions about MOC requirements and how to satisfy them. This group of diplomates is the first to take part in the transitional MOC process.

An orthopaedist from this group asked whether, according to the MOC timeline, he should have already applied to take the recertification exam in 2008. Dr. Ezaki responded that diplomates should apply to take the recertification exam four years before their certification expires. She noted, however, that diplomates whose certificates will expire in 2010 and who would like to take the exam in 2008 still have the opportunity to do so if they contact the ABOS. Although the process for recertification has changed, added Dr. Ezaki, the type of recertification examination required remains the same.

Another question dealt with the number of diplomates currently certified by the ABOS who fall under the “grandfather clause,” meaning that they are not required to participate in the MOC process because their certificates were issued prior to 1985. Dr. DeRosa estimated that 40 percent of those who are currently certified by the ABOS are in this category and that the percentage is decreasing every year as these older orthopaedists retire.

Dr. DeRosa clarified the relationship between the AAOS and ABOS by saying that they are “autonomous organizations” and added that the ABOS does not receive money from industry. The ABOS and the Academy have different boards of directors, staffs, headquarter offices, and purposes. ABOS is located in Chapel Hill, N.C., while the AAOS is located in Rosemont, Ill.

Dr. Aamoth, who was involved with both the ABOS and the AAOS during the development of the MOC process, added that the Academy’s mission centers on education, advocacy, and communication while the role of the ABOS is to protect the public by establishing standards to certify orthopaedic surgeons.

The genesis of MOC and its requirements

Before taking questions from members, the moderators gave brief presentations about the MOC process and how it has been developed. Dr. Ezaki explained that during the past decade, the public, the government, and nongovernment organizations have advocated for reforms in American medicine. The American Board of Medical Specialties (ABMS), of which the ABOS is one of 24 member boards, responded by developing six core areas that a physician should be judged on to determine competence: professionalism, communications skills and cultural competence, patient care, practice-based learning and improvement, systems-based practice, and medical knowledge.

The specialty boards, working with the ABMS, defined four components that could be evaluated by the certifying boards during a recertification cycle. The ABMS member boards approved the transition to MOC, a process that evaluates applicants on the following four components on an ongoing basis:

  • evidence of professional standing
  • commitment to lifelong learning and self-assessment
  • evidence of cognitive knowledge
  • evidence of performance in practice


The Academy and specialty societies are providing curricula such as comprehensive review courses and CME as well as self-assessment examinations to help members fulfill their MOC requirements, noted Dr. Lewallen. In addition, in 2006 the Academy transformed and renamed its annual review courses to MOC-Prep courses, held in November or December on each side of the country. The AAOS Annual Meeting also provides another opportunity for members to learn about MOC.

Dr. Ezaki referred diplomates to the ABOS Web site, www.abos.org, and the article in the January/February 2007 issue of AAOS Now, “What you need to know about Maintenance of Certification,” for details about how to satisfy the requirements of each MOC component. (The article is available online at www.aaos.org/now)