Family medicine board makes changes in certification rules

Like a college student putting off writing a term paper, Patrick Dowling, MD, MPH, avoided getting started on his maintenance-of-certification program. He waited until the week between Christmas and New Year's, then tackled questions of a self-assessment module on diabetes.

"I came away grumbling, but I did it. I later thought it was very helpful and beneficial from a clinical perspective," said Dr. Dowling, professor and chair of the family medicine department at the David Geffen School of Medicine at the University of California, Los Angeles.

Dr. Dowling expects the process to be a little less cumbersome now that the American Board of Family Medicine is making changes.

In late January, the ABFM announced new enhancements to its maintenance-of-certification program, including the option of extending the length of a board certificate from seven to 10 years. Dr. Dowling intends to pursue the 10-year option.

During the seven-year program, diplomates complete six self-assessment modules (SAMs) and one performance-practice module (or complete a METRIC module created by the American Academy of Family Physicians) before taking the recertification exam in the sixth or seventh year. Under the 10-year plan, diplomates would complete two SAMs and one performance-in-practice or one METRIC module in three separate three-year stages. The recertification exam would be in the 10th year.

The 10-year certificate would require nine total modules -- two more than the seven-year program -- but mean longer spells between recertification exams. The 10-year certificate will be offered starting January 2007. The cost has not been determined but is expected to be a lower annual cost than the seven-year certificate.

Jeff Susman, MD, said he would seek a 10-year certificate.

"It makes a lot of sense. I hate going through all those tests," said Dr. Susman, professor and chair of the Dept. of Family Medicine at the University of Cincinnati College of Medicine. "The overall direction is sound and appropriate."

Changes in board certification

Physicians used to be board-certified once in their careers. But after the American Board of Family Practice (now the ABFM) was founded in 1969, the board started issuing time-limited certificates and requiring recertification every seven years.

In 2000, medical specialty boards agreed to a transition from recertification to maintenance-of-certification programs, which focus on lifelong learning. Most boards view MOC as a continuous process and encourage diplomates to spread learning throughout the years instead of bunching modules at the end of the cycle. Most hospitals and health plans require board certification, and failing to get certified can mean losing managed care contracts.

In 2004, family physicians voiced frustrations to AAFP leaders about the MOC process of the ABFM and wanted SAMs suspended until technical and content problems were resolved. Through reviews of its program and physician feedback, the ABFM has made more than two dozen major changes to the process.

Last year, those changes included allowing physicians to download and print questions for work off the computer; providing critiques for all knowledge assessment items; and enabling doctors to preview a number of items before committing to a particular SAM.

"The overwhelming majority of people have embraced these enhancements. There's a much better understanding of what we're doing and why we're doing it," said James Puffer, MD, ABFM president and CEO.

The board has added new support features for physicians such as a customized online portfolio to track certification progress and experts available for one-on-one consultation. It also plans to add a patient safety module and methods-in-medicine modules for diplomates.

Indianapolis family physician Richard Feldman, MD, an outspoken critic of the MOC process, said the 10-year certificate is a positive step for family physicians. He said the process still needs refining, but he is glad the board has made changes.

"They have made significant improvements to help get doctors through the process," he said. "It's still not an easy process, but maybe it's not meant to be."