In my role at Chair of the Board of Regents for ACP, I will attend the upcoming AMA meeting next weekend. Many resolutions get introduced at these meetings. The number of resolutions addressing Maintenance of Certification is impressive. While the internal medicine community expresses much anger against the American Board of Internal Medicine, some of the changes that ABIM has introduced came as requirements from ABMS (the American Board of Medical Specialties).

In talking with colleagues across specialties, the frustration with these processes comes through from every direction. What is causing all this anger?

In my opinion (I am not speaking ACP policy here), the anger represents a classic response to the imposition of rules and work on physicians who are already frustrated by insurance company and government mandates. The new MOC guidelines represent another “set of hoops” that physicians must negotiate.

These regulations have face validity to the regulators, but practicing physicians just see the time and hassle that each step creates. Regulators want us to practice “evidence-based medicine”, but they do not want to practice “evidence-based assessment”.

Do we need MOC? I think that we do need to maintain our knowledge. I have argued previously that the best way to insure knowledge maintenance is through formative not summative processes. What does that jargon mean? Formative processes use questioning to identify knowledge weaknesses, and then provide education to shore up those weaknesses. Repeat questioning confirms that the learner now has a better and acceptable understanding of the material.

The ABMS goes much further than knowledge however. And these activities feel like busy work, and many physicians complain that these activities have no reasonable outcome data to support the hassles involved.

When the physician community loses faith in the process, then we should reconsider the process. Making physicians angry with the process seems counterproductive.