Published 12/1/2013
Shepard R. Hurwitz, MD

Navigating Exceptions to the “MOC Rules”

Timelines and other aspects of MOC may vary

The American Board of Orthopaedic Surgery’s (ABOS) Maintenance of Certification (MOC) program is meant to be a linear process, with diplomates meeting various requirements throughout recurring 10-year cycles (Table 1). (See “MOC’s 10-Year Cycles,” below.) And yet, it is quite possible that two diplomates whose board certification expires in the same year may have different MOC-related deadlines and may take their recertification examinations in different years, depending on several factors.

This column explores different scenarios that illustrate how one diplomate’s MOC experience may vary from that of another, and therefore be an “exception to the rule.” In this way, I hope to point out the flexibility in the ABOS MOC process that makes it possible to tailor the experience to a particular diplomate’s needs.

Taking the examination early
One scenario that represents an “exception to the MOC rule” occurs when a diplomate recertifies 2 years prior to the expiration of his or her certificate. In this case, the first reporting cycle starts the year after the certification was to expire.

So, how would this work, exactly? Let’s say that Dr. Wilson completed and passed the exam in 2012, but his certificate does not expire until 2014. Because diplomates who recertify early do not need to begin earning the required continuing medical education (CME) and scored and recorded self-assessment examination credits (SAE) until after the certificate expiration date, Dr. Wilson is not required to submit anything in the years 2013–2014. In fact, Dr. Wilson would not complete his first 3-year cycle of earning and submitting 120 credits of AMA PRA Category 1 CME credits™ (including at least 20 credits from scored and recorded SAE) until the 2015–2017 reporting cycle.

December credits
Both of the 3-year reporting cycles that occur within a 10-year MOC cycle end on Nov. 30 of a given year. But what about CME and/or SAE credits that are earned (not just started) in December? These credits may be applied to either the 3-year cycle just ending or the next 3-year cycle.

Here’s an example: Dr. Singh has earned 100 CME credits (none of which are from SAE) during a 3-year cycle that ended in November 2013. Dr. Singh needs to earn 20 SAE credits to satisfy his MOC requirements, so he takes two scored and recorded self-assessment examinations online in December 2013. These 20 SAE credits can be added to his 2011–2013 reporting cycle to complete it.

If, on the other hand, Dr. Singh meets his MOC CME requirement by Nov. 30 and decides to earn more CME credits in December 2013, those credits can be counted toward the next reporting cycle. He would need to contact the ABOS to ensure the credits are counted toward the appropriate cycle.

The case list requirement
Another MOC exception occurs when surgeons complete their second 3-year MOC cycle—meeting the CME and SAE credit requirements—but have not yet satisfied the case list requirement. In this situation, the ABOS allows the case list to be submitted with the application for the recertifying examination.

For example, Dr. Jacques, whose certification expires in 2015, waits until 2013 to submit the required CME and SAE credits for her second 3-year MOC cycle. She may choose the computer or oral exam and will be allowed to submit her case list information up until the 2014 application deadline for the 2015 exam.

A compressed schedule
Diplomates who ignore the reporting cycles altogether but still wish to recertify also have an option. They must earn and submit 240 CME credits, including at least 40 SAE credits, and must meet case list requirements by the application deadline the year before their certificates expire.

To illustrate: Dr. Abbott, who is certified through 2015, has not entered any CME, SAE, or case list information by the reporting deadline of Nov. 30, 2013. Dr. Abbott has until the May 1, 2014, application deadline to submit 240 CME credits, including at least 40 SAE credits, and a case list, and complete the application to take the recertification examination. If Dr. Abbott fails to do this, he will not be credentialed to take the recertifying exam. His board certification will expire on Dec. 31, 2015, and he will not be board-eligible.

Recertification facts
Nearly 96 percent of the diplomates who have participated in MOC through 2013 have earned and reported their CME and SAE credits in a timely manner and have taken their recertifying examination before their certifications expired. Only a small percentage—fewer than 3 percent of diplomates with time-limited certificates—have opted not to participate in MOC and thus allowed their certifications to expire.

The ABOS allows the exceptions described in this column because it wants to make it as easy as possible for diplomates to participate in continuing medical education and self-evaluation in an ongoing fashion. The ABOS is eager to provide assistance to diplomates as they take part in MOC, with the aim of ensuring that they recertify in time, rather than lose their board certification.

Have questions?
As always, please direct any and all questions about MOC to the ABOS, the only official source of information about the ABOS MOC process. Visit the ABOS online at www.abos.org and log in to view your customized MOC dashboard, or call 919-929-7103.

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

MOC’s 10-Year Cycles
The first 10-year cycle of MOC begins after an orthopaedic candidate passes the part II (oral) examination and becomes board certified.

In the first 3-year reporting cycle, the diplomate must earn and submit 120 CME credits, including at least 20 credits from approved scored and recorded self-assessment exams (SAE).

Then, the diplomate must complete a second 3-year cycle, during which he or she must earn and submit another 120 CME credits. Again, 20 of those credits must be from approved scored and recorded SAE.

During the second cycle, a surgical case list is submitted to the ABOS website—assuming the diplomate is performing surgery. Those who opt for the computer examination pathway must submit a 3-month list of surgical cases, with a minimum of 14 consecutive cases. The oral examination requires a case list from 6 consecutive months, with a minimum of 35 cases.

After completing the second 3-year reporting cycle, a diplomate may apply to take a recertifying exam. He or she must meet the application deadline, which occurs in the year that follows the end of the second 3-year reporting cycle. When CME, SAE, and case list requirements have been met and the examination application has been submitted, the diplomate can take the examination in the year his or her certification expires or can opt to take the examination early, in one of the two years prior to the year the certification expires. This means a diplomate who completes the two reporting cycles on time can choose to sit for the examination in one of three different years.