Urologists’ dissatisfaction with maintenance of certification is widespread, and they are not shy about sharing their opinion on the controversial program.
National Report-Urologists’ dissatisfaction with maintenance of certification (MOC) is widespread, and they are not shy about sharing their opinion on the controversial program.
Eighty-four percent of practicing urologists are not satisfied with the current MOC process, according to an exclusive Urology Times survey. More than half of survey respondents (54%) disagree or strongly disagree that becoming certified or recertified by the American Board of Urology (ABU) is an accurate measure of a urologist’s ability to practice quality medicine.
About two-thirds say MOC should be done away with altogether.
Urologists cite as specific concerns the administrative burden and cost associated with MOC and the belief that it does not accurately reflect their clinical skills, the survey found.
“MOC is a joke, but I’m not laughing,” wrote one respondent in an open-ended question. “I don’t think it does anything to ensure quality or value or ethical practice of urology. It just adds one more burden to my overburdened private practice of urology.”
“It does nothing to improve the quality of my care. I would suggest a review course in 7 to 10 years but no testing and no exorbitant fees,” said another. “A complete waste of my money and time,” another wrote.
The Urology Times survey was conducted via email in June and July 2016. It was intended to quantify urologists’ opinions about MOC and determine what they find bothersome about the program, what should be done about it, and whether they plan to recertify toward the end of their career.
Almost all respondents (97%) are/have been board certified (86% with a time-limited certificate), and the majority (63%) are in private practice. Twenty-eight percent have gone through the certification process once since they were originally certified, 34% have gone through it twice, 16% three times, 2% more than three times, and 20% never. The average age of respondents is 49. (Also see, “How the survey was conducted.")
Next: Is the MOC process necessary?
MOC earned low marks overall, but more so for the process involved in achieving it than the end result itself. Judging by the fill-in comments of a number of respondents, maintenance of skills and knowledge has value. How that goal is obtained is another story.
More than three-fourths (78%) of urologists said nothing more than approved CME is necessary for urologists to stay current in their medical skills/knowledge. When asked what their primary concern was about MOC, 34% said it does not accurately reflect urologists’ clinical skills/knowledge, 27% cited its administrative/paperwork burden, 24% said the program is unnecessary, and 7% cited cost.
“CME is enough; this ridiculous process has not been proven to be of any benefit to anyone but the boards themselves,” wrote one respondent. Another urologist said: “I think the MOC process overall is good. We could just be more EFFICIENT.” “Achieving CMEs by attending meetings and reading is all that is necessary to keep current,” said another.
Despite their complaints, 84% agree or strongly agree that having the ABU administer MOC is preferable to having the federal government administer this or a similar program.
Next: Testing lacks relevance to current practice, many say
A commonly heard sentiment about MOC is that, for many urologists, the testing lacks relevance to current practice. In the survey, 83% of urologists agree or strongly agree that “recertification testing places too much emphasis on aspects of urology that I do not manage.” Similarly, 77% say recertification covers too broad a scope of urology and is unfair to those who subspecialized after residency.
Another hotly debated issue is whether certain physicians should be grandfathered from MOC, which is the case for those certified before 1985. Legally, these urologists who have lifetime certificates cannot be required to enter into the MOC process, according to the ABU. Just under half (46%) of survey respondents agree or strongly agree that all urologists should participate in MOC, regardless of whether they were originally certified prior to 1985.
When asked to choose a single aspect of certification they find most bothersome, urologists put testing at the top of the list (47%). This was followed by surgical logs (35%) and CME (1.4%). Five percent of respondents indicated that there are no aspects of certification they find bothersome.
Forty percent of urologists say certification or recertification “makes me a better urologist,” but only 22% think MOC is an important way to ensure that physicians are keeping up with clinical skills and knowledge. About 57% think it matters to their patients whether or not they are board certified.
Next: Actions taken
While discontent about MOC is common, what may be more concerning is that some urologists may put their words into action and choose not to recertify later in their career-a scenario that could negatively impact an already shrinking urologist work force. In fact, 62% of survey respondents said they do not plan to take the recertification exam when they are 60 or older or within 5 years of the end of their career. About one-fourth indicated they’ll take the recertification exam, and another 13% are already age 60 or older or within 5 years of the end of their career.
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In a similar Urology Times survey question posed in fall 2015, the number of respondents saying they won’t take the recertification exam when they reach age 60 was significantly lower, at 53%.
Another possible outcome of urologists’ displeasure with the ABU’s MOC process is that they will seek certification elsewhere. One-fourth of survey respondents said they have considered obtaining board certification from an organization other than the ABU or other member board of the American Board of Medical Specialties or American Osteopathic Association.
As many urologists know, being board certified is often a requirement to practice in U.S. hospitals. Sixty-three percent of survey respondents said they are required to be certified or recertified to practice in their hospital, 23% said no such requirement exists, and 14% didn’t know. Some states have passed or introduced legislation that removes this requirement or, in some cases, prohibits making MOC a condition of licensure. (See, “Update: States limit the role of specialty certification.")
Most urologists (91%) do know that the ABU is separate and independent from the AUA.
Next: What should be done
What should happen to MOC? Given a list of three choices, 69% of urologists said it should be done away with. Another 10% said it should continue but the cost should be lowered, and 3% favored keeping the program the way it is.
About 18% of survey respondents elected to fill in an “other” response to this question. Among their suggestions: continue MOC, but as a replacement or alternative to the every-10-year recertification process; revise MOC to better assess physicians’ knowledge; rely exclusively on CME and attendance at accredited CME meetings; streamline the process; test physicians on more general information; re-evaluate costs and content; change it to be more reflective of practice; and omit written testing.
The Urology Times survey on maintenance of certification was conducted via email in June and July of 2016. Survey recipients, who were subscribers to Urology Times with email addresses on file, were required to indicate that they were a urologist before proceeding with the survey. A total of 419 qualified responses were received.
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