US Physician and Surgeon Perspectives on Board CertificationBackground • Despite 18 years of MOC...
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US Physician and Surgeon Perspectives on Board Certification A Voluntary Internet-based Survey from January 21,2018 – 19 March 2018 Westby G. Fisher, MD 1 , Timothy Sanborn, MD, MS 1 and Charles Cutler, MD 2 Presented at the AMA Annual Meeting of the House of Delegates 11 June 2018 1 NorthShore University HealthSystem, Evanston, IL 2 Einstein Medical Center Montgomery, Philadelphia, PA
Transcript of US Physician and Surgeon Perspectives on Board CertificationBackground • Despite 18 years of MOC...
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
