P

hysicians across the nation are revolting against requirements that they regularly prove their medical skills are up to date — and they’re winning significant concessions, sparking alarm among some critics who fear relaxing the rules could compromise patient care.

The controversy centers around the quizzes, tests, and projects that physicians must complete to demonstrate they’re staying fresh in their fields. Many hospitals require doctors to complete these programs and pass a daylong recertification exam every six to 10 years as a condition for employment.

But thousands of doctors have protested the mandates as a costly and pointless burden. And state legislators are listening.

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Last month, Oklahoma became the first state to forbid hospitals and insurers from requiring the recertification program as a condition for employment or reimbursement. And Kentucky enacted a law that bars mandatory participation in these programs as a condition for getting a medical license. Both bills passed unanimously. Similar measures are in progress in Michigan and Missouri.  

“There’s no evidence that [the recertification process] is a true indicator of good quality,” says Dr. David Siegler, the pediatric neurologist whose protests initiated the Oklahoma legislation. “It’s like making you jump through a hoop, but the hoop has no purpose but to jump through it. And the person who sells the hoops is making a lot of money.”

The continuing education and recertification process, which is known as MOC — for Maintenance of Certification — generally costs doctors $2,000 to $3,000 for every six-to-10-year cycle. It’s run by the American Board of Medical Specialties, an umbrella organization for 24 medical specialty boards.

The movement against MOC has raised concern among patient advocates.

“The public in Oklahoma should be up in arms,” said Leah Binder, president of the Leapfrog Group, a health care quality watchdog organization.

Most members of the public already assume physicians are being assessed regularly for knowledge and competence, said Rosemary Gibson, a patient safety scholar and an unpaid public member of the public policy committee for the American Board of Medical Specialties.

“Without an independent entity verifying a doctor is up-to-date and competent,” Gibson said, “how is a patient to know what they’re walking into?”

Michigan pediatrician Dr. Megan Edison answered that question in a tweet earlier this year:

Edison also sent an open letter to the American Board of Pediatrics explaining her refusal to continue participating in MOC.

Other doctors note that continuing education requirements for other skilled professions — like lawyers — are far less stringent. And they say there’s little independent evidence that the MOC process improves patient outcomes. The American Medical Association has said that participating in MOC should not be required for licensure, employment, or participation in insurance networks, though the group does support continuing education as long as it’s relevant to clinical practice.

Oklahoma state Representative Dr. Mike Ritze, a practicing osteopath who co-sponsored the bill to do away with MOC mandates in his state, said he feared the red tape and cost involved with maintaining certification would drive doctors out of clinical practice. “We’re trying to bring more doctors on the scene instead of chasing the ones we have away,” he said.

To stay up-to-date with MOC, physicians are required to earn a certain number of credits every few years; they can pick from a long list of activities.

A “clinical skills activity,” for instance, gives physicians a series of photos or videos presenting a patient’s symptoms. The doctors have to come up with a diagnosis and recommend treatment.

In another activity, physicians answer 25 multiple choice questions about caring for patients from diverse backgrounds.

Among the most maligned activities are the “practice performance assessment” modules, which require physicians to design, implement, and evaluate quality improvement projects in their own practices.

In response to strong pushback from physicians, the largest of the medical specialty groups, the American Board of Internal Medicine, last week said it would relax its requirements. Instead of one big recertification exam every 10 years, physicians will be able to take a series of shorter assessments on their home computers. They’ll also get more feedback about areas where they need to beef up their skills.

That process makes sense to Dr. Andrew Miller, associate chief medical officer at Jefferson Health in Philadelphia, who said he finds it useful to validate his skills every so often.

“Peoples’ lives and health depend on the quality of care we deliver,” he said. “How can we not, as a profession, put our best foot forward and certify that we’re knowledgeable?”

Correction: A previous version of this story incompletely characterized the American Medical Association’s position on MOC participation.

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