About 20 years ago I heard a similar but less sinister cadence as hospital medical staffs one by one amended their bylaws to require board certification. This mandate was theoretically in response to "public demand" - presumably patient demand. Back then some physicians pointed out that there was no evidence to prove that performance on a written standardized exam equated to high-quality patient care. Established physicians already on the medical staff were "grandfathered" so there was little resistance to the amendments to "protect our patients" and "ensure quality care."
 

Many physicians in the past have supported board certification as an indication of expertise within a specialty, but as the 24 member boards of the American Board of Medical Specialties (ABMS) have over time greatly expanded their requirements for recertification physicians are complaining that the process, now known as Maintenance of Certification (MOC), has become intrusive, difficult to comply with and financially burdensome. Physicians particularly object to the requirement for a secure standardized written examination. Although, there continues to be no compelling evidence that ABMS Certified physicians who enroll in MOC provide better patient care, this expanded certification is said to ensure quality - all of this again, in response to that "public demand." Personally, I have not heard the public outcry. In my experience many patients remain confused about board certification, and I have never had a patient ask if I participate in MOC or have recertified.
 

Now we learn that the Federation of State Medical Licensure Boards is encouraging state medical licensing boards to mandate "Maintenance of Certification" as a condition of "Maintenance of Licensure" (MOL). The self-regulated ABMS strongly supports this requirement. Of course, this is the same group that profits from the standardized tests and required reporting that are the basis of MOC.
 

The concern many physicians have expressed is whether the MOC process and the reliance upon a standardized written examination truly measures the quality of physician-provided patient care. It seems hypocritical that the ABMS which certifies the credentials of physicians remains unable or unwilling to scientifically validate the MOC process, much less written examinations, which they recommend mandating for physicians. Cynics suggest that the ABMS is motivated by the greatly expanded revenues generated by the MOC requirements.
 

The Kentucky Board of Medical Licensure (KBML) already requires that physicians participate in CME to maintain their license. I don't necessarily agree with some of the specific CME courses required by random legislative actions over the last number of years, but I believe it is our professional responsibility to keep our knowledge base current and strive for continuous improvement in the quality of care we provide our patients. Hearing the drum beat, the KBML is considering adding MOC to our licensure requirements. Given the physician shortage in Kentucky, which has led to expansion of the scope of non-physician providers, perhaps one should ask, "If a board certified internal medicine physician elects not to take an MOC examination can they still work as a nurse practitioner?"
 

Sensing the drums getting louder in Kentucky, a number of GLMS members expressed concern to GLMS. Our Policy & Advocacy Committee responded by initiating a resolution, which was carried by your elected GLMS delegates to the recent Kentucky Medical Association Annual Meeting and was ultimately passed by the KMA House of Delegates. The resolution calls upon the KMA to join the American Medical Association in advocating for an impact study that addresses the effect of maintenance of certification and maintenance of licensure requirements on physician workforce, cost to physicians, access to care, and most importantly quality improvement in patient care. In addition, it asks the KMA to urge the Kentucky Board of Medical Licensure to reject any action that would implement any requirement of maintenance of certification or the Federation of State Medical Boards maintenance of licensure program as a condition of licensure until results of an impact study are known.
 

While we await the results of the impact study, the KMA will work with the AMA and other organizations to make hospitals, employers, and payers aware of the potentially onerous impact on Kentucky's physician workforce that may result from mandating maintenance of certification as a condition of employment or of inclusion in health plans' provider panels.
 

Furthermore the KMA will study potential legislation which prohibits the state from requiring any form of the Federation of State Medical Boards' proprietary Maintenance of Licensure program, including any Maintenance of Licensure program tied to Maintenance of Certification, as a condition of medical licensure, and additionally prohibits the state from requiring specialty medical board certification and MOC.
 

Meanwhile, the GLMS and the KMA will continue to encourage physicians to strive to constantly improve their care of patients by the means they find most effective, within the standards of accepted and prevailing medical practices.
 

Just because someone is beating a drum doesn't mean everyone should automatically fall in line, sometimes it is appropriate to listen to a different drummer.
 

 

Bruce A. Scott, MD

GLMS President

502.589.2001