Looking for an Alternative to ABPN Maintenance of Certification?

The current American Board of Medical Specialties (ABMS)/American Board of Psychiatry and Neurology (ABPN) requirements for maintenance of certification (MOC) do not ensure that a practicing physician has maintained competency to practice neurology. The ABMS acknowledges this concept, and one ABMS member website included the following statement: “Many qualities are necessary to be a competent physician, and many of these qualities cannot be quantified or measured. Thus, certification is not a guarantee of the competence of the physician specialist.” In other words, board certification is meant to demonstrate competence, but the board does not guarantee competence. This concept nullifies the notion that the American College of Physicians (ACP) raised, that if you become involved in litigation, board certification will somehow protect you. The fact is that if you are negligent, no piece of paper hanging on your wall will protect you.

The costs to practicing neurologists, both in terms of time and money, to complete this process are considerable. In a recent study, the cost of physician compliance with MOC was found to range from $23,607 to $40,495 over a 10-year period, depending on specialty. Yet there is no published evidence that demonstrates that these requirements serve to improve quality of practice.

Action and Reaction

In an article published in the New England Journal of Medicine, Paul Teirstein, MD, Chief of Cardiology at the Scripps Clinic, criticized many aspects of MOC. Shortly after publication, the American Board of Internal Medicine issued a mea culpa and suspended some of the Practice Assessment, Patient Voice, and Patient Safety requirements.

On February 24, 2015, former American Academy of Neurology (AAN) President Timothy A. Pedley, MD, issued a statement on behalf of the AAN arguing that Part IV of MOC is an onerous requirement and that this ABPN requirement has imposed a hardship on neurologists.

In July 2015, the ABPN announced that as of January 1, 2016, the Feedback Module (patient or peer surveys) would become a highly recommended yet optional component of MOC. The Part IV Clinical Module component (chart review) will remain a requirement.

A New Pathway

Fortunately, there is a viable alternative to the ABMS/ABPN pathway to MOC. The National Board of Physicians and Surgeons (NBPAS) is offering recertification in ABMS medical specialties. The board of directors of the NBPAS comprises members representing many of the country’s top academic institutions and specialty organizations. All physician members of NBPAS are volunteers (there is a small paid administrative staff), in contradistinction to the ABMS boards. Members of the ABMS boards are paid six-figure salaries.

The NBPAS board recertification criteria can be found on its website (NBPAS.org). They are:

1. Previous certification by an ABMS member board.

2. Valid license to practice medicine.

3. At least 50 hours of Continuing Medical Education (CME) accredited by the Accreditation Council for CME within the past 24 months.

4. Active hospital privileges (for select specialties).

5. Clinical privileges in certified specialty have not been permanently revoked.

6. Cost: $169 for a two-year certification.

The MOC requirement itself is incorporated into Medicare law and under the Patient Protection and Affordable Care Act, although there is ambiguity regarding whether MOC must be obtained via the ABMS specialty boards. When these laws were written, the ABMS was essentially the only game in town for physicians. The ABMS has been challenged in terms of being a monopoly organization for specialty certification and recertification. Presumably because of this fact, or perhaps as a pre-emptive defense, the ABMS has recently acknowledged publicly that it does have competition in the form of the NBPAS. To punctuate this point, one ABMS member website has included the following statement, “Possession of a board certificate does not indicate total qualification for practice privileges, nor does it imply exclusion of other physicians not so certified.”

Due to pressure from NBPAS and others, the ABMS boards have had to reconsider their position on MOC. Beginning in 2016, the American Board of Anesthesiology decided to discontinue their 10-year recertification examination. Instead, their diplomates will be taking an online 30-question quiz per calendar quarter (120 questions per year). Although this is a positive change, making a 120-question, online, open-book exam for all diplomates recertifying must be significantly cheaper to produce and administer than a secured 10-year exam. That being said, the cost of this new MOC program is $210 per year instead of a lump sum of $2,100 to take the closed-book exam every 10 years. Clearly, the boards feel a reduction in cost of production for the boards should not translate to a reduction in cost to the diplomates, and that the boards should actually generate even greater revenues.

