Maintenance of certification and licensing: What you need to know
New system emphasizes self-assessment, performance improvement
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In 2000, the American Board of Medical Specialties (ABMS) made a commitment to develop a maintenance of certification (MOC) system for their 24 specialty boards. MOC aims to keep physicians up to date because medical knowledge and practice are rapidly evolving and health care systems expect greater accountability linked with performance and outcomes. Previously, board certification for most specialties was limited to a 1-time board exam; upon passing, a clinician was considered board certified for life. The American Board of Psychiatry and Neurology (ABPN) first issued time-limited certificates for board certification in 1994; 2007 was the first year of initial MOC enrollment for ABPN. Diplomates whose certificates were issued before October 1, 1994 are not required to participate in the MOC program.
The ABPN time-limited certificates are on 10-year cycles and require diplomates to fulfill 4 MOC program components: Professional Standing, Self-Assessment and Continuing Medical Education (CME), Cognitive Expertise, and Performance in Practice (PIP) (Table).1 Requirement details are available at www.abpn.com.
The ABMS MOC initiative is closely aligned with other initiatives, such as maintenance of licensure (MOL), that will impact all physicians, including those who are not board certified and those who were certified before October 1, 1994 and therefore not required to participate in MOC. Licensure, reimbursement, and institutional credentials are developing required measures based on self-assessment and performance.
Table
Maintenance of certification: 4 components
| Component | Description |
|---|---|
| Professional Standing | Diplomates must hold an active and unrestricted license to practice medicine in ≥1 state commonwealth territory or possession of the United States or province of Canada |
| Self-Assessment and CME | Self-assessment: Diplomates must participate in ≥2 major broad-based self-assessment activities that must cover new knowledge and/or current best practices and provide feedback to the diplomate that can be used as the basis for focused CME lifelong learning and/or career development |
| CME activities: Diplomates are required to complete an average of 30 specialty or subspecialty Category 1 CME credits per year over the 10-year MOC cycle. At least an average of 8 of the CME credits per year (averaged over 2 to 5 years) should involve self-assessment | |
| Cognitive Expertise | Diplomates must pass a cognitive examination before the expiration date of their certificates |
| Performance in Practice (PIP) | Diplomates will be required to complete 3 PIP units over the 10-year MOC cycle each consisting of both a clinical module (chart review) and a feedback module (patient/peer second-party external review) |
| CME: continuing medical education; MOC: maintenance of certification Source: Adapted from reference 1 | |
MOC requirements
The ABMS developed its MOC program around 6 general competencies identified by the Accreditation Council for Graduate Medical Education:
- professionalism
- patient care and procedural skills
- medical knowledge
- practice-based learning and improvement
- interpersonal and communications skills
- systems-based practice.
Physicians with “lifetime” certificates are not required to participate in MOC; there are no consequences for physicians who are not required to participate in MOC and choose not to participate, because MOC is a voluntary system. Physicians with time-limited certificates can choose not to participate, but would forfeit their certification. Physicians with certifications in multiple specialties may consider the value of maintaining all of their certifications because it would require them to participate in multiple MOC programs.
Two of the 4 parts of MOC (Parts I and III) are extensions of existing board certification requirements. Part I stipulates a diplomate hold a valid and unrestricted license in ≥1 states or jurisdictions in the United States, its territories, or Canada. Part III (Cognitive Expertise) requires that he or she must pass a cognitive examination every 10 years. To qualify to take the cognitive exam, a diplomate must meet all current MOC requirements.
Parts II and IV integrate continuing education, self-assessment, and the ability to apply both to practice improvements. Part II requires an average of 8 CME credit hours that include a self-assessment component; this likely would eliminate most traditional CME activities. The ABPN stipulates that feedback from the self-assessment must include a comparison with peers and specific literature recommendations for each question in the self-assessment. A small but growing number of accredited CME providers have developed self-directed CME activities that meet these criteria. As of 2014, only ABPN-approved self-assessment activities can be used to meet Part II requirements.
