Published 8/1/2013
Shepard R. Hurwitz, MD

What You Need to Know about MOC’s “Peer Review”

Process provides “evidence of performance in practice”

There’s no getting around it—earning continuing medical education (CME) credits is a big part of the American Board of Orthopaedic Surgery’s (ABOS) Maintenance of Certification (MOC) process. By obtaining 120 AMA PRA Category 1 CME Credits™—including at least 20 credits from scored and recorded self-assessment examinations (SAE)—in two 3-year cycles, and submitting proof to the ABOS, you satisfy a key aspect of MOC. But there’s more to MOC than CME.

Another important part of navigating the MOC process involves satisfying Part IV: Evidence of Performance in Practice, one aspect of which is “peer review,” the process used by the ABOS to obtain input from orthopaedists and other healthcare professionals who work alongside the applicant. This process helps further the ABOS’ mission “to serve the best interests of the public and of the medical profession” by soliciting vital feedback the ABOS uses to evaluate the continuing qualifications and competence of orthopaedic surgeons.

In this month’s column, I will explain what you need to know to navigate this component of MOC efficiently.

The basics
The ABOS peer review process takes place after you have done the following:

  • submitted evidence of having obtained all the required CME and SAE credits
  • submitted a 3-month list of surgical cases, with a maximum of 75 cases (for the computer examination), or submitted a case list from 6 consecutive months (for the oral examination)
  • applied for the recertification examination

The ABOS Applicant Evaluation Form is used to collect peer review information. This questionnaire asks evaluators to rate you on a wide range of areas, such as your ability to manage multiple complex problems, as well as your integrity and ethical values. Evaluators consider each question and rate you on a scale of 1 (lowest) to 4 (highest).

To begin the process, the ABOS sends the Applicant Evaluation Form to the minimum of five board-certified orthopaedists whose contact information you listed on your application for the recertification examination. These orthopaedists should be familiar with your practice and should therefore be in a good position to provide peer input.

In addition, the ABOS sends the questionnaire to key staff members at hospitals and surgery centers at which you have privileges, including the hospital chief of staff, head orthopaedic operating room nurse, and the chiefs of the following hospital departments:

  • orthopaedic surgery
  • surgery
  • emergency medicine
  • radiology
  • anesthesiology

The ABOS recognizes that not all hospitals or surgery centers have these positions and that small communities may have fewer than five board-certified orthopaedic surgeons. If either or both of these situations applies to you, and you have questions about how to fill out your recertification application, contact the ABOS for assistance at 919-929-7103. You may also contact Brenda Kulp, ABOS MOC Specialist, at bkulp@abos.org

What happens next?
After your orthopaedic colleagues and hospital staff members complete and submit the questionnaires, the ABOS staff (including information technology staff members) reviews and tabulates the questionnaires. As ABOS executive director, I am responsible for working with two former ABOS executive directors to further evaluate your materials if you receive multiple low ratings—such as “unsatisfactory” or “marginal”—from several examiners.

Next, ABOS staff members submit a report on every applicant to the ABOS Credentials Committee at its fall meeting. The committee, made up of members of the ABOS board of directors, also reviews issues of licensure and local surgical privileges and has the authority to take action against an individual by revoking his or her board certification.

If, after evaluating your materials and the staff report, the committee has no concerns about your materials, you will be approved to sit for the next offering of the recertifying examination. If the committee has concerns, however, a vote is taken, which results in one of the following decisions:

  • Allow the applicant to sit for the upcoming exam.
  • Defer the decision until the following year. The applicant will maintain his or her board certification in the interim, but must apply the following year and complete the peer review process again.
  • Require the applicant to take the oral exam.
  • Defer the decision until the ABOS conducts a site visit; the applicant maintains board certification in the interim.
  • Require the applicant to either take the oral examination or opt for deferral of the decision until the ABOS has conducted a site visit (with the applicant maintaining board certification in the interim).
  • Deny the application and require the applicant to apply for the recertification exam the following year. No additional year of certification is granted.

Historically, the ABOS has denied or deferred fewer than 2 percent of MOC applicants and has asked fewer than 1 percent of applicants to take the oral recertifying exam. When given a choice, very few diplomates have chosen to have a site visit rather than taking the oral exam.

Need more information?
As always, please direct any and all questions about MOC to the ABOS, the only official source of information about the ABOS MOC process. Call the ABOS at 919-929-7103, or visit the ABOS online at www.abos.org

Sample of ABOS MOC Applicant Evaluation Form – Not for use

Shepard R. Hurwitz, MD, is the executive director of the ABOS. He can be reached at shurwitz@abos.org