Cold Iron Truth

The Maintenance of Certification wars come to your state


The struggle against mandatory maintenance of certification (MOC) is working its way across the country. Personally, I have always been opposed to mandatory MOC, and based on my experience with the Board of Directors of the American Academy of Dermatology, most of them also are opposed. . Practically, I have not wanted dermatologists to be the first specialty group to break ranks, refuse to participate and be branded as anti-quality and anti-improvement, although there is no good evidence MOC improves quality of care.

Dr. Brett M. Coldiron, a dermatologist and Mohs surgeon in Cincinnati

Dr. Brett M. Coldiron

When a proposal to prohibit the requirement to participate in MOC was introduced in the Ohio House of Representatives by Rep. Theresa Gavarone (R-Dist. 3), I recognized it as a blessing for Ohio physicians, most of whom are not grandfathered in for life. (Some doctors have a lifetime certification and are grandfathered into the old system, thereby not subject to MOC.) As written, House Bill 273 would prohibit a physician from being required to participate in MOC for licensure, reimbursement, employment, or for admitting or operating privileges. This would allow a way out of the tightening MOC noose. If enacted, it effectively would eliminate most of the negative consequences of not participating in MOC. The bill does not prohibit a specialty board from revoking certification, or from listing a doctor as noncompliant, nor does it prevent a physician from continuing to participate in MOC on a voluntary basis.

While several states have passed anti-MOC legislation, not all are as comprehensive as the proposal in Ohio. Notably, anti-MOC legislation failed in Florida, and is considered dead in Michigan and Mississippi. If you are planning to practice in those states in the near future, you had better stay on the MOC treadmill.

The following was excerpted from my testimony at the Ohio statehouse on Oct. 11 in favor of House Bill 273:

I have nothing personal to gain from passage of this legislation since I am old enough to be “grandfathered” in as lifetime board certified in internal medicine and dermatology. However, since I was serving as president of the American College of Mohs Surgeons and the American Academy of Dermatology, I did retake the certification exam and participate in MOC, just to walk the walk, so to speak ...

My personal experience with MOC has demonstrated how useless much of it is ... most of what I must study and retest on are diseases I will never see. The “quizzes” I pay for and self-score are silly, and the 10-year exam is terrifying since it has little relevance to my practice.

Please note that I am not saying that initial board certification is not of value ... I think the requirement for several years of certified residency training, and years of study do set a high quality bar for physicians, and believe it is a useful exercise for the physician and useful for public safety and quality assurance. I do not believe a practicing physician loses all of this [knowledge] every 10 years, in fact, they learn much more as they go. The MOC process assumes that we are all rusty scuba tanks that need to be pressure tested at 10-year intervals. I must also point out that Ohio physicians are required to complete 100 continuing medical education hours every 2 years for their medical licensure, which I have no complaint about. So even if there is some leakage, there is already some topping off.

I think one board certification gauntlet is enough. I note that physicians are the only professional group masochistic enough to self-flagellate with recertification in such a fashion. ... Lawyers pass their bar once. ...

Physician burnout has been identified as a major issue for Ohio physicians and relieving them of these onerous mandates can only help. These recertification requirements cost a lot of money, and take a lot of time. ... Ohio still has a shortage of physicians relative to other Midwestern states, and anything to make the environment more hospitable is welcome. Some physicians may argue that only physicians should regulate physicians, a position I agree with until it results in unreasonable tyranny by the few [physicians] who may materially profit from the rest [of us]. Then a legislative remedy such as this is called for.

Dr. Coldiron is in private practice but maintains a clinical assistant professorship at the University of Cincinnati. He cares for patients, teaches medical students and residents, and has several active clinical research projects. Dr. Coldiron is the author of more than 80 scientific letters, papers, and several book chapters, and he speaks frequently on a variety of topics. He is a past president of the American Academy of Dermatology. Write to him at [email protected].

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