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ACEP Now: Vol 34 – No 06 – June 2015

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excellence, but licensure is really about a minimum standard. It’s not about aspiring to great things. There are more than 70 licensing boards in the United States because there are some states that have separate boards for DOs and MDs, each one of which would have to ratify, for its own internal rulemaking or state lawmaking, a process for MOL. That’s going to take a long time. If some states are going to say, “Heck, we’re not doing that at all,” they may never do it. There are some states that are going to jump right in and want to do it. For MOC, that’s a big discussion.

The American Board of Medical Specialties (ABMS) created MOC, and they are physicians. This is not someone else—they are us. If people are upset, they need to communicate with them. The AMA has been engaged, and we have worked with the ABMS to say, “Look, these programs have to be responsive to the burden on physicians and the cost to physicians, they have to be based on evidence, and they have to be able to demonstrate they’re actually improving quality and making physicians safer or better. They can’t just be busy work without value.” We have partnered with the ABMS to try to have its overarching structure be more flexible and more tailorable to these specific specialties so the tools that can be developed make sense because each specialty has different needs.

Here’s an instance where I would say, “I’d love to think the AMA can solve everything for everybody,” but it can’t. This is fundamentally about specialty-certifying programs. This is a place where ACEP’s role is arguably far more impactful than what the AMA’s is. I just got back from California, where I spent the whole weekend with dermatologists, and they hate their board. Hate is not too strong. People were walking around with pins on, like little campaign buttons, made with the red circle and the slash that said, “No MOC.” The comments people made conveyed visceral disdain, disgust, and outrage at their board. Now, if it’s just one board, you can say it’s just one board, but you’re aware the American Board of Internal Medicine (ABIM) gave a mea culpa that was effusive. It was, “We’re sorry, we were wrong” repeated over and over in their communication to their diplomats. There’s a prominent group of internists, I’m not going to use names, many of whom are nationally known, who are creating their own board to directly compete with ABIM because they feel the ABIM’s program is so out of touch with reasonableness or demonstrated value to their profession or patients that they are going to try to compete with ABIM and offer an alternative. It’s a big deal; it’s a really, really big deal.

Hate is not too strong. People were walking around with pins on, like little campaign buttons, made with the red circle and the slash that said, “No MOC.”
–Steven J. Stack, MD, FACEP

There were a couple of articles published in the JAMA journals with evidence that says, “Hey, it doesn’t look like these programs actually improve quality or safety.” The boards would likely say they have their own evidence. Maybe they were the only ones doing research in the last few years so they have evidence, but now people are energized, and there will be other doctors who demonstrate their own evidence that may tell another story. I would say that emergency docs need to speak up, and they need to speak up strongly and to the extent they feel that their board is either assessing them reasonably or that it is unfairly burdening them and giving them busy work. ACEP and the other specialty societies are on point for this because, fundamentally, this is a specialty board issue. We [AMA] will be around to be supportive and be helpful, but the individual docs in the specialties will have to push on this one.