After much of the medical community erupted in fury against new maintenance of certification (MOC) requirements set by the American Board of Internal Medicine (ABIM), the organization backed off earlier this year. But not before a rival group announced plans to offer an alternative MOC system.
That group, the National Board of Physicians and Surgeons (NBPAS), was established in January. Its president, , chief of cardiology at the Scripps Clinic in San Diego, spoke with 鶹ý about its recent progress.
"We are not against the ABMS [American Board of Medical 鶹ý]," Tierstein said. "We just provide an alternative that we think is more meaningful, and certainly a lot less expensive, and does not waste our time compared to the ABMS's certification process."
Why should physicians consider an alternative that was established only a few months ago and does not require quality improvement projects or an exam? 鶹ý talked to Teirstein to get specifics regarding the NBPAS's finances, recognition by hospitals, and response to feedback from physicians.
鶹ý: One of the biggest points of criticism directed towards ABIM is that there is no financial transparency. Tell me about the financial particulars of NBPAS.
Teirstein: The only people who have been paid from NBPAS are lawyers, IT consultants and the staff who are paid hourly to verify data provided by applicants. No board members, nor I have received any payment.
We have just over 1,000 applicants so, if you do the math we have about $150,000 in revenue to date. This has been enough to sustain our activity. We are a 501(c)(3) not-for-profit. All our data will be available on our tax returns just like all other not-for-profits.
MPT: Will hospitals accept certification from NBPAS? Do any currently?
Teirstein: We are presenting to committees now throughout the country. It's probably a 4-month process.
We have not gotten approvals yet. We've gotten a lot of support. It has to go to committee after committee, and the hospital lawyers are getting involved. It takes some time. I expect the hospitals to approve it.
MPT: MOC used to be one way to fulfill the Affordable Care Act quality reporting requirement. Will it be more difficult for physicians to get involved in quality improvement projects without MOC?
Teirstein: First of all, quality improvement projects are by the Affordable Care Act.
Secondly, most hospitals have all kinds of quality improvement projects. The most important thing is not that you're doing a quality improvement project. What's important is that you're doing something meaningful to improve yourself.
The quality improvement projects that were required by the ABIM have all been suspended because they were so bad and were admittedly unhelpful.
MPT: Some argue that MOC is a good way to maintain quality. NBPAS has significantly fewer requirements for certification. How would you respond to critics who would say that MOC raises standards for doctors?
Teirstein: They are completely wrong. All evidence is to the contrary.
See video of my debate on [This is Teirstein's presentation at the Association of Professors on Medicine winter meeting in Laguna, Calif., on February 26, 2015, as part of a debate on MOC among Teirstein; , president and CEO of the ABMS; and , president and CEO of the American Board of Internal Medicine (ABIM).]
MPT: You don't have any plans to have an exam. Why not?
Teirstein: One of our biggest problems with the exams is that it's very hard to test people without practice that are specialized in different areas. Exams very often don't have meaning to the person taking it.
You're studying things you don't know, which sounds good, but if you don't know them, it's for good reason. You're not using them. You don't need to know them.
I use the example of the anestheiologist who takes care of adults who has to learn about pediatric anesthesiology for the test. The general surgeon who takes out gallbladders all day long has to learn trauma surgery. The cardiologist who sees patients in the office has to learn about how to read [echocardiograms]. That may not be what he does.
We do what we need to do. We learn what we need to learn. These tests tend to ask us questions in areas that are outside our practice activties. They also tend to have black and white answers, and practicing is much more gray.
MPT: ABIM has continuing medical education (CME) products. Will you?
Teirstein: Perhaps.
MPT: How responsive are you to feedback from medical societies and individual physicians?
Teirstein: Very. I get comments and emails all the time, and in response to that we've made some changes. For example, we started out just in internal medicine. Now we've expanded to all the boards because of the demand that we receive on our website.
[Societies] still haven't figured out a position on this in general. They're still working on it ... They're not against it or for it. They just don't know.
ABIM Responds to Newsweek Article
ABIM -- an ABMS member -- does not have a monopoly on certifying internists, declared board chair , in a to a critical piece in last month that investigated the group's finances.
Critics of maintenance of certification (MOC) have the American Board of Internal Medicine's (ABIM) for the .
Newsweek's Kurt Eichenwald looked at the Form 990s that the ABIM and the (a not-for-profit foundation established by the ABIM in 1999) filed with the Internal Revenue Service in 2013.
The ABIM earned $55 million total in 2013, compared with $16 million in 2001, Eichenwald wrote. Pay for top officers quadrupled in the last 12 years, with the highest paid officer making more than $800,000 per year.
Meanwhile, the ABIM Foundation earned $20 million the $74 million in assets it held. The foundation spent $1.9 million in "program and project expenses" without further explanation, Eichenwald wrote.
The ABIM was quick to Eichenwald's article. The piece contained "numerous and serious misstatements, selective omissions, inaccurate information and erroneous reporting," Johnson wrote.
The assertion that ABIM has a monopoly on certifying internists was also untrue, he said.
Internists "have a choice among certifying boards that certify physicians in internal medicine and its subspecialties," he added.
Here are some previous installments of MOC Watch: