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    Maintenance of certification: Working to understand why

    Henry Rosevear, MDDr. RosevearTo be honest, I’ve never had a beer with a trustee of the American Board of Urology (ABU). But I have had numerous conversations with many other urologists, and to this day, I have yet to find anyone who enjoys the ABU’s maintenance of certification (MOC) process.      

    Further, I recently read a letter to the ABU from a fellow urologist, Stephen G. Weiss II, MD, who, because of the MOC process, publicly relinquished his board certificate. The letter, published on the Urology Times website, generated quite a buzz not only among my partners but also among every other urologist I contacted to discuss it. While Dr. Weiss’s actions may be bold, his concerns are widespread, as I learned from the less-than-glowing reaction I received to a blog about my own experience with the oral boards.

    Given the current controversy, I thought it might be worth learning about the history of the ABU and MOC to better understand why the ABU finds it necessary for us to jump through the hoops the board has created.

    Some background first. The ABU is not a new organization; it was created in 1934, one year after the American Board of Medical Specialties (ABMS) was created. MOC, however, did not exist until 2007, when in cooperation with the ABMS, the Accreditation Council for Graduate Medical Education, the American Medical Association, and the Federation of State Medical Boards, the ABU decided that all physicians “who become certified, recertified, or subspecialty certified will enter a process of Maintenance of Certification (MOC).” The details of MOC can be found here and involve everything from ensuring a physician still has his license to submitting an electronic practice log.

    The history and logistics of MOC aside, the big question is still “why?” To find the answer, I reviewed the websites of both the ABU and the ABMS. The ABU states that “MOC is designed to evaluate the continued competence of a Diplomate.” The ABMS’s website states that “Medical specialists who participate in ABMS MOC use the most current evidence-based guidelines and standards in their specialty and are widely recognized as leaders in the national movement for health care quality.”

    Sounds reasonable enough; it’s hard to argue that we shouldn’t be practicing the most up-to-date medicine. Yet my two biggest questions about MOC remain. First, what prompted the ABU to start the MOC process in the first place? And second, why don’t all urologists have to participate in MOC?

    NEXT: "As urologists, we are not the only specialty that has to deal with either board certification or MOC."

    More from Dr. Rosevear:

    Practice ‘efficiency’ is not a dirty word but a noble goal

    After the patient fall: How to save your back

    AUA 2015: PSA paper, tough live surgery are lasting memories

    Henry Rosevear, MD
    Dr. Rosevear, a member of the Urology Times Clinical Practice Board, is in private practice at Pikes Peak Urology, Colorado Springs, CO.

