The American Board of Internal Medicine (ABIM) issued an unprecedented apology letter to its diplomats, penned by Richard Baron, MD, President and CEO. “We got it wrong and sincerely apologize,” the letter states. Dr. Baron further reported that ABIM launched its Maintenance of Certification (MOC) program before it was ready for prime time.This release from ABIM has likely sensitized critics of MOC to the possibility that, perhaps, other member specialty boards—such as the American Board of Emergency Medicine (ABEM)—have also “gotten it wrong.”

Will ABEM be releasing an apology? That’s unlikely as it seems the similarities between ABIM and ABEM’s MOC programs stop with the use of the term MOC.

In order to clarify ABEM’s position on MOC and to address the potential concerns of ABEM diplomates, ACEP Now’s Medical Editor-in-Chief, Kevin Klauer, DO, EJD, FACEP, posed these questions to the ABEM leadership. Below, Francis L. Counselman, MD, President of ABEM, responds.

KK: What do you (or ABEM) think about ABIM’s letter of apology?

FC: ABEM supports ABIM’s need to create a MOC program that is meaningful to its certified physicians (diplomates), and it appears to be seeking a process by which an effective program of continuous professional development can be offered. It is imperative that we keep in mind that ABIM is not eliminating its MOC program or discontinuing its key elements, but rather, it is temporarily suspending parts of the ABIM MOC program to make adjustments that will be in better service to its diplomates and the public.

KK: How is ABEM’s MOC program different than ABIM’s?

FC: The ABEM MOC program is distinctly different largely because emergency physicians are engaged daily in adherence to quality measures. We enjoy a specialty that, in its 35 years of recognition by the American Board of Medical Specialties (ABMS), has constantly been transforming itself by improving the manner in which emergency physicians deliver compassionate, quality care to every patient, in every circumstance, and at every moment.

Two specific differences between the ABEM and ABIM programs are the Part II Lifelong Learning and Self-Assessment (LLSA) and the Part IV Assessment of Practice Performance Practice Improvement (APP PI) components. The ABEM LLSA has been shown to be highly relevant and improve patient care.¹ This is, in part, because the selected articles come largely from recommendations submitted by major emergency medicine organizations and individual emergency physicians. Having representatives from EM organizations provide CME for the activity is a further indicator of the relevance of the articles. Because emergency physicians are universally involved in department-based quality improvement activities, meeting APP PI requirements tends to be straightforward.

In order for a specialty to have legitimacy in the house of medicine, it must be recognized by the ABMS. This is why emergency medicine fought so hard decades ago to be recognized by the ABMS as the 23rd medical specialty.

Another distinguishing feature of the ABEM MOC program is the extremely high rates of participation by ABEM diplomates. In 2013, there were about 6,000 physicians with APP PI (Part IV) requirements, and more than 9,000 physicians attested to participating in these activities. In 2014, more than 10,000 diplomates attested to completing APP PI activities. Of the more than 2,000 diplomates who successfully passed the ConCert examination in 2013, only eight physicians lost certification solely due to not meeting MOC LLSA or APP PI requirements. Since then, five have completed the requirements and regained certification.

Finally, another indicator of the program’s relevance is that clinically active emergency physicians, including members of the ABEM Board of Directors and the EM community at large, have been involved in the development of the ABEM MOC program. Since its beginning in 2004, the ABEM MOC program has undergone multiple refinements, including reducing the number of readings and questions on LLSA tests, delinking the topics on the LLSA tests and the ConCert examination, and allowing practice performance to include more low-frequency, high-acuity conditions. Changes such as these were largely based on feedback from diplomates.

KK: Why does ABEM require MOC?

FC: The ABMS is an organization involving 24 medical specialty member boards, of which ABEM is one. Every ABMS member board is required to have a defined MOC program. That program should be relevant to its diplomates. ABEM further feels that MOC should provide value to diplomates, which it currently does in the form of cost and compensation. The annualized cost of ABEM’s MOC program is $265 per year, or about $5 per week, which is about the median cost of ABMS member boards and is less than 0.1 percent of the average emergency physician’s total annual compensation. The 2013 ACEP–Daniel Stern study showed that board-certified emergency physicians received $35,000 more in total annual compensation than noncertified physicians.² ABEM also participated in the Physician Quality Reporting System MOC bonus program, which was not the case with the majority of ABMS member boards. Participating in the program will have resulted in emergency physicians receiving more than $3 million in additional Medicare reimbursement.

