Together we can end the monopoly and create choice in board re-certification. Thank you for your support!
Given diversity in learning styles among individuals, the American Society of Cataract and Refractive Surgery supports and encourages educational options and physician choice for those seeking to maintain medical board certification and continue a mindset of lifelong learning.
The ASCRS leadership believes that there are different ways to learn. Some people want to attend lectures, others want to take online courses, and some want to do Quarterly Questions. The one thing we all want is options.
Dozens of surveys, studies, and opinion articles have been published with conflicting information on the benefits—or lack of benefits—of lifelong-learning programs among various medical specialties.
There are conflicting ideas as to whether the maintenance of certification programs implemented by societies are any better than CME education. There are no conclusive studies. This is why ASCRS supports options in lifelong learning programs.
In the past few years several legal challenges have elevated discussion of the pros and cons associated with Maintenance of Certification, which is put forth by member societies of the American Board of Medical Specialties (ABMS). After hearing concerns from ASCRS members, the ASCRS Membership Committee and Executive Committee began looking into the board recertification process.
“One of the major frustrations we were hearing was that ongoing MOC was expensive and burdensome, and members did not feel like it created value in a meaningful way,” John Berdahl, MD, chair, ASCRS Membership Committee, said. “ASCRS, because we take the concerns of our membership seriously, did a deep dive, looking into options in this area.”
During its research and extensive discussions on the merits of American Board of Ophthalmology’s MOC requirements, ASCRS recognized the strides ABO has made toward MOC reform. It also evaluated other avenues for the maintenance of lifelong learning. The National Board of Physicians and Surgeons (NBPAS), for example, was formed in 2015 and bases its recertification on obtaining sufficient continuing medical education credits, after initial board certification. According to Dr. Berdahl, the committees found NBPAS’ approach streamlined, cost-effective, and based on CME.
As a result of our research and discussions, ASCRS believes that ABO has made really meaningful strides over the last couple of years at MOC reform, but we also believe that competition is good and alternative recertification options, like that provided by NBPAS, should exist.
With ABO’s MOC recertification program and NBPAS recertification, ASCRS believes there are two reasonable ways for ophthalmologists to maintain their certification in the manner that best suits their learning style and practice needs.
ASCRS is not alone in encouraging availability of options and competition in board recertification. In 2018, a Maryland House delegate requested an opinion on specialty board certification. The response letter from the Maryland Department of Justice, Antitrust Division, stated that when an organization has a monopoly on the certification of physicians it “functions as a de facto requirement for practice by physicians in certain specialized fields.” Under these circumstances, the letter continued, certifying bodies may “adopt certification requirements more stringent than those necessary to verify that providers have the knowledge and skills required of specialty practice and the ability to deliver quality care.” These requirements, if unnecessary, however, could “raise the cost of specialty practice and constrain the supply of specialized practitioners, thereby harming competition and increasing the cost of healthcare services to consumers.”
In this letter, the state’s DOJ encouraged Maryland legislators to “consider ways to facilitate competition by legitimate certifying bodies, consistent with patient health and safety.” It also encouraged the state legislature to “continue allowing hospitals and insurers independently to decide whether to consider a physician’s MOC status when making business decisions, such as granting hospital privileges.”
Yes, in January 2019, ABO officially revised its MOC requirements. Physicians are now asked to answer a series of online Quarterly Questions, a departure from the previous in-person Demonstration of Ophthalmic Cognitive Knowledge (DOCK) exam taken every 10 years. Diplomates choose five peer-reviewed journal articles from an ABO-curated list and then answer questions related to these articles. The completion of Quarterly Questions can earn 8 CME/self-assessment credits and does not cost ABO diplomates an additional fee outside the $200 annual certification maintenance fees. According to the ABO’s program specs for the Quarterly Questions, diplomates with ABO certification that expires on Dec. 31, 2020, “need to meet the annual passing standards for Quarterly Questions 3 times” before their certificate expires. Those with ABO certificates expiring on Dec. 31, 2021, need to meet this annual passing standard five times before this date. ABO diplomates who are not required to seek recertification because they received their certification before 1992 can still participate in ABO’s Quarterly Questions program for $200 annually.
NBPAS requires initial certification through an ABMS member board, a valid, unrestricted state medical license, and completion of at least of 50 CME hours within a 24-month period, among other stipulations. Initial NBPAS certification costs $169; recertification is $145. Members of the U.S. military and fellows/physicians-in training can receive discounted certification.
NBPAS sees several benefits associated with certification through CME completion. CME can provide education in both established knowledge and also future directions that keep the physician on the ‘cutting edge.’ CME offerings are highly competitive and provide choice. There are numerous organizations offering high value CME activities. If physicians do not perceive value in a particular CME offering, they will go elsewhere. Additionally, most states require CME activities to maintain licensure. Therefore, using CME to fulfill life-long learning requirements provides efficiency and minimizes redundant activities.
In an effort to address questions around the various options, ASCRS has prepared this online toolkit, where members can find additional information as well as form letters for those looking to initiate the acceptance process with their hospital system.
NBPAS is committed to providing certification that ensures physician compliance with national standards and promotes lifelong learning. To learn more about NBPAS, visit nbpas.org.
If you are grandfathered in a specialty, your certification has not, by definition, expired and you only need to submit at least 50 hours (not 100 hours) of CMEs completed in the past 24 months.
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