MOC & MOL: lifelong learning or lifelong larceny?

8/23/2019 MOC & MOL: lifelong learning or lifelong larceny?

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Maintenance of Licensure

(MOL)

Maintenance of Certification(MOC)

Continuing Medical Education(CME)


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STOP the DOC MOLestation


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MOC

MOLCME

How the Regulators Prosper

Journal of American Physicians

and Surgeons Vol. 17 Number 3Fall 2012 www.JPandS.org


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MAINTENANCEOFLICENSURE (MOL)

Maintenance of Licensure (MOL) is a systemof continuous professional development forphysicians that supports, as a condition for

license renewal, a physicians commitment tolifelong learning that is relevant to their area ofpractice and contributes to improved healthcare. MOL is an umbrella term that is used to

describe the various educational activities thatphysicians participate in to improve clinicaland practice management skills.


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MAINTENANCEOF CERTIFICATION (MOC)

Maintenance of Certification (MOC) is the process ofkeeping physician certification up-to-date through one ofthe 24 approved medical specialty boards of the AmericanBoard of Medical Specialties (ABMS). The Maintenanceof Certification program provides an ongoing process thatwas designed to help physicians keep abreast ofadvances in their fields, develop better practice systems,and demonstrate a commitment to lifelong learning.Through ABMS Maintenance of Certification (MOC)process, board certified physicians in 24 medicalspecialties build six core competencies for quality patient

care for their medical specialty. These competencieswere first adopted by the Accreditation Council forGraduate Medical education (ACGME) and ABMS in1999. Physicians in Ohio are not required to be boardcertified. Board certification is a voluntary process.


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STATE LICENSING BOARDSARE COMPONENTS OF

FEDERATION OF STATEMEDICAL BOARDS (FSMB)


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SPECIALTY MEDICALBOARDS ARECOMPONENTS OF

AMERICAN BOARD OFMEDICAL SPECIALTIES

(ABMS)


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FEDERATIONOFSTATEMEDICALBOARDS (FSMB)

The Federation of State Medical Boards (FSMB) is anational non-profit organization representing the 70medical and osteopathic boards of the United States andits territories.

Federation of State Medical Boards (FSMB) MOL CoreComponents

The framework for MOL adopted by the FSMBs House of

Delegates in 2010, recommends that state boards requirephysicians to periodically demonstrate participation in three

components of effective lifelong learning in medicine.


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Reflective Self-Assessment (What improvements can Imake):

Physicians must participate in an ongoing process of reflectiveself-evaluation, self-assessment and practice assessment,with subsequent successful completion of appropriateeducational or improvement activities.

Assessment of Knowledge and Skills (What do I need toknow to be able to do?):

Physicians must demonstrate the knowledge, skills andabilities necessary to provide safe, effective patient care withinthe framework of the six general competencies as they applyto their individual practice.

Performance in Practice (How am I doing?): Physicians must demonstrate accountability for performance

in their practice using a variety of methods that incorporatereference data to assess their performance in practice andguide improvement.


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FSMB: Maintenance-of-licensure changes will not burdendoctors, by Humayun Chaudhry, DO President and CEOFederation of State Medical BoardsAMEDNEWS.COM/OPINION October 22, 2012

New systems implemented by state medical boards to encouragelifelong learning should not duplicate programs already in place orbe burdensome to physicians.

The vast majority of physicians pursue CME and training to keeptheir knowledge and skills current and already will be in substantialcompliance with MOL.

Additionally, physicians would not be required to take anexamination to comply. By implementing MOL, state medical boardswill encourage individual practice improvement efforts and serve asthe foundation for a culture of continuous professional developmentencompassing the entire medical regulatory system.


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No evidence of improvedmedical care with MOC orMOL


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Feb. 2011 FSMB MOLIMPLEMENTATION GROUP MET.

Facilitated by a non-physician (former SeniorProgram Officer from Robert Wood JohnsonFoundation)


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Maintenance of Licensure: Medical Regulation with aSheathed Sword by Richard A. Whitehouse, Esq.

Currently, Ohio and other medical boards rely upon continuing medical

education as a mechanism to insure some semblance of continuedcompetency. But, this alone is not enough, as there may be norelationship between the CME taken and the actual nature of thephysicians practice. Beyond this, the best that medical boards haveoffered in augmenting their regulatory efforts are complaint-drivenprograms limited to quality intervention, remediation, or rehabilitation.

[Ohio needs more regulation in order to] do even more to provide thepublic with meaningful assurance that licensure renewal does indeedconnote continued competence. Ohio and state medical boards acrossthe country are currently embracing a new approach to ensure thatphysicians can better fulfill this professions obligation in a mattertransparent to the public.

Whitehouses closure is chilling:

If the best outcome in battle is achieved with unsheathing the sword, sotoo should medical boards strive to achieve their goal of publicprotection in such a manner as to avoid disciplinary battle wheneverpossible. Among other things, this means doing more to ensure theongoing competency of physicians to avoid human and systems-basederrors. MOL accomplishes this, thereby saving the sword of disciplinefor cases of reckless behavior. It is a better approach to protecting thepublic and preserving the integrity of the medical profession


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Association of American Physiciansand Surgeons 2012 Survey of

Physicians85 responses

55% ---- Irrelevant to their practice50%---- Process was onerous

3%---- Valuable protection for patients

68%---- will quit before doing MOCagain


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American Board of Internal Medicine (ABIM)

2009 Revenue from Certification and MOC:

NEARLY $40 MILLION


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Christine K. Cassel, M.D.

