Docs sue Board of Internal Medicine over MOC

Four doctors have filed a class action lawsuit against the American Board of Internal Medicine (ABIM), alleging that the board illegally ties its initial certification to its maintenance of certification product. The suit also claims that ABIM illegally created and maintains a monopoly in the market for maintenance of certification (MOC). The class action is filed on behalf of more than 100,000 internists nationwide.

All four physician plaintiffs describe economic and professional suffering as a result of either failing a MOC exam or choosing to not take it. In addition to alleging a monopoly, the doctors allege that the ABIM website is misleading, labeling physicians as “not certified” even though they achieved initial certification, thus tying the MOC product to initial certification. The suit states this action has forced physicians to purchase MOC, and that ABIM “charged inflated monopoly prices for MOC, and thwarted competition in the market for maintenance of certification.”

The plaintiffs also take exception to how the ABIM grandfathered any internists who received initial certification prior to 1990. Those grandfathered doctors are not required to purchase MOC, yet are listed as “certified” on the ABIM website. According to the suit, “The president and chief executive officer of ABIM has been quoted as admitting ‘Grandfathering is a really vexing challenge. It’s difficult to defend…I would not see those doctors as equivalent to doctors who certify.’ Thus, ABIM holds grandfathered internists to a different standard than their peers, despite the fact these older physicians are many years out of their residency training and may be among those least up to date on current practice.”

The suit also claims that even though internists have little choice other than to purchase MOC, “no evidence-based relationship has been established between MOC and any beneficial impact on physicians, patients, or the public.” The plaintiffs argue this is proven by the fact that ABIM does not require those it has grandfathered to comply with MOC, and that the organization’s website states that research only suggests that MOC is a marker of care quality. The suit also points out that at least two ABMS member websites state, “Many qualities are necessary to be a competent physician, and many of these qualities cannot be measured. Thus, board certification is not a warranty that a physician is competent.”

In response to the suit, ABIM says in a statement that it will vigorously defend itself, “recognizing that doing so will consume resources far better dedicated to continuous improvement of its programs.” The organization also says that it has spent the last several years working with the internal medicine community to make ABIM’s program better and enhance the value of certification. It points to three changes to the program:

• A partnership with Accreditation Council for Continuing Medical Education to improve efficiency in the program.

• A shorter, lower-consequence assessment option called the Knowledge Check-In.

• ABIM staff is engaged in discussions with American College of Cardiology, American College of Physicians and American Society of Clinical Oncology to create alternative pathways for diplomates to maintain their certification beginning in 2019.

“ABIM leaders are proud of these changes and have devoted substantial resources to making the program better for all diplomates,” the release states. “ABIM’s focus will remain on maintaining a standard of professional achievement that the public values, signaling that ABIM diplomates are well-trained and staying current in their fields to better serve their patients.”

The plaintiffs in the case are Gerard Kenney, MD, of Pennsylvania; Alexa Joshua, MD, of Michigan; Glen Dela Cruz Manalo, MD, of Washington; and Katherine Murray-Leisure, MD, of Massachusetts. The suit was filed Dec. 6 in the Eastern District of Pennsylvania, United States District Court.