Sanford E. Emery, MD, MBA

AAOS Now

Published 4/1/2015
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Sanford E. Emery, MD, MBA

ABOS & MOC: Value for Our Profession

Value in the patient care industry has become increasingly important for patients, healthcare entities, and physicians. As orthopaedic surgeons, we expect value as well in our professional requirements of lifelong learning.

Recently, the American Board of Internal Medicine (ABIM) pulled back some of their newly instituted requirements for Maintenance of Certification (MOC), apologizing to internal medicine diplomates that they “got it wrong.” This change was in response to a groundswell of complaints regarding the yearly requirements, reporting, unpopular high-stakes tests, and new fees that comprised the ABIM’s MOC process. Practice Assessment, Patient Voice, and Patient Safety requirements have been removed as part of the ABIM’s MOC requirements.

The MOC concept and its acceptance by the healthcare community has made recertification in some form mandatory, and the American Board of Orthopaedic Surgery (ABOS) is proud of the MOC requirements that have been developed for orthopaedics. Virtually unchanged since its inception in 2010, the following ABOS requirements for MOC in a 10-year cycle were developed in a manner that recognized what the majority of current practicing orthopaedic surgeons were already doing in the maintenance of their knowledge, skills, and abilities.

First 6 years: 120 continuing medical education (CME) credits, including 20 credits for self-assessment, apportioned into two 3-year blocks.

Next 4 years: (1) An application, which includes the names of individuals who will serve as professional peer reviewers; (2) an oral or written exam, with a supporting case list for those in active practice; (3) payment of a fee for the application and the exam. (NOTE: The ABOS does not require annual fees during the 10-year recertification cycle.)

A diplomate’s (ie, board-certified orthopaedic surgeon) current certification and MOC participation status are posted on the ABOS website. The ABOS will verify this status to those organizations with a need to know and to the public.

Every specialty board has created its own requirements for MOC to meet the unique requirements of that field of practice. As orthopaedic surgeons, the members of the ABOS have crafted an MOC process that is substantially different from the one developed by the ABIM for internal medicine physicians. In recent years, we have purposely expanded the options to ensure the process is valid and efficient for our diplomates, while remaining mindful about overburdening orthopaedic surgeons, who are busy, committed practitioners.

There is no question that the effort to remain certified is work. But does MOC have value?

Let’s consider now the bigger picture. One goal of an MOC program is to ensure continuous learning as a professional. (Great Britain calls its process “Continuous Professional Development,” or CPD—perhaps a better term.) A second goal is to promote practice improvement, ie, not staying as good or as bad as we are, but getting better as physicians and surgeons.

As a patient, I expect my physicians and surgeons to make those efforts. This is the value of MOC, CPD, or whatever you choose to label the process. Today, many important stakeholders—including hospitals, credentialing organizations, licensing boards, private payers, and the Centers for Medicare & Medicaid Services—recognize the value in MOC.

The ABOS will continuously seek ways to improve MOC, decrease the workload on our diplomates, and ensure that MOC meets its purpose for the public and the healthcare community. As orthopaedic surgeons, our continuous professional development should be robust, relevant, reasonably priced, and patient focused. As a profession held in high esteem by the public, orthopaedics has the ability and responsibility to regulate itself. Maintenance of Certification should and will evolve as we collectively aim for excellence and improvement as professionals.

Sanford E. Emery, MD, MBA, is president of the American Board of Orthopaedic Surgery.