Maintenance of certification: the price of medical professionalism is $10,108.05, two weeks leave and five white hairs.

Abstract

A physician certified by the American Board of Medical Specialties (ABMS) typically has a time-limited certificate (usually ten years).(1) Although a fully trained specialty physician, one of the tenets of medical professionalism demands that a physician commits himself to lifelong improvements in knowledge and clinical practice.(2,3) This is normally achieved through participation in programmes that document ongoing medical competence, such as the American Board of Internal Medicine (ABIM) and Maintenance of Certification (MOC) programme. Many organisations recognise that such programmes are an important aspect of professional responsibility and fulfilling our part of the contract with society.(3,4) However, the methods of recertification should be relevant to a variety of practice settings, consider cost and time, and accommodate different learning styles. Some doctors have elected not to undergo MOC programmes for reasons of costs, both in terms of time and finances, irrelevance to practice and other factors.(5) In a survey conducted by the New England Journal of Medicine, it was shown that about 64% of American physicians would choose not to participate in MOC programmes.(6) Conversely, a similar poll with the public conducted by MSNBC showed that 80% believe that physicians should renew their certifications.(7) Despite the inherent public and professional belief in the need for maintenance of professional competence, MOC programmes are controversial due to time, cost, and the lack of public and institutional support for funding and apportioning of other resources. Some have expressed concerns about the hypocrisy, and ethical and financial conflicts of interest in physician-supporters and professional drivers of MOC programmes.(8) Moreover, evidence of MOC programmes in improving the quality of patient care has been challenged.(9) The regulatory climate in Singapore currently does not require recertification through participation in an MOC programme or sitting for an examination – yet.(10) However, similar to the requirements of most state medical boards, documentation of participation in accredited continuing medical education sessions is required for renewal of practice certificates (licensure) by the Singapore Medical Council (www.smc.gov.sg). Unlike in the United States (US), medical boards and credentialing committees of Singapore-based hospitals and clinical institutions currently do not require staff physicians to undergo MOC programmes or pass recertification examinations. However, the institution of residency training programmes, along the lines of the US programmes and certification examinations modelled on ABMS, may result in future Singapore-specific MOC programmes.(11) Generally, academic medical institutions require staff physicians to be current with their specialty certifications in order to have practice privileges. Moreover, physician-educators are also usually required to be current with their certifications.