Maintenance of Certification: The Elephant in the Room

Abstract

Although the American Board of Pediatrics (ABP) is doing yeoman’s work in trying to spare hospitals and pediatricians the time and expense of re-credentialing, spending $1300 on recerti-fication and preparing for a new 4-part Maintenance of Certification (MOC) process is not ideal in our view.To be sure, there are extremely powerful political forces at work here. The American Board of Medical Spe-cialties has mandated that every specialty board develop a recertification process. State legislatures, insurance companies, Medicare, hospital credentialing committees, national medical examiners, and the US Congress are all apparently trying hard to target physicians who don’t “keep up” and are threatening to increase the already loathsome credentialing paperwork burden on pediatri-cians. The ABP’s efforts to take control of the situation and head them off at the pass are laudable. If the ABP doesn’t act quickly and authoritatively, outside forces will begin making decisions for pediatricians that would probably be far more troublesome. We also appreciate the fact that the ABP is a certifying organization, not an educational one. But the answer may not be a cumbersome, 4-step process that will add to pediatricians’ burdens. And it raises the question, what—exactly—does Board certifi-cation mean? Interestingly, in the collective 60 years that we have practiced medicine, we have never been asked by parents or patients if we were board certified or have recertified.Has the ABP lost sight of its own primary (and worthy) goal, which is to ensure that pediatricians remain up-to-date and knowledgeable? Given the 21st-century technology that now exists, couldn’t this goal be better accomplished by creating an interactive computer module that every pediatrician would take annually? This module would test current knowledge, provide immediate feed-back on correct responses, and give a detailed synopsis of the deficient or problem areas so that learning might occur. It could be part of a reformed continuing medical education (CME) initiative.