Commentary: How These Useless Doctors’ Exams Are Raising Health Care Costs
Maintenance of Certification (MOC) tests for doctors like us might sound like a good idea at first glance. MOC requires us to take frequent modules and tests to remain certified and keep our jobs.
But the truth is that these tests provide no value to doctors or patients; in fact, they contribute to rising health care costs because they take doctors’ precious time away from treating patients.
Recognizing the MOC burden, nearly 20 states have introduced legislation to curb it, with Washington state passing a bill to forbid it as a condition of licensure in late March. The rest should follow suit.
MOC is a cash cow for the American Board of Medical Specialties (ABMS) and its 24 specialty boards, which administer the exams. According to its most recent tax filings, ABMS president Lois Margaret Nora made nearly $700,000 in compensation from the organization in 2016. Thirteen other executives made over $150,000 from the nonprofit in the same year. In total, ABMS spent over $10 million on compensation, more than half its annual revenues, which largely come from inflated testing fees. That’s good work if you can get it.
But can doctors like us ever be under-educated, given the complex and vital nature of our jobs? Of course not.
It’s true that doctors can never learn enough. That’s why we are the most trained professionals in existence, studying for more than 10 years before becoming certified. We then complete 50 hours of continuing medical education every year to maintain our state medical licenses and keep up to date with the latest developments in our fields.
MOC is different. It is credentialization, not education. The tests don’t mirror real-world scenarios. They provide no educational value. A 2002 meta-analysis of 33 studies found no association between MOC and positive clinical outcomes. Older doctors, grandfathered in and exempt from MOC, are no less qualified than recent grads are. And two 2014 studies comparing MOC-required and MOC-grandfathered doctors showed no performance differences.
Depending on specialty, doctors must complete monthly modules, yearly tests, and complete board recertification every 10 years. No wonder a 2016 Mayo Clinic survey found that 81% of doctors think MOC is a burden.
Each year, millions of physician hours are spent on MOC, time that could otherwise be devoted to patients. MOC requirements have brought doctors to the point where they now spend roughly two-thirds of their workday on paperwork. For physicians in rural practice, the nearest testing center can be hundreds of miles away, meaning a whole day of lost time treating patients.
Allowing doctors to be more productive by limiting MOC would also help alleviate the growing physician shortage, which the Association of American Medical Colleges predicts will grow to 95,000 by 2025. MOC requirements contribute to this doctor shortfall, with studies suggesting some doctors take early retirement to avoid them.
MOC is technically voluntary, but in practice it is not. Requirements for MOC have been included in physician licensing, hospital credentialing, and commercial insurance contracts. This means that doctors who don’t participate can lose their licenses, credentials, and insurance contracts.
State bills to reign in MOC generally prevent hospitals and insurers from requiring it as a condition of employment, payment, or license. In 2016, Oklahoma became the first state to succeed. Georgia, Maryland, Missouri, North Carolina, Tennessee, Texas, and as mentioned earlier, Washington state have followed suit.
The ABMS won’t give up its slush fund without a fight. It is engaging in a fearmongering campaign claiming doctors need MOC to be qualified. It has retained a high-priced Chicago PR firm, to whom it gave close to $450,000 in 2015.
State legislators looking for marginal—yet effective—reforms to improve patient access to physicians should join the growing number of states passing laws to eliminate MOC requirements as a condition of physician employment. The only losers from such legislation would be nonprofit administrators who are making millions off this scam.
Niran Al-Agba and Meg Edison are pediatricians in Washington state and Michigan, respectively, and are advisory board members at Practicing Physicians of America, a physician advocacy organization.