Maintenance of certification is, in my opinion, a good idea. While I had significant concerns about the structure that the ABIM was using, the idea that we have an obligation to maintain our knowledge.

I believe that the only legitimate argument is in the definition of how one documents maintenance.

The ABIM had two major problems to address. The first issue that they are working vigorously to improve is the criteria for MOC. I have written often about how I would document maintenance. I hope the performance improvement concept is taken out of MOC because we are subject to too many performance report cards already. While our interactions with patients are very important, I dislike the patient survey concept. Perhaps part of our knowledge points should include patient concepts, but I would rather leave that idea to licensing boards, hospital staffs and practice leaders.

In the current environment, including safety modules makes sense. We all have a responsibility to maintain and improve our knowledge of common safety issues.

Unlike some critics, I would like to see a more specific core curriculum, primarily based on very important new concepts (treatments, diagnostic strategies, etc.) that my peers believe I should definitely know. We should have a variety of ways to learn those concepts (given the variety of learning styles). I favor an open book test that documents that I have learned exactly those concepts. This test should have a very reasonable pass rate.

I favor this over non-specific continuing medical education. As an academic hospitalist, I have responsibility to learn both outpatient internal medicine and inpatient internal medicine. Readers know that I love renal disease and acid-base electrolyte problems. I am not as facile with rheumatology or endocrine. Should I be able to ignore those parts of internal medicine? Should I not have a responsibility to understand psychiatric drugs and the side effects that patients will have on presentation?

I do have faith in the ABIM Board. They have taken a bold step and are trying to improve their processes.

The second problem that many worry about is the ABIM finances. I hope the ABIM will address their finances with even greater transparency.

I am much more concerned about getting the first issue correct at this time. And that is my opinion. I know that many internists agree with this formulation, while others will disagree.

So let’s agree to disagree on the best way to document MOC. I will not focus on the finances, but will continue to encourage the ABIM to respond to the internal medicine community.

I truly believe that we are well represented on the ABIM board by thoughtful, ethical physicians, many of whom I know. They deserve our support as they work to fix the problems they inherited and address the mandates from ABMS.