Fresh off a victory that ended in the American Board of Internal Medicine suspending parts of its maintenance of certification program, internists are now taking aim at the costs of the program, which could be as high as $40,000 over 10 years for certain subspecialists, according to an analysis in the Annals of Internal Medicine. (2015;163:401.)
The study fueled the already-raging internal medicine fire by projecting that the cost of maintenance of certification would average $23,607, $16,725 for general internists and $40,495 for hematologists-oncologists, with most of that in time spent fulfilling the requirements over 10 years. Direct costs averaged $2,359, but the study calculated that the 2015 MOC would cost ABIM diplomates $5.7 billion over 10 years, $1.2 billion more than it did in 2013.
ABIM waved the proverbial white flag on its MOC program back in February, suspending parts of it and issuing a letter from its president that said, “We got it wrong and sincerely apologize.” That same month, the American Academy of Emergency Medicine (AAEM) surveyed its membership to find that more than 65 percent of responders said they were unlikely or highly unlikely to let their board certification lapse because of MOC. (http://bit.ly/1iWK93r.) An EMN article published last year found much the same: Emergency physicians don't share the internists' deep dislike of MOC. (“Most EPs Give MOC a Seal of Approval While Cardiologists Fight On,” EMN 2014;36:22; http://bit.ly/1n7Qp2i.)
But would the recent ABIM MOC cost analysis change their tune?
No tantamount comparison exists for emergency medicine and its maintenance of certification, but the American Board of Emergency Medicine, at Emergency Medicine News' request, provided time and cost data for its MOC. Direct costs are $2,650, according to Barry N. Heller, MD, the president of ABEM, and EPs spend nearly 145 hours over 10 years meeting the requirements.
“As a rough estimate, ABEM diplomates spend about 15 hours per year participating in MOC. This equals just over 17 minutes per week keeping up on changes in the specialty,” said Dr. Heller in a letter to EMN. “Performing any comparative cost modelling to internal medicine is very difficult, largely due to the widely disparate number of diplomates (more than 250,000 board-certified internists v. 32,611 board-certified emergency physicians) and higher MOC costs associated with subspecialization (only 4.3 percent of ABEM diplomates hold a subspecialty certificate).”
Emergency physicians make an average of $160 an hour, according to a 2013 Becker'sHospital Review survey, meaning the ABEM MOC costs an average of $23,200 in time spent certifying over 10 years, in keeping with ABIM's average of $23,607. With direct costs at $2,650 and time investment at $23,200 over 10 years, that puts an average emergency physician's annual cost at $2,585.
Dr. Heller noted that ABEM survey data showed that 98 percent of emergency physicians found the LLSA articles relevant to clinical practice and 92 percent reported that those readings influence practice. The AAEM survey somewhat bears up that assessment, though the numbers are not as overwhelmingly positive. A total of 44.9 percent found the ConCert Exam beneficial, and 48.2 percent said the same of the LLSA exams. Those numbers flipped for the Practice Improvement Activity and the Communication Activity, however, with 48.8 percent and 51.9 percent, respectively, saying they did not find them beneficial and that the effort required was excessive.
Ingrained in Specialty
The 2014 ConCert post-examination survey showed that 92.5 percent of physicians reported benefits to their careers, including more work options (60.7%), becoming a better physician (59.5%), and greater income (49.7%), Dr. Heller wrote. “MOC Part IV requires little additional time and costs nothing. ABEM has started to survey physicians when they attest to Part IV activities, and of the 849 responses received so far in 2015, 100 percent report that the activity is relevant.”
Catherine Marco, MD, a professor of emergency medicine at the Boonshoft School of Medicine at Wright State University in Dayton, OH, and an ABEM director, found that emergency physicians maintain their performance on the ConCert exam over time. (Acad Emerg Med 2014;21:532; http://bit.ly/1iZtwUC.) “My opinion is that ABEM's requirements are reasonable and worthwhile. It's designed to make us better doctors. However, you cannot compare one board with another,” she said.
Terry Kowalenko, MD, the chair of emergency medicine at Oakland University William Beaumont School of Medicine in Rochester, MN, and the secretary-treasurer of ABEM, said emergency medicine and family practice were the only specialties founded without lifetime certification. “It was always ingrained in emergency medicine that there would be continuous certification in the ConCert exam,” he said. “Because we always had something in place, it did not come as a shock.”
Dr. Heller agreed, noting that ABEM has made “substantive changes to the program to make it better align with quality activities that physicians are already doing.” He said emergency physicians might be more tolerant of the process because “from the very beginning of ABEM 35 years ago, emergency physicians have always been involved in recertification and MOC activities without resting on the laurels of one-time initial certification.”
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