It’s important that you become familiar with the rationale for MOC—including why the ABOS made this switch and how MOC is designed to benefit you as well as your patients—so you can appreciate the value of this ongoing performance improvement process.


Published 6/1/2013
Shepard R. Hurwitz, MD

Get the Inside Scoop on MOC

By now, it’s no secret that the American Board of Orthopaedic Surgery (ABOS) has replaced recertification with Maintenance of Certification (MOC), an ongoing process of knowledge- and skills-based education focused on improving quality and patient care.

And yet, you may still have questions. You may not know how and why the MOC process came to be or may be unclear on what needs to be submitted when. That’s where I come in. As ABOS executive director, I plan to use this and subsequent columns to provide you with information about the value of MOC and give you helpful insights into how to navigate the process most effectively.

Shepard R. Hurwitz, MD

How MOC came to be
The ABOS did not mandate MOC. The impetus behind the switch to MOC actually came from the American Board of Medical Specialties, the parent board of all medical specialties, which required the ABOS and the rest of its member boards to develop MOC for those they certify.

Why was it so important to move from a single recertification examination to the MOC process? Simply put, MOC is a valuable, practical way to maintain and improve the quality of care you provide to patients. In addition, MOC shows the public—including patients, payers, hospitals, health systems, and regulators—that certification is ongoing rather than static.

Basics of MOC
MOC boils down to four main components:

  • evidence of professional standing
  • evidence of lifelong learning and improvement
  • evidence of medical knowledge
  • evidence of performance in practice

To satisfy the first component—evidence of professional standing—you must have an unrestricted state medical license and unrestricted surgical privileges (if you are a physician who performs surgery), and you must undergo peer review that demonstrates professionalism and behavior.

Evidence of lifelong learning involves obtaining 120 AMA PRA Category 1 CME Credits™ in two consecutive 3-year cycles, totaling 240 credits over 6 years. In each of those 3-year cycles, 20 of the CME credits must come from scored-and-recorded self-assessment examinations.

To demonstrate evidence of cognitive expertise, you must take a secure computer examination or a practice-based oral examination. Those who opt for the computer examination pathway must submit a 3-month case list (at least 14 cases, but no more than 75 cases), while those who choose the oral examination pathway must submit a 6-month case list (at least 35 cases).

Orthopaedists who are no longer performing surgery may submit a list of 30 consecutive new patients from their office practice instead of a case list. In addition, those who are not in practice may still recertify if they submit five letters of reference instead of their patient list.

Finally, the performance in practice component focuses on providing orthopaedic surgeons with a way to evaluate the quality of their own practice using familiar metrics, with a goal of demonstrating self-improvement.

Who must participate in MOC?
Candidates who passed their part II exam and became certified in 2007 were automatically enrolled in MOC, as are all new diplomates who have become certified since then.

Those ABOS diplomates who obtained their board certification between 1986 and 2006 were automatically enrolled in MOC if they passed their recertifying exam in 2007 or later. If they did not, however, they must visit the ABOS online at and register to participate in MOC.

ABOS diplomates certified before 1986 have time-unlimited certificates, meaning that they don’t have to participate in MOC to maintain their board certification. Subspecialty certification in sports medicine and surgery of the hand are administered by the ABOS. Those subspecialty certifications are only valid if the diplomate is also board certified in orthopaedic surgery by the ABOS.

All diplomates whose certifications expire in 2017 or later must obtain 120 AMA PRA Category 1 CME Credits in each of two consecutive 3-year cycles before taking the secure cognitive examination.

Note that diplomates who have allowed their time-limited certificates to lapse, but are still performing surgery, must take the oral exam. As with recertification, there is an application fee and an exam fee for those approved to sit the exams.

Need help? Contact the ABOS
Deadlines are very important and are one of the most common sources of confusion among diplomates. Do not rely on your office staff or colleagues to learn about deadlines.

As the only official source of information about MOC, the ABOS is the only entity you should contact to clarify information about the process. Visit the ABOS website at or call the ABOS at (919) 929-7103, Monday through Friday, from 8:30 a.m. to 4:30 p.m., Eastern time. You may also email staff with questions.

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