• MOC Article
    A recent article has been published in the New England Journal of Medicine, “Ensuring Physicians’ Competence – Is Maintenance of Certification the Answer?”1 The authors examine the implementation of MOC programs by the 24 ABMS medical specialty boards, including ABEM.

    There were a few points by the authors that require clarification by ABEM.

    Clarification: Medical Licensure

    Page 2544 of the article includes the following statement:

    Part 1, the first component, is licensure and professional standing. Specialists must hold a valid, unrestricted medical license in at least one state or jurisdiction in the United States, its territories, or Canada.

    ABEM’s Policy on Medical Licensure requires that all licenses held by a diplomate must be valid and unrestricted as well as current, active, full, and unqualified.

    Clarification: Participation in ABEM MOC

    Page 2545 of the article includes the following statement:

    The American Board of Emergency Medicine, the ABIM, and the American Board of Pediatrics are taking steps to require active MOC participation every 2 years.

    The ABEM MOC program encourages physicians to keep up-to-date on clinical advance, but it is not currently considering active MOC participation every two years. ABEM diplomates currently must complete and report four LLSAs, one APP practice improvement activity, and one communication/professionalism (patient satisfaction) activity every five years.

    ABEM MOC Costs

    The ABEM-imposed costs of MOC are relatively modest. The cost to physicians for taking LLSA tests and the ConCertTM examination averages just under $260 per year. There is no charge for attesting to APP activities.

    Evidence Base for Relevance

    There is a limited, but growing body of evidence that indicate the clinical relevance of MOC programs across the 24 medical specialties. In EM, two studies were conducted by ABEM that directly indicate the relevance ABEM MOC. The first study, submitted for peer review, indicates that greater than 90 percent of ABEM diplomates indicate that the LLSA articles are relevant to their practice and that they change the way that physicians practice. The second study, which is being revised for peer review, validates the relevance the content of the ConCertTM examination.

    Although there is limited evidence about the relevance of APP for emergency physicians, there is robust evidence that many of the activities accepted by ABEM for APP requirements, such as Lean, Six Sigma, and other quality improvement activities, improve physician practice and patient outcomes. A good example is door-to-balloon times for STEMI patients. Almost any emergency department–based quality measure/improvement activity is acceptable as an APP activity.

    Lifetime Certification

    ABEM has always had a time-limited (10-year) certificate.

    1. Iglehart JK, Baron RB. Ensuring physicians' competence — is maintenance of certification the answer? N Engl J Med. 2012;367:2543-2549.