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Is Benefit of Internal Medicine MOC Worth the Time Cost, Fees?

STANFORD, CA – Meeting requirements to maintain medical board certification is both time-consuming and expensive. In light of that, according to a new study, higher quality evidence is needed to prove that the process actually improves clinical outcomes for patients.

The cost of implementing the most recent requirements for more than 250,000 physicians nationwide will be $5.7 billion over the next decade, according to the report published online by the Annals of Internal Medicine.

The study by Stanford University and University of California San Francisco researchers found that the value of the time physicians spend fulfilling requirements accounts for most of the costs associated with the latest maintenance-of-certification (MOC) requirements implemented for medical specialties by the American Board of Internal Medicine (ABIM). Fees payable to ABIM make up the rest.

“Cumulatively, 2015 MOC will cost $5.7 billion over 10 years, $1.2 billion more than 2013 MOC,” the authors write. “This includes $5.1 billion in time costs (resulting from 32.7 million physician-hours spent on MOC) and $561 million in testing costs.”

"This is a first attempt to gauge the costs of implementing the revised recertification programs, so that researchers can begin to better evaluate costs and benefits of this large investment in physician education in comparison with alternative strategies for improving healthcare quality," explained senior author Dhruv Kazi, MD, MSc, of UCSF. "Ultimately, we want to know whether these requirements offer a good return on investment for society."

Using a mathematical simulation model of the entire ABIM-certified workforce of internists, hospitalists and internal medicine subspecialists in the United States and estimated total societal costs over 10 years – including ABIM fees and the monetary value of physician time spent on fulfilling MOC requirements, researchers calculated that costs to individual physicians would average $23,607 over 10 years, with costs in some subspecialties exceeding $40,000.

Costs are higher for subspecialists than general internists because they must spend more time and money taking additional certification examinations.

"We estimate that ABIM MOC will cost 33.7 million physician-hours over 10 years,” said lead author Alexander Sandhu, MD, of Stanford and Veterans Affairs Health Services Research. “Efforts to reform MOC and lower its costs should focus on making the most efficient use of physician time."

Co-author R. Adams Dudley, MD, MBA, of USCF, added, "However, we found no high-quality studies examining the effect of the increased requirements on clinical or economic outcomes, so we were unable to model potential benefits."

Within the last few years, the ABIM, which was created early in the last century to develop uniform standards, changed its once-every-10-years MOC program to a more continuous one, gradually increasing the amount of testing required. In 2014, requirements and fees again were increased but, after mounting criticism from physicians and specialty societies, the ABIM temporarily suspended some of the new requirements in February 2015 while retaining the increased fees and number of modules. The latest requirements were evaluated in the new study.