Source: American Association of Medical Society Executives
Ohio Academy of Family Physicians staff attended the recent American Association of Medical Society Executives meeting in San Diego. During that conference, staff attended the breakout session “Continuing Board Certification: Vision for the Future Commission” created by the American Board of Medical Specialties (ABMS) to inform future decisions about board certification. Recently, an online survey elicited feedback from three key stakeholder groups: physicians, non-physician providers and other stakeholders involved in the delivery of health care, and the general public to inform the work of the commission.
In total, 36,392 people participated in the survey, including 34,616 physicians, 1,373 non-physician providers and stakeholders involved in the delivery of health care, and 403 members of the general public. The physician survey included responses from all 24 ABMS Member Boards and all 50 states. The survey findings are summarized below:
When asked if they value maintenance of certification (MOC), one in 10 physicians (12%) said they value the program, nearly half (46%) said they have mixed feelings about it, while 41% said they do not value the program.
The survey asked physicians about their concerns regarding the MOC program. Participants were allowed to choose up to four options from a set list. The most frequently cited response was “costs” (58%). “Burdensome” was next highest (52%), followed by “does not accurately measure my ability as a clinician” (48%). “Does not help me improve my practice in a meaningful way” (43%) was the fourth most popular response.
Physicians were also asked to select which activities from a set list should be considered by the Vision Initiative Commission for continuing certification. The most popular responses were “continuing medical education” (84%) and “self-assessment questions delivered at regular intervals” (52%). Less popular choices were “open-book exam” (34%) and “assessment of the quality and safety of care provided” (24%), among the other choices.
Of the physician respondents, 96% are Board Certified. Additionally, 69% of respondents noted they are currently enrolled in a primary specialty MOC program, and 33% are currently enrolled in a subspecialty MOC program. Sixteen percent are lifetime certification holders. These categories are not mutually exclusive. Finally, 6% are not enrolled in an MOC program or are a lifetime certificate holder.
In summary, approximately half of physician respondents see MOC as too costly, burdensome, and not a true reflection of their abilities as clinicians. Some physicians want continuing certification to focus on practice-relevant continuing medical education (CME) opportunities, self-assessment, open-book exams, and quality of care assessments.
Other Healthcare Stakeholders Findings
When asked how familiar they are with the requirements that physicians must fulfill to maintain their Board Certification, 39% of stakeholders said they were “very familiar,” 46% said they were “somewhat familiar,” 9% said “somewhat unfamiliar,” and 5% said they were “not at all familiar” with the requirements.
When asked if they consider Board Certification when selecting a physician, more than half of the stakeholder respondents (57%) said they always consider it, more than a quarter (27%) said they sometimes consider it, and 15% said they never consider it. Next, when asked if Board Certified physicians provide higher-quality care than non-Board Certified physicians, nearly six in 10 respondents (59%) believe they do; one in five (22%) didn’t know. One in five (19%) said Board Certified physicians don’t provide higher-quality care.
When asked if they consider Board Certification when selecting a physician, more than half of the general public respondents (56%) said they always consider it, more than a quarter (28%) said they sometimes consider it, and 16% said they never consider it. Next, when asked if Board Certified physicians provide higher-quality care than non-Board Certified physicians, more than eight in 10 respondents (84%) believe they do; the remaining 16% said Board Certified physicians don’t provide higher-quality care.
General public respondents were also asked about the activities physicians should be required to do to stay up to date and maintain clinical skills and expertise. The participants were given a set list and asked to select all the options that may apply. More than half of general public respondents selected the following options: “participate in a minimum number of continuing medical education (CME) hours each year” (85%), “periodic exercises to measure, and if necessary, improve quality of care” (74%), “periodically assess performance to compare with other doctors in the specialty” (64%), “have communication and clinical skills rated via patient surveys” (59%), “have performance rated via colleague surveys” (56%), and “take exam at regular intervals assessing clinical knowledge” (56%). The only activity not selected by more than half of the respondents was “self-assessment activities to determine how well he or she is doing” (48%). Two percent said, “none of the above.”
While these data must be interpreted with caution, the results provide important insights for the Vision Initiative Commission. The Commission will consider these results as part of their overall continuing certification testimony.
While a small percentage of physicians value MOC, a larger portion has either mixed views or do not value MOC. They currently see MOC as too costly and burdensome, not an accurate depiction of their abilities or relevant to their practice, and duplicative. However, physicians see some value in MOC for its CME opportunities and tracking, focus on lifelong learning, keeping physicians up to date, and self-assessment programs. Respondents want continuing certification to include a focus on relevant CME opportunities, self-assessment delivered at regular intervals, open book testing, and an assessment of the quality and safety of the care provided.
Other Health Care Providers and Consumers
Board Certification is a recognized credential and plays an important role in selecting a physician. In fact, both groups strongly indicated that Board Certification is important when selecting a physician and they believe Board Certified physicians provide a higher quality of care.
About the Vision Initiative Commission
As a collaborative process, the Commission brings together multiple partners to vision a system of continuing Board Certification that is meaningful, relevant and of value, while remaining responsive to the patients, hospitals, and others who expect that physicians are maintaining their knowledge and skills to provide quality specialty care.
The Commission framework began with a comprehensive assessment of the current continuing Board Certification system. The Commission holds hearings, provides information publicly, and tests and seeks feedback on concepts and ideas during the process. The Commission’s final recommendations will be submitted to ABMS and its Member Boards for consideration and implementation in February 2019.