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Physician Attitudes About Maintenance of Certification

A Cross-Specialty National Survey



      To determine physicians' perceptions of current maintenance of certification (MOC) activities and to explore how perceptions vary across specialties, practice characteristics, and physician characteristics, including burnout.

      Patients and Methods

      We conducted an Internet and paper survey among a national cross-specialty random sample of licensed US physicians from September 23, 2015, through April 18, 2016. The questionnaire included 13 MOC items, 2 burnout items, and demographic variables.


      Of 4583 potential respondents, we received 988 responses (response rate 21.6%) closely reflecting the distribution of US physician specialties. Twenty-four percent of physicians (200 of 842) agreed that MOC activities are relevant to their patients, and 15% (122 of 824) felt they are worth the time and effort. Although 27% (223 of 834) perceived adequate support for MOC activities, only 12% (101 of 832) perceived that they are well-integrated in their daily routine and 81% (673 of 835) believed they are a burden. Nine percent (76 of 834) believed that patients care about their MOC status. Forty percent or fewer agreed that various MOC activities contribute to their professional development. Attitudes varied statistically significantly (P<.001) across specialties, but reflected low perceived relevance and value in nearly all specialties. Thirty-eight percent of respondents met criteria for being burned out. We found no association of attitudes toward MOC with burnout, certification status, practice size, rural or urban practice location, compensation model, or time since completion of training.


      Dissatisfaction with current MOC programs is pervasive and not localized to specific sectors or specialties. Unresolved negative perceptions will impede optimal physician engagement in MOC.

      Abbreviation and Acronym:

      MOC (maintenance of certification)
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        • Baron R.J.
        • Johnson D.
        The American Board of Internal Medicine: evolving professional self-regulation.
        Ann Intern Med. 2014; 161: 221-223
        • Iglehart J.K.
        • Baron R.B.
        Ensuring physicians' competence—is maintenance of certification the answer?.
        N Engl J Med. 2012; 367 ([published correction appears in N Engl J Med. 2013;368(8):781]): 2543-2549
      1. American Board of Medical Specialties. Standards for the ABMS program for maintenance of certification (MOC): For implementation in January 2015. Accessed March 18, 2016.

        • Hawkins R.E.
        • Lipner R.S.
        • Ham H.P.
        • Wagner R.
        • Holmboe E.S.
        American Board of Medical Specialties Maintenance Of Certification: theory and evidence regarding the current framework.
        J Contin Educ Health Prof. 2013; 33: S7-S19
        • Lipner R.S.
        • Hess B.J.
        • Phillips Jr., R.L.
        Specialty board certification in the United States: issues and evidence.
        J Contin Educ Health Prof. 2013; 33: S20-S35
        • Drazen J.M.
        • Weinstein D.F.
        Considering recertification.
        N Engl J Med. 2010; 362: 946-947
        • Lipner R.S.
        • Bylsma W.H.
        • Arnold G.K.
        • Fortna G.S.
        • Tooker J.
        • Cassel C.K.
        Who is maintaining certification in internal medicine—and why? A national survey 10 years after initial certification.
        Ann Intern Med. 2006; 144: 29-36
        • Culley D.J.
        • Sun H.
        • Harman A.E.
        • Warner D.O.
        Perceived value of Board certification and the Maintenance of Certification in Anesthesiology Program (MOCA®).
        J Clin Anesth. 2013; 25: 12-19
        • Cook D.A.
        • Holmboe E.S.
        • Sorensen K.J.
        • Berger R.A.
        • Wilkinson J.M.
        Getting maintenance of certification to work: a grounded theory study of physicians' perceptions.
        JAMA Intern Med. 2015; 175: 35-42
        • Levinson W.
        • King Jr., T.E.
        • Goldman L.
        • Goroll A.H.
        • Kessler B.
        Clinical decisions: American Board of Internal Medicine maintenance of certification program.
        N Engl J Med. 2010; 362: 948-952
        • Weiss K.B.
        • Bryant Jr., L.E.
        • Morgan L.B.
        • O'Kane M.E.
        The ABIM and recertification.
        N Engl J Med. 2010; 362 (author reply 2429-2430): 2428-2429
        • Steele R.
        Maintenance of certification.
        Clin Pediatr (Phila). 2011; 50: 584-586
        • Strasburger V.C.
        Ain't misbehavin': is it possible to criticize maintenance of certification (MOC)?.
        Clin Pediatr (Phila). 2011; 50: 587-590
        • Teirstein P.S.
        Boarded to death—why maintenance of certification is bad for doctors and patients.
        N Engl J Med. 2015; 372: 106-108
        • Kritek P.A.
        • Drazen J.M.
        Clinical decisions: American Board of Internal Medicine maintenance of certification program—polling results.
        N Engl J Med. 2010; 362: e54
      2. Physicians for Certification Change. Petitions and pledge of non-compliance. Accessed March 18, 2016.

      3. Baron R. ABIM announces immediate changes to MOC program. Accessed February 25, 2015.

      4. National Board of Physicians and Surgeons website: Accessed March 18, 2016.

      5. Chadwick JS. Physician survey reveals widespread dissatisfaction with maintenance of certification (MOC). Accessed April 22, 2016.

        • Freed G.L.
        • Dunham K.M.
        • Lamarand K.E.
        • Research Advisory Committee of the American Board of Pediatrics
        Permanent pediatric diplomate awareness of and perspectives on maintenance of certification.
        J Pediatr. 2009; 155: 919-923.e921
      6. American Board of Internal Medicine. All-diplomate survey: Improving the MOC assessment experience. Accessed August 19, 2016.

