This letter is in response to two recent articles in Emergency Medicine News. (EMN 2011;33:1, http://bit.ly/ABEM-MoC;EMN 2011;33:5; http://bit.ly/LeapABEM.)
The American Board of Emergency Medicine (ABEM) is an emergency physician–led organization that is committed to improving emergency care and establishing standards for certification. Every ABEM director must be a clinically active physician, and is subject to the mounting challenges of clinical practice. All directors must participate in Maintenance of Certification (MoC).
There is compelling evidence that many physician skills decline over time. (Ann Intern Med 2005;142:260.) Despite this, ABEM believes (and patients expect) that emergency physicians do improve their knowledge during their careers. Emergency physician participation in MoC provides a credible, objective demonstration of this continuous professional development.
The ABEM MoC program is extremely clinically relevant at every stage. An interim analysis of the 2011 Lifelong Learning Self Assessment (LLSA) activity (MoC, Part II), shows that only 2.2 percent of participating emergency physicians felt that the LLSA articles were not clinically relevant. Results from the 2011 ConCert examination (MoC, Part III) show that physicians who had more years of clinical experience tended to score higher. This occurs largely because the examination is clinically focused and relevant; the test avoids esoteric minutiae. Finally, in the Assessment of Performance Practice (APP) element (MOC, Part IV), the emergency physicians themselves determine the area of their clinical practice they will assess, meaning the physicians define the degree of clinical relevance, not ABEM.
ABEM designed APP to give credit to physicians for their ongoing work in areas such as improving adherence to various core measures and other quality initiatives (e.g., door-to-balloon times). APP is designed to minimize any need for creating new activities. APP is free of charge, and the online attestation process is easy to use and quickly completed.
Contrary to the suggestion that Canada and Europe do not have recertification requirements, Canada and the United Kingdom have ongoing certification activities that are more government regulated. (JAMA 2009;302:2008.) One privilege of practicing medicine in the United States is the opportunity to be self-regulating. This can only continue if the process of MoC is robust; otherwise, it would not be credible in the eyes of the government and public. We believe MoC helps stave off more onerous regulation.
To be clear, every director on the ABEM board is a volunteer, and does not receive a salary. Some directors do report some income related to travel expenses. The executive director, who is a full-time employee of ABEM, receives an appropriate, market-based salary. As a 501(c)6 nonprofit organization, all such information is publically reported.
ABEM supports the notion that the heavy load carried by emergency physicians can be lightened. ABEM hopes to assist with this through several initiatives, one of which is promulgating increased CME opportunities linked to MoC activities. ABEM will continue to strive to enhance the value of MoC for emergency physicians, including investigating new and innovative options.
Richard N. Nelson, MD