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Published 9/1/2008
Jennie McKee

Debunking the myths of MOC™

Separate fact from fiction when it comes to Maintenance of Certification

What have you heard about Maintenance of Certification™ (MOC)? That MOC requires you to take call? That non-operating orthopaedists don’t have to participate to maintain their board certification? If some of your MOC knowledge has come by word-of-mouth, you may have received conflicting information.

AAOS Now gathered a list of “MOC myths” and asked Shepard R. Hurwitz, MD, executive director of the American Board of Orthopaedic Surgery (ABOS), to shed some light on these common misconceptions.

Myth 1: MOC requires orthopaedic surgeons to take call.
Dr. Hurwitz:
The ABOS does not require orthopaedists to provide emergency coverage or indigent care as part of the MOC process. The current peer review evaluation form, which is the foundation of the ABOS’ credentialing process, simply asks whether the candidate or diplomate accepts community responsibility for emergent orthopaedic care and indigent care. The purpose of this question is to gain feedback from fellow practitioners as well as administrators, clinical service chiefs, and emergency personnel about whether orthopaedic surgeons are fulfilling their obligations.

If a surgeon does not take call and has no obligations to an emergency department, hospital, or community, the ABOS rarely investigates; however, if the ABOS receives reports that a surgeon has agreed to take call or is duty bound to take call by an agreement with a health system and is not honoring his or her obligations, the ABOS feels obliged to obtain more information.

Please note that no single “bad mark” in the peer-review process leads to deferral or denial; the ABOS requires several bad marks in different categories of behavior to take any adverse action at the credentialing level.

Myth 2: Non-operating surgeons aren’t required to participate in MOC.
Dr. Hurwitz:
Orthopaedists with time-limited certificates (meaning certificates were issued in or after 1986) who no longer perform surgery are required to participate in the MOC process to maintain their board certification. They must undergo the same credentialing process as orthopaedists who do perform surgery, including documenting continuing medical education (CME) and self-assessment examination (SAE) credits, taking a secure examination, and submitting a case list of consecutive new patients evaluated and treated in their practice. The number of cases to be submitted and documented is currently set at 30 for this category of ortho­paedist. If a non-operating diplomate resumes surgery, he or she must notify the ABOS to maintain certification.

Myth 3: There is no way for non-practicing orthopaedic surgeons to participate in MOC.
Dr. Hurwitz:
Non-practicing orthopaedists—including those who are engaged in full-time research, administrative work, non-orthopaedic consulting, and other types of work—can participate in MOC. They must provide references, obtain the necessary CME and SAE credits, and take the computer-based exam.

Myth 4: A patient survey is part of MOC.
Dr. Hurwitz:
A patient survey is not currently part of MOC, although one is being developed in conjunction with other surgical specialties. The survey will provide feedback to the surgeon regarding the issues addressed in Part IV of MOC: “Performance in Practice.”

When it becomes available, the survey may also be beneficial because in the near future, the Centers for Medicare & Medicaid Services and many insurers will require some form of patient feedback for either preferred payment status (pay-for-performance) or maintenance of payment. Furthermore, state relicensure may soon require some form of patient survey.

Myth 5: Members of the ABOS board of directors don’t have to participate in MOC.
Dr. Hurwitz:
All members of the ABOS board of directors—as well as all oral examiners and question-writers—have to meet all the requirements and deadlines of MOC to remain board-certified orthopaedic surgeons.

Myth 6: The ABOS and AAOS are the same organization.
Dr. Hurwitz:
The ABOS and the AAOS are two separate organizations. The AAOS is the preeminent provider of musculoskeletal education to orthopaedic surgeons and others, through its Annual Meeting, multiple CME courses, medical and scientific publications, and electronic media materials. The ABOS serves the public and the orthopaedic profession by certifying that a surgeon has received the requisite training and has the requisite knowledge and skills to obtain and maintain the designation of being board-certified.

Myth 7: There’s no easy way to find information about my MOC requirements and deadlines—or to keep track of my CME credits.
Dr. Hurwitz:
You can find your MOC requirements and deadlines, which are based on when your board certification expires, by visiting

Simply click on the “Diplomates” tab and select the year your certification will expire from the drop-down menu. You can also contact the ABOS at (919) 929-7103.

Editor’s Note: The AAOS offers a free transcript service that automatically logs any CME credits earned through Academy-sponsored courses, multimedia programs, and exams—as well as CME credits earned from other orthopaedic societies. In addition, you can add any CME earned from other sources (such as orthopaedic specialty societies that do not yet participate in the unified transcript program) to the online record. You will need to retain your documentation from those organizations. Visit the transcript service at www.aaos.org/transcript

Myth 8: MOC doesn’t affect me yet.
Dr. Hurwitz: MOC is a continuing process that requires your ongoing participation and attention. No matter which year your certification expires, you should be planning your MOC participation and engaging in CME and self-assessment activities. For example, because you must acquire CME and SAE credits in two 3-year cycles prior to applying for the cognitive examination, those whose certificates expire in 2017 and after should already be acquiring CME and SAE credits as part of the first 3-year cycle (
see Fig. 1).

In summary, if you have a time limit on your board certification, you need to be aware of your MOC requirements and deadlines and should be working toward meeting them. In fact, even orthopaedists whose board certification is not time-limited may be required by their hospitals to participate in the MOC process.

Any other myths?
Remember, no matter what you hear about MOC, the ABOS is the only official source of information. If you have a question, be sure to contact the ABOS—either online at
http://www.abos.org or by phone (919) 929-7103.

Jennie McKee is a staff writer for AAOS Now. She can be reached at mckee@aaos.org