Don't MOC him

Tired of preparing for a Maintenance of Certification (MOC) test that didn’t reflect his skills or what he practiced on a daily basis, Paul Teirstein, MD, set out to create an alternative to the process.

Teirstein, a San Diego-based cardiologist, started an online petition in 2014 to find other doctors who were equally fed up with the time and money required to comply with MOC. He sent it to six colleagues as a test group. Within days, he had 300 signatures, and two months later, he had 23,000. “When I saw that, I thought, ‘Wow, this is really wrong. This is an issue we can all agree on,’” says Teirstein.

INTERACTIVE MAP: Anti-MOC legislative scoreboard

After presenting the results to the American Board of Medical Specialties (ABMS), the organization that oversees MOC, he was told no changes would be made. “People told me the horse was out of the barn, it was too late and that they were too big of an organization to fight,” Teirstein says. “They told me to just do my MOC testing and make better use of my time.”

Disappointed but undeterred, he decided to start his own program as an alternative to the MOC process while still supporting initial board certification. He formed the National Board of Physicians and Surgeons (NBPS) to oversee the new program which, in place of testing, requires accredited continuing medical education credits as well as meeting certain licensure and credentialing requirements.

“We are trying to stop an onerous and expensive regulatory requirement by a private organization, and I think we are making progress,” says Teirstein. By the end of 2017, nine states had passed some form of alternative recertification legislation while another 11 were considering similar laws.

Teirstein seeks either a complete revision of MOC that includes the removal of testing and any appearance of financial motivation relating to MOC, or recognition of his NBPAS alternative certification by more hospitals and insurance companies. At the end of 2017, 66 hospitals accepted the alternative certification, and no payers besides Medicare. 

Next: "They’ve made some good changes, but not enough"

 “This is a marathon and will not happen quickly,” he says. “I think the American Board is wrong. They’ve made some good changes, but not enough.”

Some ABMS boards are now allowing physicians to take a smaller exam every two years instead of an all-day exam every 10, but Teirstein says the tests still don’t help patients or improve care and still appear to be about financial gain for the ABMS boards.

He hopes that as more states pass alternative recertification legislation and more hospitals or payers agree to accept his alternative, it will be easier for others to sign on, too. But he doesn’t expect it to be effortless. Teirstein already spends about three unpaid hours a day on his goal to educate more legislators, payers and hospital leaders about the burdens of MOC. “It is very rare to find a physician in practice that doesn’t think MOC isn’t a complete waste of time,” he adds.

FURTHER READING: Doctors sound off, question MOC

Despite the challenges ahead, he encourages other physicians to take the time to push for change in medicine they believe in. “Physicians are so busy multi-tasking all the time that they can hardly get through the day,” says Teirstein. “But if you don’t stop and focus on the important things that may not be as urgent, you are not going to succeed in making change.”