Dr. Clifford Hudis, CEO of the American Society of Clinical Oncology (ASCO), shares ASCO’s approach to addressing the continuing saga of the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program. Many oncologists have expressed angst about the MOC process, and ASCO, under Dr. Hudis’ leadership, approached the situation methodically, distributing a survey to its members to assess the problem and explore next steps. This must-listen interview marks the first time the results of this survey have been shared publicly.
To add context to the ABIM maintenance of certification saga and dilemma, up until 1990, the board certification for physicians was lifelong. “Of course, whenever you need to practice, you have to be licensed in the state to practice medicine or its subspecialties and you need to do CMEs. You need to maintain your license by engaging in lifelong learning,” said Dr. Nabhan. In 1990, ABIM changed that when they decided, unilaterally, that this ABIM certification is no longer lifelong. Physicians need to actually sit for the boards every 10 years. The idea, as noted by Dr. Nabhan was that they need to maintain their education because medicine really advances very fast. “And of course, by the way, to sit for the board examination every 10 years, you have to pay the ABIM a lot of money. Subsequent to that, they became two choices that if you need to maintain your certification, you can sit for the board examination every 10 years or you can be enrolled in LKA, which is Longitudinal Knowledge Assessment.”
This LKA testing, which allows you to answer questions via email or by logging onto a site, consists of 30 questions per quarter. ” It is an open book technically, so you’re allowed to Google or do up-to-date or wherever you really want. And these are general medical oncology, internal medicine, cardiology questions, whichever board you are sitting on,” in the words of Dr. Nabhan.
Additionally, one needs to pay to be enrolled in the Longitudinal Knowledge Assessment or in the every 10 years examination, on top of obtaining MOC points, through various courses and conferences. Dr. Nabhan and thousands like him content that there’s never been any documentation that process enhances patient outcomes. Conversely, the ABIM contends that there is; however, much all of the papers they cite as evidence were authored by the ABIM themselves.
In July 2023, Aaron Goodman, an associate professor at UCSD initiated a petition to end the MOC, to end the recertification. To date, that petition has has garnered over 20,000 votes.
Dr. Hudis, who prior to becoming CEO served in various volunteer and leadership roles at ASCO, and his colleagues at the society, distributed a survey to roughly 9,000 physicians to gain insight into their feelings on this controversial process. The survey was very short and direct, and required only a few minutes to complete on a Smartphone. According to Dr. Hudis, ASCO received 1,700 responses in total, or about 20% of the eligible group. The findings, in the words of Dr. Hudis, showed that there is an “overwhelming belief that MOC as currently implemented, isn’t making care better,” and “is not testing things that matter.”
These findings seem to capture the overall industry sentiments of the ABIM MOC process. “Our takeaway is that these top line results right now mirror what we’re hearing anecdotally, and I know you’re hearing, they mirror what we heard on social media. And our presidents will go out and visit with the state affiliates and other communities tell us that they’re hearing the same thing at that level as well. So right now, I am modestly or moderately reassured that the concern is not just real and legitimate, but it probably does reflect the majority view.”
To find out more about the survey, the process that went it into creating, and on Dr. Hudis’ thoughts on possible solutions, listen now to this can’t-miss episode.
This podcast originally appeared on Healthcare Unfiltered.