On July 15, we had the opportunity to participate in a Summit convened by the American Board of Internal Medicine (ABIM) and attended by ABIM leaders and 26 societies representing both primary internal medicine and medicine subspecialties. The Summit was scheduled in response to the dissatisfaction with the ABIM Maintenance of Certification (MOC) program expressed by the greater internal medicine community. Stakeholders were provided the opportunity to share feedback from their constituents and discuss the MOC program. We presented the somewhat unique concerns of hospice and palliative medicine specialists:

  • Hospice and palliative medicine has 10 co-sponsoring boards with varying expectations for MOC making the creation and approval of MOC activities that are relevant to HPM practitioners a challenge.
  • At present, there is a lack of reciprocity between Boards for MOC activities.
  • There is additional strain created on our already limited workforce by the requirement to maintain primary board certification. This is particularly onerous for those who practice HPM full time, as the vast material tested on the primary exam may be irrelevant to their practice.

A brief word of context: Since Hospice and Palliative Medicine received formal recognition as a medical subspecialty by the American Board of Medical Specialties (ABMS) in 2006 and the American Osteopathic Association (AOA) in 2007, AAHPM has been meeting with and advocating for the needs of the Hospice and Palliative Medicine (HPM) community related to certification, maintenance of certification (MOC) osteopathic continuous certification (OCC), and fellowship programs.

The American Board of Internal Medicine (ABIM) has been evolving its MOC program and there has been a great deal of communication between the ABIM, ABIM specialties and subspecialties, and ABIM physicians in the last few months. On July 10, ABIM announced several changes to the MOC. ABIM stated that it will:

  • Increase flexibility on deadlines. ABIM’s Board agreed to create a year “grace period” for those who have attempted but failed to pass the MOC exam.
  • Ensure transparency of information. In response to questions raised about ABIM’s governance and finances, they have added information to their website and ABIM’s 990s are publicly available on Guidestar.
  • Ensure a broader range of CME options for medical knowledge/skills self-assessment (Part 2). To reduce redundancy and give physicians credit for relevant assessment activities in which they are already engaged, ABIM will align its knowledge assessment requirements and standards with already existing standards for certain types of CME products and providers.
  • Provide more feedback regarding test scores. The ABIM agreed to provide more in-depth, actionable feedback on individual performance on all exam score reports by 2015.
  • Evolve the “Patient Survey” requirement to a “Patient Voice” requirement. This requirement focuses on a variety of structured mechanisms to hear from patients. In addition to patient surveys, educational and training programs in patient communication, participation in patient/family advisory panels, and use of shared decision-making tools, activities which many of our members may already be doing, may also meet the patient voice requirement.
  • Reduce the data collection burden for the practice assessment requirement. ABIM is re-designing the process to provide additional pathways to meet the requirement and focus more on measurement and improvement activities.

In a letter dated July 28, 2014, ABIM summarized the major issues presented at the Summit and reiterated that the purpose of the ABIM is to “issue a publicly recognized credential that indicates an individual has met professionally-determined standards in a defined discipline”. Specifically, they agreed that the secure exam “must evolve” and they announced plans to form a committee to explore how to move forward. Formal mechanisms for society input will be developed. Addressing extremely negative feedback related to Part 4 (self-evaluation of practice assessment), the ABIM promised dramatic changes over the next 12-24 months.

We are encouraged to learn of ABIM’s proposed changes to its MOC program and will continue to work closely with the ABIM to improve the MOC program. We welcome your comments and concerns . Your feedback enables us to accurately represent the concerns of our members. Please share your thoughts with us via the AAHPM blog.

Tara Friedman, MD, FAAHPM, AAHPM Board Member
Holly Yang, MD, FACP, FAAHPM, AAHPM Board Member