The ABPN has also responded positively by forming an MOC clinical advisory committee to evaluate how MOC impacts practice and “potentially” improves patient care. Their use of the word “potentially” is particularly encouraging, because it implicitly suggests that evidence needs to be found to support that claim.

The Future of Board Certification

The ABMS boards acknowledge that NBPAS exists as a legitimate alternative board, but they do not feel threatened at all. They are confident that physicians, like sheep to be herded, will continue to blindly pay to do unnecessary work in the name of board certification.

Unfortunately for the ABMS boards, more than 3,000 physicians have become diplomates of NBPAS, which has become accepted as a viable alternative to ABMS by an increasing number of hospital credentialing departments. It is only through an expanding number of diplomates that NBPAS can increase its acceptance and rival the inflexible, self-centered monopoly that ABMS has become.

With more institutions accepting NBPAS certification, the influence and leverage of NBPAS will grow, and physicians will be relieved of the burden of complying with costly and time-consuming requirements that do not improve practice. There is no harm in being dual-boarded, and becoming a diplomate of NBPAS prior to the expiration of an ABPN/ABMS board certification is a low-risk decision that supports a prophysician grassroots movement. During this time of unprecedented physician unity, organizations like NBPAS appear well positioned to help return the practice of medicine to physicians rather than detached administrators.

The current American Board of Medical Specialties (ABMS)/American Board of Psychiatry and Neurology (ABPN) requirements for maintenance of certification (MOC) do not ensure that a practicing physician has maintained competency to practice neurology. The ABMS acknowledges this concept, and one ABMS member website included the following statement: “Many qualities are necessary to be a competent physician, and many of these qualities cannot be quantified or measured. Thus, certification is not a guarantee of the competence of the physician specialist.” In other words, board certification is meant to demonstrate competence, but the board does not guarantee competence. This concept nullifies the notion that the American College of Physicians (ACP) raised, that if you become involved in litigation, board certification will somehow protect you. The fact is that if you are negligent, no piece of paper hanging on your wall will protect you.

The costs to practicing neurologists, both in terms of time and money, to complete this process are considerable. In a recent study, the cost of physician compliance with MOC was found to range from $23,607 to $40,495 over a 10-year period, depending on specialty. Yet there is no published evidence that demonstrates that these requirements serve to improve quality of practice.

Action and Reaction

In an article published in the New England Journal of Medicine, Paul Teirstein, MD, Chief of Cardiology at the Scripps Clinic, criticized many aspects of MOC. Shortly after publication, the American Board of Internal Medicine issued a mea culpa and suspended some of the Practice Assessment, Patient Voice, and Patient Safety requirements.

On February 24, 2015, former American Academy of Neurology (AAN) President Timothy A. Pedley, MD, issued a statement on behalf of the AAN arguing that Part IV of MOC is an onerous requirement and that this ABPN requirement has imposed a hardship on neurologists.

In July 2015, the ABPN announced that as of January 1, 2016, the Feedback Module (patient or peer surveys) would become a highly recommended yet optional component of MOC. The Part IV Clinical Module component (chart review) will remain a requirement.

A New Pathway

Fortunately, there is a viable alternative to the ABMS/ABPN pathway to MOC. The National Board of Physicians and Surgeons (NBPAS) is offering recertification in ABMS medical specialties. The board of directors of the NBPAS comprises members representing many of the country’s top academic institutions and specialty organizations. All physician members of NBPAS are volunteers (there is a small paid administrative staff), in contradistinction to the ABMS boards. Members of the ABMS boards are paid six-figure salaries.

The NBPAS board recertification criteria can be found on its website (NBPAS.org). They are:

1. Previous certification by an ABMS member board.

2. Valid license to practice medicine.

3. At least 50 hours of Continuing Medical Education (CME) accredited by the Accreditation Council for CME within the past 24 months.

