USPhysicianandSurgeonPerspectivesonBoardCertification

AVoluntaryInternet-basedSurveyfromJanuary21,2018–19March2018

WestbyG.Fisher,MD1,TimothySanborn,MD,MS1andCharlesCutler,MD2

PresentedattheAMAAnnualMeetingoftheHouseofDelegates11June2018

1NorthShoreUniversityHealthSystem,Evanston,IL2EinsteinMedicalCenterMontgomery,Philadelphia,PA

ConflictsofInterest

•  Dr.Fisherhasnofinancialconflictsofinteresttodisclose.Heisanunpaid

boardmemberofPracticingPhysiciansofAmerica,a501c6physician

membershiporganization.

•  Dr.Sanbornhasnoconflictstodisclose

•  Dr.Cutlerhasnoconflictstodisclose.Dr.CulterservesontheAmerican

BoardofMedicalSpecialties(ABMS)“VisionCommission”taskedwith

evaluatingthecurrentstateofABMSMaintenanceofCertificationandis

anadvisortoPracticingPhysiciansofAmerica

Background

•  1933–AdvisoryBoardofMedicalSpecialties(today’sAmericanBoardof

MedicalSpecialties(ABMS))wascreated.

•  1936-TheAmericanBoardofInternalMedicine(ABIM)created.

•  Forthefirst33yearsofexistence,theABMSanditsmemberboards

issuedlifetimecertificatesfollowingpassageofaone-timeboard

certificationexamination.

•  Later,someboardsarguedthatone-timecertificationdidnotprovide

sufficientevidencethatphysicianscouldremaincompetentthroughout

theircareers.

Background

•  1969AmericanBoardofFamilyMedicinewascreated

–  Onlyissuedtime-limitedcertificates

•  1976AmBoardofSurgeryandAmBoardofThoracicSurgery

–  Bothswitchedtotime-limitedcertificates.

•  1986AmBoardofInternalMedicine

–  Beganissuingtime-limitedcertificatesforCriticalCarespecialistsand

allothermedicalsubspecialtiesin1990.

–  Physiciansinternistswhoreceivedtheircertificatesbefore1990were

“grandfathered”anddidnothavetore-certify.

Background

•  In1998,theAmericanBoardofMedicalSpecialties(ABMS)

establishedtheir“TaskForceonCompetence,”whichledallABMS

memberboardstocreateexpandedandmorestandardizedform

oftime-limitedboardcertificationcalledMaintenanceof

Certification™(MOC™).

–  MOC™comprisedoffourparts:

•  PartI:Licensureandprofessionalstanding

•  PartII:Life-longlearningandself-assessment

•  PartIII:Cognitiveexpertisethroughformalexamination

•  PartIV:Practiceperformanceassessment

Background

•  By2006,all24ABMSmemberboardshad

receivedapprovalfortheirindividualMOC™

products.

•  In2013,theAmericanOsteopathicAssociation

followedsuit,institutedtime-limitedcertificates

forosteopathscalled“OsteopathicContinuous

Certification(OCC).”

PhysicianConcernsWithContinuousCertification

•  Effectiveness

•  Fiscalirresponsibility

•  Cost

•  Researchmethods

•  Undisclosedlobbying

•  BusinessconflictsexposedduringCongressionaltestimony

Background

•  Despite18yearsofMOC™/OCCthereislittle

independentevidenceofimprovedpatient

outcomesorsafety.

•  PhysicianandsurgeonperspectivesonMOC™/

OCC’sconflictsofinterest,researchmethodologies,

andadverseeffectsareunknown.

Methods

•  WeperformedanInternet-basedvoluntary

surveyofpracticingphysicianandsurgeon

perspectivesoninitialandcontinuousUS

BoardCertification

Methods•  SurveyMonkey(SanMateo,CA)

–  8pages,32questions

•  Voluntaryrecruitmentbysocialmediachannels

•  12Jan2018-19March2018

•  Toldtheywouldbeaskedfortheirname/emailattheendofsurveywhen

startingsurvey.

•  LikertScales1-5forattitudesoninitialandcontinuouscertification

•  IPaddressestrackedtoexcludenon-USparticipantsandtoencourage

limitmultipleresponsesfromsameperson.

•  Skippagelogicusedtodirectparticipantstoappropriatequestionsbased

ontheiranswers.

ExclusionRequirements

•  Non-physiciansorsurgeons

•  Physicians/surgeonsfromoutsideUS(except

physiciansinthemilitary/charitableorganizations

overseas)

•  Non-clinicalresearchers

•  Industry-employedphysicians

•  Physiciansnotyetcertified

Survey

•  Demographics•  Age/gender/state/specialty•  Practicesetting

•  PracticingDO,MD,non-USdegreesonly

•  EverBoardCertified?•  Numberofcertifications•  Numberbefore1990•  Statelicensuredisclosure•  Likertscale1-5

•  Value•  Cost•  Abilitytoassessquality

•  ParticipatinginMOC™/OCC•  Reason•  Relevance/value•  COI’s•  RighttoWork•  Harms

•  Thoughtsoncontractterms/burnout/monopoly/CMEenough

Degree

DO

MD or Non-US Med

Other

Survey ExitThank you

(Optional Name andEmail Entry)

DemographicsGender, Age, Practice set-

ting, State/Territory, Practice Specialty, Years post-training

Doctor Osteopathy

1) Should AOA allow recert by others (NBPAS)?

