The ABIM Announces a New Plan and This Time It May Actually Mean Something

This morning the American Board of Internal Medicine (ABIM) published on its website a press release about new testing options for MOC.  The statement is short on details, but promises substantial change.

The plan, arising from the recommendations in last year’s Assessment 2020 Task Force report and created after gathering input from stakeholders and physicians, describes an alternative to the traditional 10-year secure exam. Candidates may either choose the traditional 10-year exam or this new plan. As someone who just last fall suffered through hundreds of study hours and the indignities of the testing center security measures in completing and passing my 10-year exam in Focused Practice in Hospital Medicine Exam, my curiosity is piqued.

The three facets of the new plan from the press release:
1. “Take the form of shorter assessments that doctors can choose to take on their personal or office computer—with appropriate identity verification and security—more frequently than every 10 years but no more than annually;”

Does this mean 10 annual tests? 5 biannual tests? How many questions? Will this be the same question load divided over ten years or will the overall question burden multiply like killer bunnies?

2. “Provide feedback on important knowledge gap areas so physicians can better plan their learning to stay current in knowledge and practice; and”

Feedback is great. Will doctors be able to study what they are lacking knowledge in and retake a failed sub-test?

3. “Allow physicians who engage in and perform well on these shorter assessments to test out of the current assessment taken every 10 years.”

What if you do fail one of the sub-tests? Is each test stand alone or are the total questions answered correctly cumulative over the ten year period? Will failing any sub-test make you fall out of compliance with “Participating in MOC” until you pass the next one?

So, a lot of questions raised by these three seemingly hopeful statements. How will these questions get answered?

Well, further down in the press release we see that the three aspects of the plan are lacking details because the details do not yet exist. Here is what ABIM says will be happening from now until December 31, 2016, by which time the “ABIM expects to provide more specific details about what the alternative assessment option will look like…”

“ABIM will continue to:
• Seek physician input about MOC assessment content through the blueprint review process;
• Study the feasibility of offering “open book” assessments;
• Investigate ways to provide secure assessments at a physician’s home or office;
• Determine how best to offer physicians immediate feedback on their assessment performance
and learning activities to help them improve; and
• Work with societies to expand the number of continuing medical education (CME) activities available for MOC credit.”

So, without specifics, this is really a thought bubble being floated out into the IM community signifying an intent and a potential direction, but without a lot of there there.

This announcement of change, unlike previous ones that simply made superficial changes to the types of “points” needed, I must admit has the feel of real change. But call me skeptical. I know the details and unanswered questions will be everything when it comes to answering the big questions around burden, cost and effectiveness. And of course this doesn’t even begin to answer the questions around the whole “points” structure and the Medical Knowledge modules and Practice Assessments. Will this supplant those or just add on? Ultimately, will this be less of a burden or more of a burden? And the big question around Value and Effectiveness! Will they finally show that this method (or the old one for that matter) of MOC actually signifies a level of proficiency in the real world clinical practice of medicine?

And what of Hospitalists? This plan is for Internal Medicine and “possibly one or two subspecialties starting in January 2018.” Will our Focused Practice in Hospital Medicine exam be part of this new plan? We seem like the perfect group, young, eager, tech savvy to test something like this out, right?

If this parceled out testing protocol does indeed become the preferred method, and our HM test is far down the list to roll out, will all of the gains we have made in getting our members and fellow hospitalists to sign up for the exam and declare their expertise and skill in hospital medicine, be eroded as hospitalists choose the “easier” method of the new general IM exam?

Ugh, dealing with the ABIM has made me such a pessimist. I will try to be better.

So, bravo, ABIM! I commend you for what finally feels like real talk of improvement in the process.

But I will believe it when I see it.

