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Brief ReportPolicy Brief

Engagement of Family Physicians Seven Years Into Maintenance of Certification

James C. Puffer, Andrew W. Bazemore, Warren P. Newton, Laura Makaroff, Imam M. Xierali and Larry A. Green
The Journal of the American Board of Family Medicine September 2011, 24 (5) 483-484; DOI: https://doi.org/10.3122/jabfm.2011.05.110170
James C. Puffer
MD
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Andrew W. Bazemore
MD, MPH
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Warren P. Newton
MD
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Laura Makaroff
PhD
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Imam M. Xierali
PhD
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Larry A. Green
MD
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Abstract

Transitioning Family Physicians to continuous Maintenance of Certification (MOC) was intended to support the quality improvement movement nationally, but it also risked decreasing their engagement due to the increased requirements for retaining certification. However, after completing the transition of all family physicians into MOC in 2010, participation appears higher than ever.

Quality concerns in the US health care system led the American Board of Medical Specialties to introduce Maintenance of Certification (MOC) in 2000 and subsequently require implementation by all its 24 members. Numerous reports have suggested that resistance to participation in MOC by board certified physicians might impede the effort at improving the quality of health care.1,2 The American Board of Family Medicine (ABFM) began its transition to Maintenance of Certification for Family Physicians (MC-FP) for those family physicians certifying or recertifying in 2003. This new process required continuous demonstration of professionalism, regular self-assessment of knowledge, and measurement of quality improvement in practice in addition to the traditional assessment of cognitive expertise by examination.

Seven years later, Family Medicine is the first specialty in which all diplomates have faced the choice of either engaging in this process or allowing their certification to lapse.3 Using ABFM administrative data, we evaluated the MC-FP participation status of the first of seven cohorts to enter this process. We found that of the 11,260 family physicians who certified or recertified in 2003 and thus entered Stage 1 of MC-FP, 8589 (76%) successfully completed their first and second 3-year stages and extended their original 7-year certificates by 3 years, thereby earning a full 10-year MC-FP cycle. Of the remaining 2671 family physicians who either defaulted to, or chose to remain on, the traditional 7-year pathway, 1335 successfully completed the 7-year pathway requirements. Some 1148 of these physicians successfully maintained their certificates by passing the MC-FP examination in the 7th year of their MC-FP cycle (see Figure 1).

Figure 1.
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Figure 1.

Maintenance of Certification for Family Physicians (MC-FP) participation: 2003 cohort.

Therefore, 88% (9924/11,260) of family physicians who entered the initial MC-FP cohort in 2003 are actively engaged in maintenance of certification. Historical comparison data demonstrate that in the recertification paradigm that existed before 2003, approximately 75% to 80% of family physicians who certified or recertified in any given year would return to recertify within 7 years. These findings suggest a significant commitment to professionalism in the discipline of Family Medicine, which was the first specialty to require periodic recertification when it was established as a specialty in 1969. Even given this precedent, engagement in MC-FP may be viewed as higher than expected, given historical data from the preceding recertification model. This is an encouraging sign, particularly if anticipated links between MC-FP, improved quality, and lower cost of care are confirmed. In the coming years, demonstrating MC-FPs impact on quality and cost, as well as reducing disparities in engagement, are essential challenges for the specialty.4

Notes

  • This article was externally peer reviewed.

  • Funding: No sources of funding, except for the American Board of Family Medicine, which contracts annually for health policy/health services research conducted by the Robert Graham Center for Policy Studies related Maintenance Certification and Quality.

  • Conflict of interest: none.

  • Received for publication May 10, 2011.
  • Revision received July 8, 2011.
  • Accepted for publication July 8, 2011.

References

  1. 1.↵
    1. Levinson W,
    2. King TE Jr.,
    3. Goldman L,
    4. et al
    . American Board of Internal Medicine Maintenance of Certification Program. N Engl J Med 2010;362:948–52.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Drazen JM,
    2. Weinstein DF
    . Considering recertification. N Engl J Med 2010;362.
  3. 3.↵
    1. Xierali IM,
    2. Rinaldo JCB,
    3. Green LA,
    4. et al
    . Family physician participation in maintenance of certification. Ann Fam Med 2011;9:203–10.
    OpenUrlAbstract/FREE Full Text
  4. 4.↵
    1. Bazemore AW,
    2. Xierali IM,
    3. Petterson SM,
    4. et al
    . American Board of Family Medicine (ABFM) maintenance of certification: variations in self-assessment modules uptake within the 2006 cohort. J Am Board Fam Med 2010;23:49–58.
    OpenUrlAbstract/FREE Full Text
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The Journal of the American Board of Family     Medicine: 24 (5)
The Journal of the American Board of Family Medicine
Vol. 24, Issue 5
September-October 2011
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Engagement of Family Physicians Seven Years Into Maintenance of Certification
James C. Puffer, Andrew W. Bazemore, Warren P. Newton, Laura Makaroff, Imam M. Xierali, Larry A. Green
The Journal of the American Board of Family Medicine Sep 2011, 24 (5) 483-484; DOI: 10.3122/jabfm.2011.05.110170

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Engagement of Family Physicians Seven Years Into Maintenance of Certification
James C. Puffer, Andrew W. Bazemore, Warren P. Newton, Laura Makaroff, Imam M. Xierali, Larry A. Green
The Journal of the American Board of Family Medicine Sep 2011, 24 (5) 483-484; DOI: 10.3122/jabfm.2011.05.110170
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