2011 AMA House of Delegates Weighs Maintenance of Certification, Licensure Issues

June 29, 2011 05:45 pm Barbara Bein

Issues involving maintenance of certification, or MOC, maintenance of licensure, or MOL, and osteopathic continuous certification, or OCC, were ardently debated by new-to-practice and established physicians during the 2011 annual meeting of the AMA House of Delegates, June 18-22 in Chicago.

But in the end, delegates decided to refer the most prominent resolution involving these issues and their impact on the physician workforce -- especially in primary care and underserved areas of the country -- for further study by the Council on Medical Education.

The AMA Young Physicians Section introduced the heavily debated resolution(www.ama-assn.org) (see pp. 98-99 of 134-page PDF) regarding the impact of MOC, MOL and OCC on the physician workforce. The resolution, which called for the AMA to study the validity, methodology, cost and effectiveness in documenting physician competence of the recredentialing system for board certification and report back at the AMA 2012 Annual Meeting, noted that several events are affecting physician certification and licensure:

  • the implementation of MOC by the American Board of Medical Specialties in 2000;
  • the issuance of a proposed template for implementation of MOL by the Federation of State Medical Boards this year; and
  • the upcoming implementation of OCC by the American Osteopathic Association and its osteopathic certification boards before January 2013.

Supporters of the resolution were concerned about the "significant" monetary and time commitments for enrolling in and completing MOC and OCC. This is time spent away from providing care to patients at a time when physician shortages are anticipated, especially in primary care and in medically underserved areas, said supporters.

In addition, according to the resolution, after MOL is fully implemented, practicing physicians will need to be enrolled in MOC/OCC or MOL to practice medicine in the United States. Physicians who are not currently enrolled in MOC/OCC may choose to retire rather than "incur the expense or perceived hassle" of beginning the certification or licensing processes. Moreover, the "burden" of completing the MOC/OCC requirements may affect medical students' and residents' choice of specialty or practice location.

The resolution asked the AMA to work with five stakeholder organizations to study the effect of such certification and licensing issues on the physician workforce.

According to the Reference Committee on Medical Education report(www.ama-assn.org) (see pp. 28-29 of 38-page PDF), speakers testified about their concerns that MOC and MOL requirements may force some physicians into early retirement. As a result, the reference committee recommended that the resolution be referred, and AMA delegates agreed.

J. Mack Worthington, M.D., of Chattanooga, Tenn., an AAFP delegate to the AMA who focuses on medical education issues, told AAFP News Now that the licensing and certification organizations should work together to see that the needs of both patients and physicians are met.

"Family physicians care about their patients. We want to ensure that family physicians are up-to-date and provide the very best of care for their patients. The focus should be on our patients and on lifelong learning.

"Since there are several organizations trying to address these issues, it could result in a complex array of requirements that would be hard to meet, especially for some of our doctors who may be near the end of their careers."

AAFP Vice President for Education Perry Pugno, M.D., M.P.H., told AAFP News Now, "The issues surrounding MOC, OCC and MOL are complicated, but it is absolutely critical that we get all of these new demands on family physicians' time coordinated to avoid duplication and conflict among those requirements.

"The worst possible outcome would be for these new systems to become onerous enough to precipitate early retirement among primary care physicians and further exacerbate the challenges our nation faces in health care access."

In other matters regarding licensing and certification, the AMA

  • will advocate that each state medical board be required to accept evidence of successful participation in certain certifications as fulfilling all components of MOL and that the boards accept programs created by specialty societies as evidence that physicians are participating in continuous lifelong learning;
  • will petition the American Board of Medical Specialties and the American Osteopathic Association to encourage their specialty boards to offer certified CME credit for required MOC and OCC activities dealing with practice performance assessment and lifelong learning (the AMA will encourage specialty societies to grant certified CME credit for activities they offer to fulfill requirements of their MOC processes); and
  • adopted new policy specifying that during state medical board investigations regarding quality of care, physicians be given at least 30 days to respond, prompt board decisions, sworn expert review by a physician in the same specialty, a list of witnesses providing expert review and exculpatory expert reports.