Burke Kealey

Burke Kealey, MD, SFHM is the Senior Medical Director for Hospital Specialties at HealthPartners Medical Group in Bloomington, Minnesota. Dr. Kealey began his career as a hospitalist in 1995 and has worked in medical leadership since 2000. In 2003 he was awarded SHM’s Award for Clinical Excellence. He has Chaired SHM’s Practice Analysis Committee and helped produce several of SHM’s Compensation and Productivity surveys. Dr. Kealey is a past president of SHM’s board of directors and has served as secretary and treasurer in past terms.

Dr. Kealey has a strong interest in ensuring that hospital medicine practices are effectively managed with a strong focus on the triple aim of affordability, great experience, and best health for our patients.

Raised in Texas, Dr. Kealey received his undergraduate degree from Texas A&M University, his medical degree from the University of Texas at Houston, and then moved north for Internal Medicine training at the University of Minnesota Hospitals and Clinics. While in chief residency he met his lovely wife Samantha, a Minnesota native and current Emergency Medicine physician. Together, they have 4 children.

6 Comments

  1. Rupesh Prasaf on May 6, 2016 at 8:32 pm

    Hi,

    I think that ABIM will need to clarify regarding the details of this alternate process of certification, and specify the inclusion and exclusion criteria for the providers in the sub-specialties included in this. For example, it is unclear how this would impact the physicians who just went through the process of MOC. Also it is unclear what the assessments would entail. I would think the Hospital Medicine is likely to be one of the sub-specialities included in the alternate pathway.

    Hopefully we get further clarity by the end of this year, but this certainly appears to be a step in the right direction.

    Thanks.
    Rupesh.

    • Burke Kealey Burke Kealey on May 9, 2016 at 3:38 pm

      “appears to be” is the key phrase here, Rupesh. It is up to us to make sure we continue to stay active and have our voice heard in the process. I personally would like to see a pilot that can be studied, changed, and adapted before asking everyone to chooses or not an unknown and untried process. But that is not how the ABIM has worked to date.

  2. Tom Smith on May 8, 2016 at 1:26 am

    Interestingly, the ABIM is only making the new MOC option available to those that have certifications expiring in 2018 and beyond.

    In their announcement, it seems that the ABIM was vague about this but when you dig deeper, it is pretty clear that they are excluding those that need recerts in 2016 or 2017.

    For those of you that need to recertify in 2016 or 2017, the ABIM is not giving you the new MOC option. In other words, you must follow the existing MOC pathway and pass the current secure exam!

    The anesthesia board was able to allow their 2016 recerts to participate in their new MOC option when they announced it in 2015. Why can’t the ABIM figure out a way to do the same with those that having expiring certifications in 2016 or 2017?

  3. Tom on May 8, 2016 at 4:50 pm

    While being optimistic that these changes are for the better, the ABIM has posted that those with certifications expiring in 2016 or 2017 are not going to be part of this new MOC process. They have to continue with the current process and pass the current secure exam. Then and then only can they sign up for new process.

    Why couldn’t the ABIM grandfather in those with certs expiring in 2016 or 2017? The anesthesia board introduced their new MOC in Sept. 2015 and made it available to all of those with expiring certs in 2016. The ABIM makes the announcement in May 2016 but needs to 2 years to implement?

    • Burke Kealey Burke Kealey on May 9, 2016 at 3:27 pm

      I feel your pain. I just took my test last October. It seems clear that the ABIM only has an idea of a direction, but the details have not been worked out. I for one would be very hesitant to sign up day 1 without knowing the details. It is so vague now that it could be a very good thing, but this still could also end up being more of a burden than today’s setup.

  4. Mike on May 9, 2016 at 1:20 pm

    What about those of us who carry multiple board certificates like Pulmoary, Critical Care, Sleep, and Internal Medicine? It would appear that some of us could be taking a lot of tests after the new program is rolled out, if offered. I personally like the National Board of Physicians and Surgeons (NBPAS.org) for re-certification. Considerably less expensive, and requires only submission of attended CME certificatess.The only issue is getting hospitals and payers to recognize and acknowledge their certification.

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