2) Should FSLB require OCC for state licensure?

Ever ABMSBoard Certified?

No

Yes

Initial ABMSCertification DetailsTotal number, Number before 1990,

State license disclosure,Perceptions, Cost

Participatein MOC®/OCC?

No

Yes

Reason for participation,Perceptions of

Relevance/Value, COI’s, Effect right to work?

Failed MOC® or experienced

harm from it?

Perceived Harms from MOC®/OCC

Fees, loss of adm privileges,loss of employment,

relocated, etc.

Thoughts on contract terms, burnout, monopoly,

CME enough?

MOC®/OCC

No

MOC®/OCC

Yes

Non-clinicalResearcher or

Teacher?

No

Yes

Results

•  7125responses

•  7007physician/surgeonresponsesavailableforanalysisafteroverseas/incompletesurveys

removed.

HeatMapofRespondentIPAddresses(n=7007)

•  Gender n(%)

–  Male 3632(52)

–  Female 3375(48)

•  Age

–  21-35 771(11)

–  36-50 3378(48)

–  51-65 2307(33)

–  66orolder 551(8)

•  PracticeSetting

–  PrivatePractice 1865(27)

–  GroupPractice/Independent 1199(17)

–  Hosptial/University/HealthSystemEmployee 2939(42)

–  GroupPractice/Contracted 637(9)

–  Other 369(5)

•  StageofTraining

–  HaveMD/DObutnotfinished 120(2)

–  Clinicalphysicianposttraining0-10years 2330(33)

–  Cllinicalphysicianposttraining11-20years 2048(29)

–  Clinicalphysicianposttraining21-30years 1527(22)

–  Clinicalphysician>30years 760(11)

–  Retiredclinicalphysician 152(2)

–  Teachphysicians,don’tseepatient 32(0)

–  Non-clinicalresearchphysician 38(1)

DemographicCharacteristics

Degree

DO

MD or Non-US Med

Other

Survey ExitThank you

(Optional Name andEmail Entry)

DemographicsGender, Age, Practice set-

ting, State/Territory, Practice Specialty, Years post-training

Doctor Osteopathy (n=755)

1) Should AOA allow recert by others (NBPAS)?

2) Should FSLB require OCC for state licensure?

Ever ABMSBoard Certified?

No

Yes

Initial ABMSCertification DetailsTotal number, Number before 1990,

State license disclosure,Perceptions, Cost

Participatein MOC®/OCC?

No

Yes

Reason for participation,Perceptions of

Relevance/Value, COI’s, Effect right to work?

Failed MOC® or experienced

harm from it?

Perceived Harms from MOC®/OCC

(n=390)Fees, loss of adm privileges,

loss of employment, relocated, etc.

Thoughts on contract terms, burnout, monopoly,

CME enough?

MOC®/OCC

No

MOC®/OCC

Yes

(n = 7007)

(n = 801) (n = 33)

(n = 6173)

(n = 429)

(n = 6048)

(n = 6477)

(n = 4793)

(n = 1211)

(n = 394)

(n = 4697)

(n = 4303)

(n = 5812)

Non-clinicalResearcher or

Teacher?

No

Yes (n = 70)

(n = 6477)

(n = 6004)

7007Respondents

6477ABMSBoardCertified

(92%)

801DOs(11%)

4793ParticipateinMOC/OCC(74%)

394PerceivedHarm(8%)

DemographicsGender,Age,PracticeSetting

(n=7007)

Gender Age

PracticeSetting/YearsinPractice

Stilltraining

0-10years

10-20years

20-30years

>30years

Retired

Teachonly

Non-clinicalresearch

(n=7007)

PrimaryPracticeSpecialty*

*Correlationto2016AAMCPracticingPhysicianWorkforce0.87p=0.76

InWhatStateorUSTerritoryDoYouPracticeMedicine?(n=7007)

InitialBoardCertification

19%“Grandfathers”

InitialBoardCertificationPerceptions

PhysicianPerceptionsofBoardCertificationn=6477

EstimatedCosts

53.7%>$4,000

(n=6477)

HowManyDoctorsParticipateinContinuousCertification?

(n=6004)

OfThoseThatParticipateinMOC/OCC,WhyDoTheyDoSo?

(n=4697)

HospitalandInsuranceCompanyRequirementsarethePrimaryReasonDoctorsParticipateinContinuousCertification

PhysicianPerceptionsofMOC/OCC(n=4697)

MOC/OCCConflictsofInterestAwareness(n=4697)

94%ofphysiciansunawaretheirdatawerebeingsold

ResearchTechniques

PerceivedRighttoWorkThreat(n=4697)

86%ofphysiciansandsurgeonsconcernedMOC™/OCCthreatenstheirrighttowork.

WhatPercentageofPhysiciansFailRe-certification?(n=4697)

PerceivedHarmsofFailingRe-certification(n=390)

Retakesoftencostmore

} Psychologicalharmsmostprevalent

Lossofhospitalprivileges

JoblossDisenrolledfrominsurancepanel

Plantoretire

Shame,Depression.Anxiety,orSuicidalIdeation

ContributiontoPhysician“Burnout”(n=5805)

95%ofphysiciansfeelMOC/OCCincreases“burnout”

ForMoreInformation

•  http://www.practicingphysician.org/MOC