NEW ORLEANS -- The American Board of Internal Medicine's (ABIM) effort to win over skeptics to its revised program for maintenance of certification (MOC) didn't seem to gain a lot of new adherents here at the American College of Physicians annual meeting.
"Board certification matters to many physicians," said Marianne Green, MD, chair of ABIM's internal medicine board. "It's a credential that people are proud to hold, and it has real performance standards behind it, and that should mean something. But for it to really mean something you have to help us develop it ... If we're getting it wrong in terms of meaning and relevance to you, then we need to hear from you."
ABIM officials also were still apologizing for the ABIM's earlier MOC program, which drew a lot of criticism from physicians. "We didn't do a good job explaining the reason for the maintenance of certification program," said Richard Baron, MD, ABIM's president and CEO. "It's really about staying current in knowledge and practice over the course of your career ... This is what the program meant to get across, that we're keeping pace and staying on top of things."
Green explained the board's new alternative to the rigorous MOC exam that board-certified internists are required to take every 10 years. The new, lower-stakes exam, which is being launched later this year, is called a "Knowledge Check-In" and is designed to be taken every 2 years. This year it is being offered to physicians certified in internal medicine and nephrology; it will be rolled out to all specialties by 2020, Green said.
Both the Knowledge Check-In and the 10-year board exam will offer access to UpToDate, a comprehensive medical reference database, for use during the test, she added. In addition, the test "can be taken at home, in a workplace or at a testing facility. There are many more times and dates available, and the results are given right at completion -- you'll know whether you passed or not. More detailed feedback will be sent to you shortly thereafter ... That's what's going to drive your learning in those domains where you're not as strong as you'd like to be."
The initial launch of the 2-year exam will be a "no consequences" affair, Green explained: physicians who fail the exam the first time they take it in 2018 or 2019 won't lose their board certification. Instead, they can re-take the exam in 2020.
After that, the 2-year exam will work as follows: if they fail a 2-year exam, they won't lose their certification; they can just re-take the exam 2 years later. If they pass that one, their certification is renewed; if not, they will still keep their certification, but they must take the 10-year exam the following year.
In addition to the exams, diplomates will be required to complete at least one MOC activity every 2 years, "even if it's [worth] as little as 1 point," Green said. Diplomates must earn a total of 100 points every 5 years, 20 of which must be medical knowledge. The Knowledge Check-In exam is worth 20 points toward that goal, she noted.
Chuck Cutler, MD, a private-practice physician from East Norriton, Pa., was not impressed. "Other boards are going to a formative process, and ABIM is stuck in a summative [exam] process," he said. "You pass a test, you're a good doctor; you fail a test, it's a huge embarrassment, and you're a bad doctor. Your only choice is to pay ... [and take the test again] so you have a credential."
Baron disagreed. "We'd regard the two assessments as a formative experience," he said. "The difference between formative and summative is not a bright line ... and it's not accurate to say all the other ... boards have gone to a formative decision."
Another audience member complained about the price of the exams. Baron pushed back, saying, "Our fees [amount to] less than $200 a year -- it's hard to see that as exorbitant fees ... We did reduce the fee for retake of a failed test by 50%; we did that a few years ago."
He also responded to a question about some older diplomates who were "grandfathered" into the maintenance of certification and whether they would be of equivalent quality to other board-certified physicians; these grandfathered doctors don't have to take ongoing exams.
"Grandfathering is a really vexing challenge," said Baron. "It's pretty difficult to defend ... I would not see those doctors as equivalent to doctors who recertify."