As part of the College’s ongoing efforts to address the American Board of Internal Medicine’s (ABIM’s) new Maintenance of Certification (MOC) requirements, the ACC has developed the following response that takes into account member feedback over the last several months and outlines the College’s commitment to improving the process moving forward. This response was unanimously approved by the ACC’s Executive Committee and Board of Trustees. As stated in the document, the ACC’s commitment to its members and their patients remains steadfast. Advocating for our members to assist them in the provision of professional, knowledgeable and compassionate care, coupled with demonstration of ongoing competence, will continue to guide our actions and fulfill 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 life-time certification prior to 1990 (“grandparents”), and mandate completion of any MOC activity every two years, accumulation of 100 MOC “points” distributed between Part II and Part IV activities within five years, completion of patient survey and patient safety activities, and passing a secure examination every 10 years. The revisions of standards initially established in 2006 have sparked heated discussions across the entire ACC membership and have 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 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 ACC and distributed through our state chapters in the spring of 2014. The survey was completed within four weeks by over 4,400 members (12 percent of the total solicited). Nearly 90 percent of respondents opposed the changes to MOC, citing, among multiple concerns, higher than expected costs. Nearly a 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 non-clinical 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 ACC assume certification responsibilities. No single process revision was chosen by more than 50 percent of respondents. A significant majority (68 percent) did recommend that ACC work with ABIM to revise the requirements. There was a strong request for 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 the following:
- 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 ABIM to participate in discussions involving MOC, including its educational and financial aspects;
- Review of the evidence base underlying current recommendations;
- Investigation of impact of MOC changes on non-ABIM certified members;
- In the interim, ACC will support its membership by:
- Free provision of web-based MOC modules and navigation tools to ACC members;
- 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;
- Bidirectional communication with and engagement of membership through Chapters, Sections and Councils.
In order to begin this process, the ACC President, Chief Executive Officer, and Executive Vice President for Science, Education, and Quality met personally on May 27, 2014 with the Chief Executive Officer of the ABIM in his offices in Philadelphia, PA.
The College’s commitment to its membership and their patients remains steadfast. Advocating for our members to assist them in the provision of professional, knowledgeable and compassionate care, coupled with demonstration of ongoing competence, will continue to guide our actions and fulfill our obligations to society.