Sunday, April 02, 2023

MOC and the Demise of CME

With the ongoing forcing of participation in Maintenance of Certification (MOC) of US physicians by the American Board of Medical Specialties (ABMS)and its 24 member boards, we are seeing the slow demise of physician-selected Continuing Medical Education (CME) in America. Attendance at specialty society meetings is at an all-time low. Doctors, increasingly employed and facing the reality of how to spend their continuous professional development budget, must choose to maintain their board certification or pay for  CME credits at a course of their choosing. Paying even more money to socialize and interact with colleagues, to share ideas, review posters, and participate in group learning sessions is going away. 

Specialty societies have read the tea leaves. Their budgets are tight now too. Is there any wonder then that the largest subspecialty society, the American College of Cardiology (ACC), buddied up with the American Board of Internal Medicine (ABIM) to sell their continuous professional development products like ACCSAP (ACC Self Assessment Product), EchoSAP (Echo Self-Assessment Product), CathSAP, HFSAP (Heart Failure Self-Assessment Product), and (the soon-to be) EP SAP (Electrophysiology Self Assessment Product)? Buy their products for the cool tune of $1500-1900 for "20% review of the field," and doctors get CME and MOC credits "without the stress of having to achieve a passing score" on their Performance Assessment!

The Federation of State Medical Boards (FSMB), a private non-profit, has been working tirelessly to influence state medical boards on the value of MOC, too.  Their Interstate Licensing Pact requires their physicians to (1) pay $700 on top of each state's licensing fee, (2) be fingerprinted with background checks, and (3) requires physicians to be ABMS board certified (and participate in MOC). At least two states, Georgia and Illinois, now accept participation in MOC in lieu of CME requirements for licensure.

Meanwhile, there is no proof MOC makes us better doctors. 


But we sure become wonderful computerized data points.

Consequently, physicians are left isolated from their colleagues. They are no longer valued for their creativity, intellect or social skills, but work productivity. They are data points shared between those of Medical Industrial Complex hospital systems, insurers, drug companies and their pharmacy benefit managers, and medical device companies that pay hefty fees for access to that data.

Physicians are burning out an leaving medicine in droves. Gaslighting of physicians by the member organizations of the Accreditation Council of Graduate Medical Education (read AMA, ABMS, CMSS, AHA, among others) regarding the "importance" of maintaining your certification through MOC (or is it LKA "Longitudinal Knowledge Assessment" now?) is a big reason why.

Yes Virginia, CME is on life support and its prognosis, thanks to MOC, is grim.


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