KK: Let’s discuss a related topic that is often a bit confusing for providers: Maintenance of Licensure (MOL). Some are wondering how it differs from Maintenance of Certification (MOC), but my specific question for you is regarding the frustration that docs have about MOC. Is this really a process that fosters quality of care, lifelong learning, and being a better, competent provider? Or is this just extra expense for providers and an intrusion into their practice?

The third and final thing is that we are working doggedly to improve physician professional satisfaction and practice sustainability. We are trying to find out about things that make doctors happy and things that make them sad and
frustrated.

SS: There’s a perception among the licensure and certifying boards that there is a need for the public to know and be reassured that their physicians are engaged in lifelong learning and self-assessment throughout their careers and that they’re achieving board certification. A license is not an anointment until death. It is one step in a journey that is your lifelong professional practice. Now, we can agree or disagree on whether that is the case, but it is their belief that the public is requiring this, and so they have moved forward with these different paradigms.

The board-certifying bodies are way out ahead, and the licensure boards are not, but the concern is that only 70 to 80 percent of physicians in the United States are board certified. This means that if you are licensed but not board certified, the assertion can be made that you have no expectation to demonstrate continuing competency because you’re not subject to a specialty board and its requirements. Once you get your license, a lot of times, as long as you send in your check, you get to keep it unless you get into trouble with the board. Some in the licensure community have said, “We have to come up with some way to address that part of the population that is not board certified.” So MOC does not equal MOL, nor does MOL equal MOC, but MOC, being a robust program to ensure the lifelong self-assessment and competency of physicians, certainly should stand in fulfillment of anything that would be required for MOL. They are very different programs, and MOL, I would say, is more intended to make sure there is some base floor of safety because licensure does not guarantee excellence, it only increases the likelihood of minimum competency. Board certification may directionally foster some aspect of