Board self-assessment modules under fire from family physicians

Some family physicians say the American Board of Family Practice's maintenance-of-certification program needs revamping to avoid confusion and to make the process less onerous for doctors.

Physicians expressed their frustrations during the congress of delegates of the American Academy of Family Physicians and asked the AAFP to take action. AAFP delegates want the academy and ABFP to develop a plan to educate family physicians about the process, and they want the AAFP to urge the board to suspend required self-assessment modules.

"We're not objecting to the concept. It's what was developed that is unreasonable," said Richard Feldman, MD, an Indianapolis family physician and immediate past president of the Indiana Academy of Family Physicians.

AAFP chapters in Indiana, Kansas, Michigan and Ohio proposed resolutions on maintenance of certification during the academy's meeting in Orlando, Fla., in October. The resolution that passed on developing an education plan also calls for telling family physicians why MOC is the new standard of certification and what benefits can be derived from the process.

Delegates passed a second resolution calling for the AAFP to urge the board to suspend the self-assessment modules as a required part of MOC for family physicians until technical and clinical content problems are adequately resolved. Delegates also recommended that the board develop an alternative way for doctors with unreliable access to the Internet to complete modules. The resolutions were addressed to the American Board of Family Medicine because the ABFP is adopting that name as of Jan. 1, 2005.

The AAFP sent a letter to the board and asked it to make self-assessment modules optional through 2005, said AAFP President Mary Frank, MD. AAFP leaders also recommend that a module be completed every other year.

"We've listened to what our members said, and we've asked [the board] to make some modifications," said Dr. Frank, a family physician in Rohnert Park, Calif.

Incentives to stay certified

After the American Board of Family Practice was founded in 1969, it began to issue time-limited certificates and require recertification every seven years.

In 2000, medical specialty boards agreed to transition their recertification programs into maintenance-of-certification processes, which focus on continuous lifelong learning. In MOC, family physicians must undergo six self-assessment modules to evaluate medical knowledge and judgment. The ABFP recommends that diplomates complete one module per year rather than do them all near the end of the seven-year cycle.

Doctors have incentive to stay board-certified. Most hospitals and health plans require board certification. Failing to get certified can mean losing managed care contracts. Some hospitals, health plans and insurers are exploring whether to require maintenance of certification of their doctors.

The American Medical Association supports the concept of voluntary recertification but opposes recertification as a condition of employment.

Some family physicians say MOC is burdensome and requires too-frequent testing. In response, ABFP President Thomas E. Norris, MD, sent a letter to about 70,000 board-certified family physicians, saying the board listened carefully to the debate and acknowledges the concerns. He said the board is increasing its communication efforts to provide more information about MOC and enclosed a paper on the program with his letter.

The board has made about 20 major modifications as a result of physician feedback, Dr. Norris said. But it will not suspend its MOC program, he said.

"Suspending the process, to me, would send the wrong message to the American public that we don't care about quality -- and that couldn't be further from the truth," said Dr. Norris, who is also vice dean for academic affairs at the University of Washington School of Medicine in Seattle.

ABFP Executive Director James C. Puffer, MD, said about 4,500 physicians have started the MOC process. "We know that some of them are unhappy," he said. "We're trying to listen carefully to all of their concerns and do every possible thing that we can do to make this process as easy and efficient and effective as possible."