The August 2014 issue of Contemporary Pediatrics featured an article titled “Maintenance of Certification: Myths, facts, and FAQs,” written by Virginia A. Moyer, MD, MPH, vice president for Maintenance of Certification (MOC) and quality for the American Board of Pediatrics (ABP). The editors received dozens of responses from pediatricians, all critical of the MOC process and questioning the necessity of the program. In this Peds v2.0 article, I describe the transition from permanent board certification to MOC and detail the many controversies surrounding the current program. Elsewhere in this issue, I don my “pediatrician” hat and express my own opinions regarding MOC (“MOC: A view from the trenches”).
History of board certification
To put MOC in perspective for pediatricians, it is important to understand the origin of the board certification process. As you will see, today’s MOC program represents a radical departure from the board certification program as originally developed by specialty boards.
In the early part of the 20th century, there were no requirements to prevent untrained physicians from calling themselves ophthalmologists, dermatologists, or pediatricians. Anyone who had a “special interest” in narrowing his or her practice focus could be listed as a specialist in the directory of the American Medical Association (AMA). The need to distinguish physicians who completed specialty training gave rise to the creation of specialty boards such as the American Boards of Ophthalmology, founded in 1917; Otolaryngology in 1924; Obstetrics and Gynecology in 1930; and Dermatology in 1932.
The American Academy of Pediatrics (AAP) was formed in 1931, but it did not see its role being that of a specialty board. One of its first actions was to task a Committee on Medical Education to investigate the need for a distinct ABP whose role was to certify physicians who had completed a pediatric internship and residency as board-certified pediatricians.
Through the cooperative efforts of the AAP, the American Pediatric Society, and the AMA Section on Pediatrics, the ABP was formed in 1933. Its purpose was straightforward—to certify pediatricians for practice. Members received no salary and paid no dues, and were responsible for developing an examination and certification process. Pediatricians could apply for certification after completing 1 year of internship, 2 years of residency, and 2 years of practice or further training. Interestingly, board certification in pediatrics received significant pushback from many academic institutions, and it took nearly 20 years for certification to gain widespread acceptance among virtually all American pediatricians.1
In 1933, the same year the ABP was founded, the American Board of Medical Specialties (ABMS) was formed whose membership consisted of the 5 existing boards—ophthalmology, otolaryngology, obstetrics and gynecology, dermatology, and pediatrics. Its role was simply to develop guidelines and regulations for all its member boards. Today there are 24 member boards under the ABMS, including the ABP.
Evolution from board certification to MOC
In 1989, the ABP stopped issuing a “permanent” certification in pediatrics, and began issuing time-limited certification that would require periodic recertification for pediatricians to claim board certification status. Several years later in 2010, the ABMS drastically changed the model of certification, from one based on a lifelong certification to today’s model that is based on continuous “maintenance” of certification.
As a consequence, in 2010 the ABP began issuing certificates with no end dates. Figure 1 illustrates the ABP’s most recent data on the certification status of pediatricians practicing in this country. According to a recent article by Paul Kempen, currently 25% of all licensed physicians in the United States are not board certified. Additionally, he reports that less than 1% of physicians with lifelong certificates have recertified, and in 2010 the ABMS indicated that less than half of American physicians were participating in MOC.2