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    Letters to the editor

     

    To the Editor:

    [Regarding “The top 5 challenges physicians face in 2015,” January 2015 Contemporary OB/GYN]:

    Many practicing physicians are becoming angered over MOC, finding it not beneficial to their individual practices and quite burdensome. Properly done scientific studies have never proven MOC to improve the quality of care.1

    Shouldn't MOC have been scientifically tested prior to its mandate? I am quite worried that MOC is damaging camaraderie in the House of Medicine especially in my field of ob/gyn. 

    In Los Angeles we are seeing dramatic drop-offs in attendance at our grand rounds, local meetings, and academic symposia. The hours that the non-grandfathered physicians have to spend to meet MOC requirements and complete their CME, and given the hours that we all work, time to partake in what were once very well-attended, high-quality educational meetings is limited. Analysis of attendance data from ACOG national meetings as well as regional meetings shows dramatic drop-offs. My hypothesis is that this is mostly due to MOC.2,3

    Membership in our organizations is also markedly decreased.2,3

    As in the Libby Zion case, well-meaning people often institute change that actually is more harmful than beneficial. MOC is one of the ideas that need to be put on hold and further evaluated academically. How many of our departments at our leading teaching hospitals are having a hard time dealing with work-hour limits for their resident staff? How many patients have been injured by hand-offs that would not have occurred if not for work-hour limits?

    How do we justify damaging physician collegiality, damaging camaraderie, wasting limited valuable hours, and creating a teach-to-the-test mentality without evidence that MOC improves the quality of healthcare? Everyone agrees that physicians must continue their education. We are never done learning. The debate is whether physicians should determine how and what they learn, or should an outside, self-appointed, self-serving board.

    As I asked in the February 10, 2012, issue of Medical Economics, why don't lawyers have to be recertified?4 No other profession mandates MOC. It is not required of lawyers, CPAs, dentists, architects, engineers, airline pilots, nurses, or nurse practitioners. Our courts, teeth, buildings, and bridges are not falling apart.

    Half of the counties in America do not have one obstetrician to deliver a baby. Perhaps those obstetricians being paid almost $600,000 annually5 (not including other benefits and compensation) to create and administer MOC should leave their ivory towers and actually practice medicine. Perhaps ABOG should take a cue from the ABIM, which recently admitted that they "got it wrong"6,7 and put MOC on hold until well designed scientific studies could demonstrate its effectiveness. Alternatively our subspecialty should find a way to guarantee that all qualified CME is in fact improving the practice of obstetrics and gynecology. The latter scenario should lead to ABOG readdressing MOC, so that it is more in tune with the digital age and not trapped in a one-size-fits-all approach to physician continuing education.

    References

    1. Mandel HC. Maintenance of certification. N Engl J Med. 2013;368(13):1262.

    2. Personal communication with leadership of the 69th Annual Obstetrical and Gynecological Assembly of Southern California, March 24, 2014.

    3. Mandel HC. Recertification and maintenance of certification. Journal of American Physicians and Surgeons. 2011;16(3):65.

    4. Mandel HC. Why don’t lawyers have to be recertified? Medical Economics. 2012; 

    5. Change Board Recertification. The Board’s form 990 income tax returns. http://www.changeboardrecert.com/tax-returns.html. Accessed February 10, 2015.

    6. American Board of Internal Medicine. AMB announces immediate changes to MOC program. http://www.abim.org/news/abim-announces-immediate-changes-to-moc-program.aspx. Accessed February 10, 2015.

    7. American Board of Internal Medicine. MOC FAQ. http://www.abim.org/maintenance-of-certification/moc-faq/default.aspx. Accessed February 10, 2015.

    Howard C. Mandel, MD, FACOG

    Los Angeles, California

     

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