Future Thoughts: Transforming Healthcare One Idea at a Time

Maintenance of Certification (MOC)

In recent years several professional medical organizations have begun developing a complex process for ongoing credentialing; it is generally referred to as Maintenance of Certification or MOC. According to the anonymous authors of Wikipedia, the process is undergoing extensive debate although most physicians I hear talking about is seem to assume it is a “done deal” and are working on implementation.  I can understand physician concerns about MOC as it seems to be a pretty onerous process that includes documentation of continuing education, didactic testing and submission of a practice improvement project.  Clearly the transformational idea is that we need something more than continuing education and practice hours to demonstrate not only continued profession-specific skills but also acquisition of evolving competencies such as population health, quality improvement, or best use of inter-professional teams as examples.  The idea that we need something more than we have to document continued competency is great but is the MOC process the solution?  The MOC process clearly requires lots of time and, therefore, money.  And, of course, what is the impact of this trend on other health professions practice regarding continuing competency?  The MOC process may well be the direction we all go based, for example, on a recent publication, “Opportunities for Integrating MOC Part IV Requirements into PBRN Practice” (AHRQ Pub No. 15-0055-EF, June 2015). In this monograph the authors clearly assume that the MOC process will soon apply to nurse practitioners and physician assistants as well as physicians.  Do we want to do this?  And if we don’t use this model in the future, will that failure somehow be used against other health professional as an additional barrier to practice?

It makes a lot of sense to question the assumption that our current practice, i.e. continuing education and maintaining an active practice, is sufficient to verify competency; but is the MOC process any more valid, reliable and feasible?  I suggest all health professionals begin putting some serious thought and scholarship into studying methods for measuring and verifying on-going competency, as I suspect the days of mandated continuing education and an active practice being sufficient are short. And if we don’t have a good plan and the data to support it, I would bet that we will be pushed into the physician model of MOC.  And that will cost us!


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