We have more details on what the ABIM is considering regarding changes to the Maintenance of Certification (MOC) process since they last announced some very high-level ideas in the spring. The ABIM is now requesting feedback through a member survey on some proposed options to update its controversial MOC process. Specifically, they are outlining two main alternatives to the current 10-year high-stakes, high-prep, high-anxiety MOC exam: a 5-year pathway and a 2-year pathway.
The chart below from the ABIM blog hits the key points.
The email to the membership with the survey link attached goes into more depth about what each proposal could entail but also adds some things not shown in the table, the most key of which is that both of these options would be “low stakes”. Specifically, they call out the fact that “if you don’t do well on one assessment, you will not lose your certification”. This, if true, is very different from the “high stakes” nature of the current exam, in which jobs, practices and careers can be riding on the results of this one exam.
I took the survey; within it, the ABIM tries to outline the proposals for lowering the stakes. I will try and summarize them here:
Regardless of whether you are on the every 5-year or every 2-year pathway, the rules seem to be basically the same. Take a lesser assessment commensurate with 2 years’ or 5 years’ worth of material. If you do not pass, take it again. If you do not pass the second time, then you must take a 10-year level of exam as is currently done. If you fail this, then you get one more try before you are deemed no longer certified.
I agree that this does seem to be a more forgiving paradigm. Personally, I would give three chances up front. Imagine being on the 2-year pathway and having a bad test day (baby up all night, covering extra shifts for a partner, etc…). Now imagine the stakes for that second exam. Fail here, and you are not only running out of chances but facing the current gauntlet of the 10-year exam and all of the hyper-preparation and cramming that that entails. I quibble.
I do applaud the move to a lower stakes assessment, as does the AMA, and my belief is that at some point, we must be accountable for showing our knowledge. Let’s just make sure it is the right knowledge applicable to our practices.
Even with these new developments, a few questions remain. Will these tests be over general knowledge, thus requiring the same amount of studying as the 10-year exam, even though there are fewer questions? Or will these be over more focused content areas, like “cardiology for the hospitalist”, “perioperative medicine” or “infectious diseases in the hospital”? Or perhaps new changes in the field since the last testing period?
And lastly, there is still no analysis of the costs to the test-taker and costs to the system for either of these newer models. Does the 2-year path cost more than the 5-year? One could see how more volume of testing might raise the price, but then ditching the need for testing centers and using better grading systems (they promise immediate results, so there must be less effort/resources involved in grading and validating the results than the current system) could go towards lowering the cost. As I wrote about last year, the great majority of costs to physicians and the system are indirect to the process: hundreds of hours studying, attending board review sessions, travel and hotel costs, etc… Is the ABIM thinking about all of this in when developing their new models? They sure seem to ignore the totality of costs in today’s world.
The journey continues. We know in a vacuum that the ABIM has stumbled through at least its last 20 years with blinders on, failing to account for the massive changes simultaneously happening to healthcare and its members when implementing its own requirements. It has taken a crisis for the ABIM to finally listen to its members (and critics) and start to factor in outside ideas and opinions to formulate plans that are more aligned with the changing healthcare world.
Something new is coming in 2018 (we hope), and your input could still help shape it for the betterment of our practices, our systems and our patients. For those IM hospitalists, I encourage you to go back to your emails, log in to the and give ‘em a piece of your mind.