Author + information
- Patrick T. O'Gara, MD, FACC, President, American College of Cardiology∗ ( and )
- William J. Oetgen, MD, MBA, FACC, Executive Vice President, Science, Education and Quality, American College of Cardiology
- ↵∗Address correspondence to:
Dr. Patrick T. O’Gara, American College of Cardiology, 2400 N Street NW, Washington, DC 20037.
Over the last several months, the American College of Cardiology (ACC) has continued to solicit and receive feedback from its members about the American Board of Internal Medicine’s (ABIM’s) new Maintenance of Certification (MOC) requirements. The vast majority of members find fault with the changes imposed by the ABIM and look to the College to take a leadership role in working with the ABIM to revise them.
To that end, we, along with ACC’s Chief Executive Officer Mr. Shalom Jacobovitz, met with ABIM’s Chief Executive Officer Dr. Richard Baron in Philadelphia, Pennsylvania, in late May to share with ABIM leadership the results of the survey initiated by our Board of Governors. This was the first in what will be a continuing dialogue with the ABIM on how best to manage the recertification process in a manner that meets the needs of affected physicians, patients, and the public, while reducing both disruption and frustration and maximizing value.
The following statement summarizes the College’s approach as of June 2014. It has been approved unanimously by the ACC Executive Committee and Board of Trustees. Our commitment to our members and their patients remains steadfast. The ACC recognizes the legitimate concerns that have arisen over the new ABIM requirements and looks forward to working with other professional societies and the ABIM to recalibrate the process so that we can continue to assist our members in the provision of professional, knowledgeable, and compassionate care, and balance the need for demonstration of ongoing competence with fulfillment of our obligations to society.
ACC Response to the ABIM’s MOC Requirements
The ABIM instituted significant changes to its MOC process on January 1, 2014. The modifications apply to all physicians, including those who received lifetime certification prior to 1990 (“grandparents”), and mandate the completion of any MOC activity every 2 years, accumulation of 100 MOC “points” distributed between Part II and IV activities within 5 years, completion of patient survey and patient safety activities, and passing a secure examination every 10 years. The revision of standards initially established in 2006 has sparked heated discussions across the entire ACC membership and has called into question the validity, relevance, utility, and associated financial and opportunity costs of meeting these revised MOC requirements. ACC members have clearly expressed their frustration and dissatisfaction with the process and have proposed several alternative approaches. This communication is intended to state the ACC’s position on MOC and to provide a strategic framework for College initiatives to improve the process.
As background, it is important to share the results of a member survey commissioned by the ACC and distributed through its state chapters in spring 2014. The survey was completed within 4 weeks by over 4,400 members (12% of the total solicited). Nearly 90% of respondents opposed the changes to MOC, citing, among multiple concerns, the higher-than-expected costs. Nearly one-third of respondents indicated that the changes will affect their future career plans and will likely accelerate career decisions such as early retirement, part-time work, or transition to nonclinical work. Approximately one-quarter of physicians in practice for 15 years or more specified that early retirement was a probable outcome. Recommended process revisions included reverting to the 2006 standards, removing various MOC parts (II, III, or IV), or having the ACC assume certification responsibilities. No single process revision was chosen by more than 50% of respondents. A significant majority (68%) did recommend that the ACC work with the ABIM to revise the requirements. There was a strong request for the ACC to make more MOC modules available and more easily accessible.
The ACC recognizes that the ABIM’s mission as a standards-setting organization differs from its own mission as an educational organization. The ACC strongly supports the ideals of lifelong learning and continuous professional development. The College and its members are acutely aware of the need to continuously maintain the public trust by transparently demonstrating ongoing competence as guided by the principles of high-value patient care. Our membership holds itself to the highest professional standards. The ACC is an educational organization in which the ongoing learning of our members is accorded strategic priority. Educational activities must be designed and delivered in ways that enhance provider performance and improve patient outcomes.
The ABIM-imposed changes in the MOC process have called into question the optimal methodology for achieving the intertwined goals of lifelong learning and high-value care.
In response to these changes and our members’ concerns, the ACC commits to do the following:
▪ Have ongoing discussions with ABIM leadership, in partnership with other cardiovascular professional organizations whose members are similarly affected, to review these issues and to explore changes in MOC requirements that will result in more meaningful outcomes and less onerous burdens for ACC members;
▪ Request for ACC representation at the ABIM to participate in discussions involving MOC, including its educational and financial aspects;
▪ Review the evidence base underlying current recommendations; and
▪ Investigate the impact of MOC changes on non-ABIM-certified members.
In the interim, the College will support its membership by:
▪ Free provision of web-based MOC modules and navigation tools;
▪ Expansion of Part IV MOC modules through ACC programs, such as the NCDR’s inpatient registries and the PINNACLE registry;
▪ Creation of mechanisms for ACC members by which patient safety and patient survey requirements can be efficiently fulfilled; and
▪ Bidirectional communication with and engagement of membership through chapters, sections, and councils.
Note: There is evidence that the ABIM has heard the concerns of its diplomats and is acting responsively. In a July 10, 2014 letter to the internal medicine community, and in a face-to-face meeting in Philadelphia on July 15, 2014, which was attended by 26 internal medicine subspecialty societies including the ACC, the ABIM committed to:
• Provide a 1-year grace period for those who have attempted but failed to pass the secure examination.
• Update its governance and financial information on its website.
• Ensure a broader range of CME options for medical knowledge and skills self-assessment (Part II).
• Provide more feedback regarding test scores.
• Evolve the “patient survey” requirement to a “patient voice” requirement and increase the number of ways this requirement can be met.
• Reduce the data collection requirement for the practice assessment requirement; utilizing performance improvement activities already in place and minimizing the time and complexity of data input.
• Investigate changes in the secure examination to increase relevance with specific attention to exploring applications for practice focus areas (“modular examinations”) and open-book examinations.
For its part, the ACC has recently:
• Released a special video that catalogs the suite of ACC resources available to help members meet the MOC Part IV requirements.
• Determined that free-standing MOC modules will be offered to ACC members at no charge.
• Posted online (CardioSource.org/MOC) a comprehensive list of ACC MOC Part II offerings. New modules will be added as they become available.
- American College of Cardiology Foundation