Maintenance of Certification -- A Hot Topic in Medicine Most Patients Don't Know About But Should

Would you be willing to visit a physician who is not "board certified"? That may be a question you'll have to ask yourself if a small but vocal group of doctors get their way.

At present, there are 880,000 practicing physicians in the United States. More than 800,000 of them are certified by one or more of the member boards of the American Board of Medical Specialties. The first boards, among them Obstetrics and Gynecology and Dermatology, were founded in 1933; the last, Genetics and Genomics, in 1991. Because of the sheer number of doctors practicing in the fields, the more popular boards include Internal Medicine and Pediatrics. While a doctor does not need board certification to practice, many hospitals, insurance companies, and professional organizations require it.

Usually, a doctor receives his certification after he has earned a medical degree and obtained a license. Currently, certification lasts for ten years. At that time, the doctor must pass another board examination to retain certification. This process is called maintenance of certification (MOC). It is designed to ensure that a doctor stays up-to-date with the latest developments in his field. Most patients consider this to be essential. However, some doctors complain MOC is expensive and time-consuming. They want to end the requirement -- the sooner the better.

The most famous doctor to revolt against MOC is Rand Paul, the U.S. senator and Republican presidential candidate who is a practicing ophthalmologist. Originally certified by the American Board of Ophthalmology, Paul balked at recertification after ten years, and in 1997 founded his own certification board, the National Ophthalmology Board. Naturally, his board certified him, and he continued to claim he was "board certified," even after he allowed his ABO certification to lapse.

Here is the problem with up-start boards, Paul's specifically. "Overall," one publication reported, "only 50 to 60 doctors were certified by Paul's board, and their certifications were never accepted by the medical establishment, as his board's operations came under scrutiny.... For one, his board officers were his wife and her father, not ophthalmologists. In addition, the board's website was mostly a mission statement, riddled with grammatical errors." To make matters worse, over time the board shut down, reopened, then went out of business for good.

As this drama was playing out, doctors much less famous than Paul took up the cause. One was an orthopedic surgeon from Santa Barbara, California, named Daniel Craviotto who, in April 2014, published in The Wall Street Journal an op-ed entitled "A Doctor's Declaration of Independence." Among his complaints -- besides time-wasting electronic recordkeeping and shrinking Medicare reimbursements -- was maintenance of certification. Craviotto argued MOC was "expensive, imposing, and a convenient method for our specialty societies and boards to make money."

He teamed up with, among others, Michael Strickland, an internist from Cincinnati, Ohio, and Judith Thompson, a general surgeon from New Braunfels, Texas, to form United Physicians and Surgeons of America. In turn, that organization sponsored, from June 20-26, a conference entitled "Let My Doctor Practice: Summit at the Summit," held in Keystone, Colorado, whose mission was "to return the practice of medicine to those who actually practice medicine."

A look at the YouTube channel for Let My Doctor Practice is revealing. In addition to a series of amateurish original "comedy" videos depicting the travails of a young practicing physician, the channel features a video of Michael Strickland burning his medical license as if he were burning a draft card. "I invite you to do the same," Strickland says in the video, addressing his fellow physicians. "We need change. We need some relief now."

As for the Let My Doctor Practice conference, organizers devoted one full day to MOC. Judith Thompson summed up the collective thinking when she said: "If a person has already met certain criteria and proved competency in their field of specialty, then why should they have to double back, pay fees, jump through hoops to meet someone else's definition of what may have nothing to do with what we are doing?"

One of the guest speakers, Paul Teirstein, of Scripps Clinic, agreed. Like Rand Paul before him, he too has started his own certification board. His is entitled the National Board of Physicians and Surgeons. "I am no longer a supporter of our recertification exam," he said. "I don't believe we need exams. I don't think it's a good way to learn."

The average patient visiting a doctor today would have no idea a debate is raging about something seemingly routine -- maintenance of certification -- that could engender such strong emotions among doctors. How this conflict is resolved will help determine both the way doctors remain current in their field -- something patients expect them to do -- and the way that fact is conveyed to the public.