4. Active hospital privileges (for select specialties).

5. Clinical privileges in certified specialty have not been permanently revoked.

6. Cost: $169 for a two-year certification.

The MOC requirement itself is incorporated into Medicare law and under the Patient Protection and Affordable Care Act, although there is ambiguity regarding whether MOC must be obtained via the ABMS specialty boards. When these laws were written, the ABMS was essentially the only game in town for physicians. The ABMS has been challenged in terms of being a monopoly organization for specialty certification and recertification. Presumably because of this fact, or perhaps as a pre-emptive defense, the ABMS has recently acknowledged publicly that it does have competition in the form of the NBPAS. To punctuate this point, one ABMS member website has included the following statement, “Possession of a board certificate does not indicate total qualification for practice privileges, nor does it imply exclusion of other physicians not so certified.”

Due to pressure from NBPAS and others, the ABMS boards have had to reconsider their position on MOC. Beginning in 2016, the American Board of Anesthesiology decided to discontinue their 10-year recertification examination. Instead, their diplomates will be taking an online 30-question quiz per calendar quarter (120 questions per year). Although this is a positive change, making a 120-question, online, open-book exam for all diplomates recertifying must be significantly cheaper to produce and administer than a secured 10-year exam. That being said, the cost of this new MOC program is $210 per year instead of a lump sum of $2,100 to take the closed-book exam every 10 years. Clearly, the boards feel a reduction in cost of production for the boards should not translate to a reduction in cost to the diplomates, and that the boards should actually generate even greater revenues.

The ABPN has also responded positively by forming an MOC clinical advisory committee to evaluate how MOC impacts practice and “potentially” improves patient care. Their use of the word “potentially” is particularly encouraging, because it implicitly suggests that evidence needs to be found to support that claim.

The Future of Board Certification

The ABMS boards acknowledge that NBPAS exists as a legitimate alternative board, but they do not feel threatened at all. They are confident that physicians, like sheep to be herded, will continue to blindly pay to do unnecessary work in the name of board certification.

Unfortunately for the ABMS boards, more than 3,000 physicians have become diplomates of NBPAS, which has become accepted as a viable alternative to ABMS by an increasing number of hospital credentialing departments. It is only through an expanding number of diplomates that NBPAS can increase its acceptance and rival the inflexible, self-centered monopoly that ABMS has become.

With more institutions accepting NBPAS certification, the influence and leverage of NBPAS will grow, and physicians will be relieved of the burden of complying with costly and time-consuming requirements that do not improve practice. There is no harm in being dual-boarded, and becoming a diplomate of NBPAS prior to the expiration of an ABPN/ABMS board certification is a low-risk decision that supports a prophysician grassroots movement. During this time of unprecedented physician unity, organizations like NBPAS appear well positioned to help return the practice of medicine to physicians rather than detached administrators.

The current American Board of Medical Specialties (ABMS)/American Board of Psychiatry and Neurology (ABPN) requirements for maintenance of certification (MOC) do not ensure that a practicing physician has maintained competency to practice neurology. The ABMS acknowledges this concept, and one ABMS member website included the following statement: “Many qualities are necessary to be a competent physician, and many of these qualities cannot be quantified or measured. Thus, certification is not a guarantee of the competence of the physician specialist.” In other words, board certification is meant to demonstrate competence, but the board does not guarantee competence. This concept nullifies the notion that the American College of Physicians (ACP) raised, that if you become involved in litigation, board certification will somehow protect you. The fact is that if you are negligent, no piece of paper hanging on your wall will protect you.

The costs to practicing neurologists, both in terms of time and money, to complete this process are considerable. In a recent study, the cost of physician compliance with MOC was found to range from $23,607 to $40,495 over a 10-year period, depending on specialty. Yet there is no published evidence that demonstrates that these requirements serve to improve quality of practice.

Action and Reaction

In an article published in the New England Journal of Medicine, Paul Teirstein, MD, Chief of Cardiology at the Scripps Clinic, criticized many aspects of MOC. Shortly after publication, the American Board of Internal Medicine issued a mea culpa and suspended some of the Practice Assessment, Patient Voice, and Patient Safety requirements.