KK: Can you define ABEM’s relationship with ABMS?

FC: In order for a specialty to have legitimacy in the house of medicine, it must be recognized by the ABMS. This is why emergency medicine fought so hard decades ago to be recognized by the ABMS as the 23rd medical specialty. That is also why, this past fall, ABEM proudly celebrated its 35th anniversary as an ABMS member board. As an ABMS member board, ABEM can also offer subspecialty certification. ABEM has worked hard to gain certification eligibility for emergency physicians in 12 different subspecialties, including critical care medicine, EMS, hospice and palliative medicine, medical toxicology, pediatric emergency medicine, sports medicine, and undersea and hyperbaric medicine.

In order for the ABEM Board of Directors to optimally meet the ABMS MOC standards in a way that best serves the specialty, ABEM continually surveys diplomates at nearly every step of the MOC process.

ABEM has a representative, Michael L. Carius, MD, on the ABMS Board of Directors, and the Chair Elect of the ABMS, John C. Moorhead, MD, is an emergency physician. ABEM has sought broad representation on several ABMS committees so that the views of the emergency medicine community can contribute to ABMS policy decisions.

KK: What would happen if ABEM elected not to comply with ABMS requirements?

FC: Noncompliance with ABMS requirements would put ABEM’s standing as an ABMS member board at risk. At the very least, ABEM’s credibility within the ABMS certification community would be damaged. It is important to recall that ABMS recently adopted a new set of MOC requirements, the ABMS 2015 MOC standards. Prior to their approval, ABEM purposefully sent the 2015 MOC standards to every key membership organization in emergency medicine for comment and input. ABEM and the ABMS received no recommendations for revisions, and there were no concerns about the requirements expressed to ABEM or the ABMS from any emergency medicine organization.

KK: What would happen if ABEM were not an ABMS medical specialty board?

FC: The standing of emergency medicine in the house of medicine would plummet. If ABEM withdrew from the ABMS, decades of progress would be lost. It would be a devastating blow to thousands of physicians who have contributed to our specialty. Moreover, the ability to have accredited residency programs would be in jeopardy.

KK: Has ABEM supported the ABMS MOC initiatives (specifically at the board level)?

FC: As a member board, ABEM must comply with the 2015 MOC standards, and the ABEM Board of Directors supports these standards. As mentioned earlier, every emergency medicine organization had the opportunity to comment on the ABMS 2015 MOC standards.

In order for the ABEM Board of Directors to optimally meet the ABMS MOC standards in a way that best serves the specialty, ABEM continually surveys diplomates at nearly every step of the MOC process. In 2014, ABEM convened a national MOC summit that included representatives from every major EM organization (including resident organizations) to find ways to further enhance the ABEM MOC program. And, in 2015, ABEM will add even more opportunities for diplomate feedback.

In summary, the ABEM MOC program ensures the public that emergency physicians are actively engaged in a standardized, nationally recognized program of continuous professional development. High participation rates in the ABEM MOC program are largely due to the commitment that emergency physicians have to improving their care for the ill and injured. This is why ABEM has started to acknowledge ABEM diplomates who have been certified for 30 years or more though a special recognition program. These women and men have, throughout at least three decades of their medical careers, been involved in recertification activities and MOC activities without resting on the laurels of one-time initial certification. ABEM is proud to be in partnership with emergency physicians who demonstrate the absolute best in medical care by their unwavering service to the public and by embracing the highest standards in the specialty of emergency medicine.

ABEM wishes to thank the ACEP Now editorial staff for reaching out to ABEM at this important time about this important issue.

References

1. Jones JH, Smith-Coggins R, Meredith JM, et al. Lifelong learning and self-assessment is relevant to emergency physicians. J Emerg Med. 2013;45:935-41.
2. American College of Emergency Physicians, Stern D. ACEP/Daniel Stern compensation reports: 2013 regional emergency medicine salary survey—clinical results. Irving, TX: ACEP; 2014.