Founding Director of Robert Wood Johnson ClinicalScholars Program

Founding Director of Center for Health PolicyResearch

One of 20 scientists chosen by President Obama toserve on Presidents Council of Advisors onScience and Technology


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2009 ABIM Executive Director,

Christine K. Cassel, M.D.

Compensation:

$861,691

35 hour work week


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http://www.healio.com/~/media/Journals/PedAnn/2012/3_March/10_3928_00904481_20120206_14/fig1.ashx


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James A. Stockman, III, M.D.

President, American Board ofPediatrics, Inc.

2010 Compensation:$873,321

49 hours/week


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http://www.healio.com/~/media/Journals/PedAnn/2012/3_March/10_3928_00904481_20120206_14/fig2.ashx


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The American Board of

Pediatrics is the first of the 24ABMS member boards toimplement continuous

certification, issuing certificateswhich state that ongoing

certification is contingent uponmeeting the requirements ofMOC.


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Under MOC, in order to maintain theirAmerican Board of Pediatrics (ABP)

certification, pediatricians now mustbegin a process that includes thefollowing:

Have an unrestricted and valid license to practice medicine in

the United States.

Participate in continuing learning and self-assessmentprograms

Pass a written exam, which varies for general and specialtycertificates

Complete practice performance assessment and conduct peer

and patient surveys


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At www.medstudy.com you can receive apromotional flyer that stated: PASS THE

ABIM RECERT EXAM WITH MedStudy.RECERT Core Curriculum material can beobtained for $465, which includes freeshipping and 150 hours CME!. Additionally,

for $175, one can receive Internal MedicineBoard-Style Questions and Answers, whichare advertised as being like a sneak previewof your recent exam. For $1,125 you cantake the Internal Medicine RecertificationBoard Review Course, sponsored, of course,by ABIM.
http://www.medstudy.com/http://www.medstudy.com/


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CME Category I

AMA PRA

CME Category II


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OHIOS CONTINUING MEDICAL EDUCATION(CME) REQUIREMENT

Every two years a physician must complete 100 hours ofCME. At least 40 credits of CME MUST be earned inCategory 1, although the total 100 credits MAY be earnedin Category 1.

Currently, the State Medical Board of Ohio offers 25Category 1 credits to physicians who participate in ABMSMOC programs


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CME REQUIREMENTS FOR LICENSURE

12 States 50 hours/year

7 States 0 hours/year


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Accreditation Council for ContinuingMedical Education (ACCME)

AMA

ABMS

FSMB

AHA American Hospital Association

Association of American Medical Colleges

Association for Hospital Medical EducationCouncil of Medical Specialty Societies

A ti it E l ti


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Activity Evaluation

Your Patient Has an Adverse Reaction to a Drug: How to Reportto FDA's MedWatch

Although optional, we encourage you to please complete the activHy evaluation form before proceeding toyour certificate.

This activity is designated for a maximum of 0.25AMA PRA Category1 Credit(s)m. Physicians should onlyclaim credit commensurate with the extent of their participation in the activity.

1.Please select the amount of time you spent in this activity, rounding up to the nearest quarter hour.

The amount you choose will determine the amount of credit you receive for this activity.15 minutes

(0.25 credits)

2.Faculty was knowledgeable and effective. [Please use the "additional comments" field to provide

further information.]

o Strongly Agree

o Agree

o No Opiniono Disagree

o Strongly Disagree

3.The online format was appropriate for the subject matter and I was able to access all components of

the activity without difficulty. [Please note any concerns in the "additional comments" field.]

o Strongly Agree

oAgree

o No Opinion

o Disagree

o Strongly Disagree

4. This activity will assist in the improvement of my: [Check all that apply.]

o Competence

o Performance

o Patient outcomes


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5.I plan to make the following changes to my practice: [Check all that apply.]o Modify treatment plans

o Change my screening/prevention practice

o Incorporate different diagnostic strategies into patient evaluation

o Use alternative communication methodologies with patients and families

o Other [please explain in the "additional comments" field below]

o None; the activity validated current practice

6. What is your level of commitment to making the changes stated above?

o Very committed

o Somewhat committedo Not very committed

o Do not expect to change practice

7.What are the barriers you face in your current practice setting that may impact patient

outcomes? [Checkall that apply.]

o Lack of evidence-based guidelines

o Lack of applicability of guidelines to my current practice / patientso Lack of time

o Organizational IInstitutional

o Insurance / Financialo Patient adherence / complianceo Treatment related adverse events

o Other [Please use the "additional comments" field below to provide further information]

8.This activity supported achievement of each of the learning objectives. [Please use the

"additional

comments" field below to provide further information].

Describe the FDA MedWatch Program and implications of the program for patient safety

Activity Evaluation


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Identify the types of adverse events and product problems or

errors that should be reported using the FDA MedWatch Form3500.

Explain how to submit a report to the FDA MedWatch Program.

9. The material was organized clearly for learning to occur.

o Strongly Agreeo Agree

o No Opinion

o Disagree

o Strongly Disagree

10.The content learned from this activity will impact my practice.

o Strongly Agree

o Agreeo No Opinion

o Disagree

o Strongly Disagree

o I am not currently in practice

11.Does this activity promote improvement in healthcare?

o Yes

o No

12.The activity was presented objectively and was free of commercial bias. (Please use the additionalcomments fields to provide further information

o Strongly agree

o Agree

o No Opinion

o Disagree

o Strongly Disagree


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13. I would recommend this activity to others

o Agree

o No Opinion

o Disagree

o Strongly Disagree

14. Please list CE/CME topics that would be of value to you

15. Additional Comments:

Documents

MOC & MOL: lifelong learning or lifelong larceny?