Virginia’s Broken System of Physician Recertification

by Suja S. Amir, MPA

Every ten years, physicians take what are called Maintenance of Certification (MOC®) exams, created to test a physician’s education after being in practice 10+ years.

Here’s the problem: this evaluation is administered and sold by one company, the powerful and well-connected American Board of Medical Specialties (ABMS).

And over the years they have successfully lobbied hospitals and insurance companies to punish or even fire physicians who refuse to purchase the product — even though these tests are not required by Medicare, Medicaid, Veterans Affairs, or Virginia’s Board of Medicine.

However, the vast majority of the material on the exam has little relevance to the actual work and while, it may cover topics that say, a primary care physician encounters, it is an exam that is filled with esoteric facts to memorize. After 36 years of requiring physician participation in re-certification exams and a proprietary continuing professional development program, robust evidence-based data does not exist to support the current ABMS maintenance of certification (MOC®) process improves physician knowledge base or patient outcomes. In fact, 81% of physicians feel MOC® is a burden and only 15% felt recertification was worth the effort.

These tests are also outrageously costly — both monetarily and with what could very well be a physician’s most valuable commodity: time with their patients. The average wait time in Virginia for patients to get an appointment with a physician is 24 days.

I remember the time and effort my husband sacrificed in college, medical school and especially residency. I thought of the sleep he missed to be with patients and to learn his medical specialty. I thought of the time he was away from me and our first-born child while he was earning around $35,000/year working over 80 hours a week.

We saved every penny in order to pay for one test, when he was in medical school and residency, so much so that I had to personally cash in vacation time to pay for one of them upfront. This doesn’t include any of the board review classes/exam materials and looming medical school loans that were awaiting us at the end of it all.

This was for one recertification test that wasn’t even required by the state medical boards. All because one company has squashed the competition and convinced physicians, hospitals and insurance companies that they didn’t have any other options for recertification.

Dr. Westby Fisher, an electrophysiologist and a board member for Practicing Physicians of America commented:

“It is also strange that the ABMS would call their fees ‘reasonable’ when those fees only apply to new, younger, often debt-burdened physicians and not to older physicians certified before 1990. Older physicians are not required to participate in MOC® to keep hospital privileges or insurance panel payments. Age discrimination – a hallmark of the ABMS MOC®® program – is not ‘reasonable’ to any ethical working physician or member of the public.”

I’d add to this also discriminates against women, racial and ethnic minorities, sexual and gender minorities and people with disabilities, as the demographics of “older physicians” is overwhelmingly male and white.

But mercifully, there is good news for doctors like Amir.

In response to the growing number of medical professionals unhappy with the ABMS monopoly, the National Board of Physicians and Surgeons (NBPAS) was formed in 2015 by physicians from the Mayo Clinic, Harvard, Yale, Dartmouth and other prestigious academic medical institutions to start the NBPAS which allows for another pathway for continuing board certification, and I have been working with a nonprofit advocacy organization called The Virginia Coalition on MOC® Reform to support state legislation to allow for greater choice among physicians in need of recertification.   Virginia currently has two hospitals that accept NBPAS and there are over 130 hospital/hospital systems across the country that accepts NBPAS.

Delegate Sam Rasoul for the last three years has championed legislation on this issue for the last three years. This year, HB 1449 and SB 982 seek to continue the push for MOC® Reform.

Rasoul, in 2019 tried to come to a consensus by working tireless with practicing physicians and those who seek to oppose this bill.  He set up multiple stakeholder meetings with practicing physicians, medical societies, VCU, UVA, MSV and VHHA to discuss solutions for the 16,000 practicing physician in Virginia.  They declined to participate in the bipartisan effort.  And now, that the bill is out? The hundreds of Virginia physicians who have written to their legislators over the course of the last week seems to be getting overshadowed.

Why would these organizations be so heavily opposed to his bill? Why are they not assisting with providing consensus language?

These entities all have financial ties to MOC®.  They have purchased licensing agreements from ABMS and can sell the product right back to their employed physicians.

Therefore it is quite fitting, that the first legislator in Virginia to pledge not to take donations from special interests, is the same legislator who has championing this change for practicing physicians.

This legislation will (1) provide hospitals and insurance companies another certification option, (2) save hospitals millions of dollars annually that they spend on MOC® exams and (3) cost Virginia taxpayers absolutely nothing.

No one disagrees that hospitals and insurance companies should be allowed to value and require continuing education and recertification, but physicians should be given options, plain and simple.

Well-connected special interest groups like ABMS have had free reign over territory that they felt was rightfully theirs for far too long.  Admittedly, this has been an uphill fight. It’s a bit like David and Goliath, or even a band of revolutionaries against the British Empire, if you will.

But like the Siege of Yorktown, momentum seems to be turning. In October 2019, the Medical Society of Virginia physician membership unanimously passed resolutions about reforming the MOC® process, and organizations like the Association of American Physicians & Surgeons, Practicing Physicians of America and the Medical Society of Northern Virginia have all signed onto our physician’s choice platform.

There’s a better way, and fans of the musical know that just because something is difficult doesn’t mean it’s not worth the fight. Our plan is to “fan this spark into a flame,” as Alexander Hamilton might say.