How High Maintenance is Your Certification?

May 3, 2013
Eric Postal, MD

Radiologists are entering their profession with a new set of rules (subject to change) into which they had no input, yet for which they were footing the bill.

The Association of American Physicians and Surgeons has launched a federal lawsuit against the American Board of Medical Specialties over the latter’s MOC (maintenance of certification) program.

Whether or not you personally are in favor of MOC and/or its kissing-cousin MOL (maintenance of licensure), and no matter how much or little you know of the legal merits of the case, one thing is clear: Some attorneys are being pretty well-paid for all of this. And, whether directly via your MOC/MOL fees or indirectly through reduced reimbursement and taxes, we physicians will be footing the bill.

This brings up the question: What are we getting for our money?

Before this all came along, it wasn’t as if physicians, radiological or otherwise, had zero responsibility for remaining current and competent. Each medical facility and municipality had requirements for continued medical practice, including quotas for CME. Docs also had individual motivations to keep their skills sharp - if not out of a desire to do a good job for ethical or competitive reasons, then at least to avoid malpractice nightmares. There were costs associated with keeping current, of course, financial, as well as time and effort expended.

So along came MOC. For an additional fee (steadily rising above $300 per year after 2009, and as far as I’m aware without any limit on future increases), we were graced with an additional entity to ride herd on us, blessing (or finding wanting) our efforts to remain professionally capable. This did not replace or even diminish the desire of hospitals, states, feds, etc. to continue imposing their own hurdles and hoops for us to jump over and through.

So, again, what did we get for our money? A third party to tally our CME and SAM credits, since we evidently could not be trusted to do this ourselves. A new requirement for something called PQI, which nobody really seemed to understand - until it was explained that this was to track and improve various aspects of our practices, at which point it became clear that this, too, was something we were already doing as needed. And a new mini-board exam every ten years, requiring most of us to travel to official testing centers (another expense).

Well! That last one was something we certainly weren’t already doing to ourselves. And unless I miss my guess, we weren’t exactly clamoring for it. What was the value of this new cycle of stress and worry that you might not retain your credentials to practice the profession which had been your livelihood for the previous 10, 20, 30 years?

There wasn’t a grand campaign to seek input from radiologists across the country who would be participating in this new initiative - because those to be affected weren’t radiologists yet. All then-practicing radiologists, including those designing the MOC program, were to be grandfathered in and exempt from participation unless they volunteered otherwise.

So, 1,000-plus radiologists per year began entering their profession with a new set of rules (subject to infinite change) into which they had zero input, yet for which they were footing the bill.

Is it any wonder this lawsuit is happening, or that others might follow?