MOC: Medicine's 'ugly civil war'

The simmering controversy over requirements for maintenance of certification (MOC) and accompanying physician unhappiness with the American Board of Internal Medicine (ABIM), long confined to the medical community, burst into public view in March. That’s when Newsweek magazine published an article critical of the ABIM under the provocative headline, “The Ugly Civil War in American Medicine.”

The article, by investigative reporter Kurt Eichenwald, recaps the changes in MOC requirements over the years and physician complaints about the process, such as being tested on skills and knowledge they don’t need, and situations they don’t encounter in their everyday practices. The article describes the declining passage rates on recertification tests in many sub-specialties, and implies that the ABIM profits from doctors’ having to re-take the tests.

“Making doctors appear ignorant became big business, worth millions of dollars, and the ABIM went from being a genial organization celebrated by the medical profession to something more akin to a protection racket,” Eichenwald wrote. Lori Slass, a spokeswoman for the ABIM, says in the article that any suggestion that the ABIM is “purposely failing candidates…to generate more revenue is flat-out wrong.”

The article also delves into the financial statements of the ABIM and the ABIM Foundation, noting that the ABIM’s revenues went from $16 million in 2001 to $55 million in 2013, while “total pay for the ABIM’s top officers quadrupled.”

As for the ABIM Foundation, Eichenwald says its website “reads like a lot of mumbo-jumbo,” and points out that it earned $20 million on its $74 million in assets in 2013, while spending nearly $2 million on unexplained programs and projects.

In a written response, ABIM Chairman David Johnson, MD, said the Newsweek article “contains numerous and serious misstatements, selective omissions, inaccurate information and erroneous reporting.” The assertion that the ABIM seeks to profit by make the recertification exams harder so that doctors have to retake them “is untrue and not supported by data.” Pass rates “rise and fall over the years and vary across disciplines. In total, 96% of physicians who ABIM certifies passed an exam to maintain their certification,” Johnson writes.

The article’s reporting on the finances of the ABIM and the ABIM foundation, “reflects a poor understanding of that information and a highly selective presentation of information designed to prove his faulty premises,” the statement continues.

“ABIM recognizes serious challenges in developing a relevant, meaningful Maintenance of Certification program that identifies physicians whose knowledge has been reassessed and who have shown that they have kept up to date with evolving medical information” Johnson says. “We are sincere in our desire to work openly with the internal medicine community to rethink the ways in which ABIM serves physicians and the public.”