        • Dyrbye L.N.
        • West C.P.
        • Satele D.
        • et al.
        Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population.
        Acad Med. 2014; 89: 443-451
        • Shanafelt T.D.
        • Hasan O.
        • Dyrbye L.N.
        • et al.
        Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014.
        Mayo Clin Proc. 2015; 90 ([published correction appears in Mayo Clin Proc. 2016;91(2):276]): 1600-1613
        • Freed G.L.
        • Dunham K.M.
        • Clark S.J.
        • Davis M.M.
        • Research Advisory Committee of the American Board of Pediatrics
        Perspectives and preferences among the general public regarding physician selection and board certification.
        J Pediatr. 2010; 156 (845.e841): 841-845
        • West C.P.
        • Dyrbye L.N.
        • Sloan J.A.
        • Shanafelt T.D.
        Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals.
        J Gen Intern Med. 2009; 24: 1318-1321
        • Miller L.E.
        • Smith K.L.
        Handling nonresponse issues.
        JOE. 1983; 21: 45-50
        • Association of American Medical Colleges
        Physician Specialty Data Book 2014.
        AAMC Center for Workforce Studies, Washington, DC2014
      7. United States Department of Agriculture Economic Research Service. 2013 Rural-Urban Continuum Codes. Accessed April 18, 2016.

      8. American Board of Medical Specialties. Fact sheet: American Board of Medical Specialties. Accessed April 14, 2016.

        • Jones J.H.
        • Smith-Coggins R.
        • Meredith J.M.
        • Korte R.C.
        • Reisdorff E.J.
        • Russ C.M.
        Lifelong learning and self-assessment is relevant to emergency physicians.
        J Emerg Med. 2013; 45: 935-941
      9. Marco CA, Wahl RP, Counselman FL, et al. The American Board of Emergency Medicine ConCert™ Examination: emergency physicians' perceptions of learning and career benefits [published online ahead of print March 28, 2016]. Acad Emerg Med.

        • Levinson W.
        • Holmboe E.
        Maintenance of certification: 20 years later.
        Am J Med. 2011; 124: 180-185
        • Holmboe E.S.
        • Wang Y.
        • Meehan T.P.
        • et al.
        Association between maintenance of certification examination scores and quality of care for medicare beneficiaries.
        Arch Intern Med. 2008; 168: 1396-1403
        • Gray B.M.
        • Vandergrift J.L.
        • Johnston M.M.
        • et al.
        Association between imposition of a Maintenance of Certification requirement and ambulatory care-sensitive hospitalizations and health care costs.
        JAMA. 2014; 312: 2348-2357
        • O'Neill T.R.
        • Puffer J.C.
        Maintenance of certification and its association with the clinical knowledge of family physicians.
        Acad Med. 2013; 88: 780-787
        • Sandhu A.T.
        • Dudley R.A.
        • Kazi D.S.
        A cost analysis of the American Board of Internal Medicine's maintenance-of-certification program.
        Ann Intern Med. 2015; 163: 401-408
        • Hayes J.
        • Jackson J.L.
        • McNutt G.M.
        • Hertz B.J.
        • Ryan J.J.
        • Pawlikowski S.A.
        Association between physician time-unlimited vs time-limited internal medicine board certification and ambulatory patient care quality.
        JAMA. 2014; 312: 2358-2363
      10. The American Board of Anesthesiology. Why is the ABA changing MOCA? Accessed March 18, 2016.

      11. American Board of Obstetrics + Gynecology. ABOG begins innovative pilot program to enhance maintenance of certification process. Accessed April 20, 2016.

        • Phillips R.
        ABFM to simplify maintenance of certification (MOC) for family physicians and make it more meaningful: a family medicine registry.
        J Am Board Fam Med. 2015; 28: 431-433
        • Hojat M.
        • Veloski J.J.
        • Gonnella J.S.
        Measurement and correlates of physicians' lifelong learning.
        Acad Med. 2009; 84: 1066-1074
        • Lee T.H.
        Certifying the good physician: a work in progress.
        JAMA. 2014; 312: 2340-2342
        • Eva K.W.
        • Regehr G.
        Self-assessment in the health professions: a reformulation and research agenda.
        Acad Med. 2005; 80: S46-S54
        • Davis D.A.
        • Mazmanian P.E.
        • Fordis M.
        • Van Harrison R.
        • Thorpe K.E.
        • Perrier L.
        Accuracy of physician self-assessment compared with observed measures of competence: a systematic review.
        JAMA. 2006; 296: 1094-1102
        • Gallagher T.H.
        • Prouty C.D.
        • Brock D.M.
        • Liao J.M.
        • Weissman A.
        • Holmboe E.S.
        Internists' attitudes about assessing and maintaining clinical competence.
        J Gen Intern Med. 2014; 29: 608-614
        • Sargeant J.
        • Bruce D.
        • Campbell C.M.
        Practicing physicians' needs for assessment and feedback as part of professional development.
        J Contin Educ Health Prof. 2013; 33: S54-S62
        • Duffy F.D.
        • Lynn L.A.
        • Didura H.
        • et al.
        Self-assessment of practice performance: development of the ABIM Practice Improvement Module (PIM).
        J Contin Educ Health Prof. 2008; 28: 38-46