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    • Anonymous
      Please enough of these MOC topics. Get rid of it. It is essentially a source of income revenue for those who control. I can not truly believe that this author thinks it makes us better urologists because you pass yet another exam. There are physicians who can pass any exam, but practice garbage. Enough already.
    • Anonymous
      Please enough of these MOC topics. Get rid of it. It is essentially a source of income revenue for those who control. I can not truly believe that this author thinks it makes us better urologists because you pass yet another exam. There are physicians who can pass any exam, but practice garbage. Enough already.
    • According to the ABU's website: The Board makes no attempt to control the practice of urology by licensed or legal regulation, and in no way interferes with or limits the professional activities of any duly licensed physician. Does anyone actually believe this disclaimer? I know of a fellow urologist who was interrogated by the ABU for his excessive use of Uroflow/PVR's. A written letter would not due. They forced him to shut down his practice, fly to Dallas and appear before them. They refused to allow him to have a lawyer at his side and proceeded to berate him on ALL the ancillary income streams of his practice. This unfortunate physician happened to be a certified RAC auditor who had gone to great lengths to obtain this certification and (unlike most of us) was not afraid to code aggressively. The ABU's power play against this urologist was demeaning, stressful and uncalled for. How many other Diplomats have been dragged into their august presence? Why don't we get to see these statistics? I repeat: Does anyone believe the ABU doesn't interfere with our ability to practice urology?
    • According to the ABU's website: The Board makes no attempt to control the practice of urology by licensed or legal regulation, and in no way interferes with or limits the professional activities of any duly licensed physician. Does anyone actually believe this disclaimer? I know of a fellow urologist who was interrogated by the ABU for his excessive use of Uroflow/PVR's. A written letter would not due. They forced him to shut down his practice, fly to Dallas and appear before them. They refused to allow him to have a lawyer at his side and proceeded to berate him on ALL the ancillary income streams of his practice. This unfortunate physician happened to be a certified RAC auditor who had gone to great lengths to obtain this certification and (unlike most of us) was not afraid to code aggressively. The ABU's power play against this urologist was demeaning, stressful and uncalled for. How many other Diplomats have been dragged into their august presence? Why don't we get to see these statistics? I repeat: Does anyone believe the ABU doesn't interfere with our ability to practice urology?
    • Dr. yourskeptic
      I doubt any of us are doing CME's or taking courses or reading articles/updates because of MOC. What we do because of MOC is spend time tracking things, filling out forms, being annoyed by web modules, etc. It's a means to collect extra revenue and act as big brother. It doesn't make better Urologists. It just acts as a CYA for certifying bodies.
    • Anonymous
      Why do we keep having to read these blogs from a greenhorn urologist who just passed his oral boards (and therefore by definition knows next to nothing) This type of column should be written by an experienced urologist
    • Anonymous
      The ABU has slipped down the slippery slope of regulatory body overreach. Their culture is counter to the spirit of many physician's which they seek to "regulate". With their deadlines that carry harsh and excessive punitive fees and the culture that speaks loudly in any letter received from the ABU, they have positioned themselves as the defacto governmental body that traditionally harasses, creates onerous rules and is always demanding money. Many seem to say between Govt and ABU, we are better off with the ABU. Well the ABU has assimilated that exact role of dreaded government. Essentially, the 2 are one and the same. Send in your fees, follow our directions, don't ask questions; as the tacit threat of being stripped of your hard earned Board certification looms overhead. Just look at the comments from Dr. Weiss's "Letter to the ABU" in the last Urology Times. We have grown men that have completed surgical residencies, some of the most demanding training in the medical field state: “I am embarrassed that I and most other urologists do not have the balls to do this.” “We urologists as a group lack the intestinal fortitude of Dr Weiss” “I do not have the testosterone level that Dr. Weiss has.” Sadly all true comments. Many post anonymously, as do I. The culture of fear created by the ABU is a testament. The notion that Gerald H. Jordan and his cronies in Charlottesville, VA, are jotting down names is considered a likely possibility. Thus you tell me if the ABU has not evolved into the dreaded governmental role? I encourage everyone to pay attention and become a member of The Association of American Physicians and Surgeons - AAPS - a non-partisan professional association of physicians in all types of practices and specialties across the country that has been fighting for the individual liberty, personal responsibility, limited government, and the ability to freely practice medicine according to time honored Hippocratic principles. Principles that today’s certifying boards have trampled out of greed and lack of respect for the autonomous physician. The AAPS has sought to preserve the practice of private medicine since 1943 which today is truly under attack not only by our government, by our own certifying medical and surgical boards. It is the only group that has a track record that proves they stand up against the tyranny of government, as well as the more insidious tyranny of groups like the AMA, ABIM, and now the ABU. http://www.aapsonline.org/ A viable alternative to the ABU as a board certifying agency to secure competent and well trained doctors includes; The National Board of Physicians and Surgeons (NBPAS.org). A reputable alternative Board providing continuing board certification with a nationally recognized Board to oversee a more equitable and efficient manner to secure well trained physicians. Since these issue have come to the forefront, some personal investigation in my local hospitals find I am working side by side with many non-board certified physicians. Despite the medical staff by-laws that posts board certification as a requirement for privileges, turns out it is rarely enforced. I must say I envy these physicians who are free of the hassle, the expense and the over reach of some Board breathing down their neck. Had I not asked, I never would have known. They have always seemed to be competent, well trained physicians. As the profitability of being a doctor further decreases and the compliance issues continue to skyrocket, shedding my board certification and all that goes with it may be soon be a pleasant relief.
    • Dr. Stephen Mong
      I believe that Board Certification prior to 1985 was unlimited and thus was interpreted as a contract between the diplomat and the ABU. Although not sure, I believe that the ABU cannot require those holding certification prior to 1985 to participate in MOC to maintain certification.
    • Dr. Stephen Mong
      I believe that Board Certification prior to 1985 was unlimited and thus was interpreted as a contract between the diplomat and the ABU. Although not sure, I believe that the ABU cannot require those holding certification prior to 1985 to participate in MOC to maintain certification.

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