On February 24, 2015, former American Academy of Neurology (AAN) President Timothy A. Pedley, MD, issued a statement on behalf of the AAN arguing that Part IV of MOC is an onerous requirement and that this ABPN requirement has imposed a hardship on neurologists.

In July 2015, the ABPN announced that as of January 1, 2016, the Feedback Module (patient or peer surveys) would become a highly recommended yet optional component of MOC. The Part IV Clinical Module component (chart review) will remain a requirement.

A New Pathway

Fortunately, there is a viable alternative to the ABMS/ABPN pathway to MOC. The National Board of Physicians and Surgeons (NBPAS) is offering recertification in ABMS medical specialties. The board of directors of the NBPAS comprises members representing many of the country’s top academic institutions and specialty organizations. All physician members of NBPAS are volunteers (there is a small paid administrative staff), in contradistinction to the ABMS boards. Members of the ABMS boards are paid six-figure salaries.

The NBPAS board recertification criteria can be found on its website (NBPAS.org). They are:

1. Previous certification by an ABMS member board.

2. Valid license to practice medicine.

3. At least 50 hours of Continuing Medical Education (CME) accredited by the Accreditation Council for CME within the past 24 months.

4. Active hospital privileges (for select specialties).

5. Clinical privileges in certified specialty have not been permanently revoked.

6. Cost: $169 for a two-year certification.

The MOC requirement itself is incorporated into Medicare law and under the Patient Protection and Affordable Care Act, although there is ambiguity regarding whether MOC must be obtained via the ABMS specialty boards. When these laws were written, the ABMS was essentially the only game in town for physicians. The ABMS has been challenged in terms of being a monopoly organization for specialty certification and recertification. Presumably because of this fact, or perhaps as a pre-emptive defense, the ABMS has recently acknowledged publicly that it does have competition in the form of the NBPAS. To punctuate this point, one ABMS member website has included the following statement, “Possession of a board certificate does not indicate total qualification for practice privileges, nor does it imply exclusion of other physicians not so certified.”

Due to pressure from NBPAS and others, the ABMS boards have had to reconsider their position on MOC. Beginning in 2016, the American Board of Anesthesiology decided to discontinue their 10-year recertification examination. Instead, their diplomates will be taking an online 30-question quiz per calendar quarter (120 questions per year). Although this is a positive change, making a 120-question, online, open-book exam for all diplomates recertifying must be significantly cheaper to produce and administer than a secured 10-year exam. That being said, the cost of this new MOC program is $210 per year instead of a lump sum of $2,100 to take the closed-book exam every 10 years. Clearly, the boards feel a reduction in cost of production for the boards should not translate to a reduction in cost to the diplomates, and that the boards should actually generate even greater revenues.

The ABPN has also responded positively by forming an MOC clinical advisory committee to evaluate how MOC impacts practice and “potentially” improves patient care. Their use of the word “potentially” is particularly encouraging, because it implicitly suggests that evidence needs to be found to support that claim.

The Future of Board Certification

The ABMS boards acknowledge that NBPAS exists as a legitimate alternative board, but they do not feel threatened at all. They are confident that physicians, like sheep to be herded, will continue to blindly pay to do unnecessary work in the name of board certification.

Unfortunately for the ABMS boards, more than 3,000 physicians have become diplomates of NBPAS, which has become accepted as a viable alternative to ABMS by an increasing number of hospital credentialing departments. It is only through an expanding number of diplomates that NBPAS can increase its acceptance and rival the inflexible, self-centered monopoly that ABMS has become.

With more institutions accepting NBPAS certification, the influence and leverage of NBPAS will grow, and physicians will be relieved of the burden of complying with costly and time-consuming requirements that do not improve practice. There is no harm in being dual-boarded, and becoming a diplomate of NBPAS prior to the expiration of an ABPN/ABMS board certification is a low-risk decision that supports a prophysician grassroots movement. During this time of unprecedented physician unity, organizations like NBPAS appear well positioned to help return the practice of medicine to physicians rather than detached administrators.