Response: Re: Future of Board Certification in a New Era of Public Accountability

To the Editor: It is reassuring to hear from readers like Dr. Donohoe,¹ who have embraced the concept of American Board of Medical Specialties (ABMS) Maintenance of Certification (MOC). In his letter he expresses concern about who is required to participate in MOC, and states, “those who created this policy do not have to recertify.” In fact, Dr. Donohoe's certifying board, the American Board of Internal Medicine, requires its board members to recertify regardless of the status of their original certification. This is true of other member boards of the ABMS as well.

Dr. Donohoe also raises the issue of physicians who were certified before the ABMS and its 24 member boards developed the common standard of term-limited certificates. Because these physicians were presented with certificates that did not require recertification, they are not required to participate in MOC programs offered by ABMS member boards. Dr. Donohoe cited research suggesting that these physicians may be ideal candidates to benefit from MOC. Although most of the ABMS member boards have a policy of voluntary participation in MOC for these physicians, we are closely monitoring the emerging evidence related to this issue and how it might change future standards. In the meantime, our policy is to actively encourage physicians with non–time-limited certificates to voluntarily engage in MOC as a way to improve their ongoing competence and provide their patients with a reliable measure of physician accountability.

One new effort is our alignment of the MOC program with the Physicians Quality Reporting Initiative of the US Centers for Medicare & Medicaid Services (CMS). In the recently passed health care reform legislation (US Patient Protection and Accountable Care Act), there is a provision that enables physicians to meet the requirements of Physicians Quality Reporting Initiative and receive a bonus from CMS by participating in an ABMS member board MOC program. ABMS is working with CMS to launch this program in 2011.

However as noted in the paper referenced by Dr. Donohoe,² ultimately, ABMS and its member boards seek to elevate the quality of patient care by providing physicians with an ongoing process of assessment and continuous professional development that requires participants to demonstrate clinical competency and keep pace with advances in the field of medicine throughout their entire careers. Although Dr. Donohoe's letter relating his personal experience with MOC is anecdotal, it reinforces what we’ve heard time and again from participating physicians: MOC results in better care for their patients.