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Evaluating the Perception Among Rheumatologists of Maintenance of Board Certification in the US.

ABSTRACT: OBJECTIVE:There continues to be a debate about the value and purpose of maintenance of certification (MOC) programs in the US. The goal of this study is to assess the impact, value, and purpose of MOC programs in rheumatology. METHODS:A survey was sent to 3,107 rheumatologists in the US. The survey addressed how rheumatologists perceive the value and impact of MOC programs on rheumatology practice and patient care. RESULTS:A total of 515 rheumatologists completed this survey. The majority (74.8%) believed there was no significant value in MOC, beyond what is already achieved from continuing medical education. Most rheumatologists did not believe MOC was valuable in improving patient care (63.5%), and the majority felt that the primary reason for creating MOC was either the financial well-being of board-certifying organizations (43.4%) or to satisfy administrative requirements in health systems (30%). Although 65.6% perceived that staying current with new medical knowledge was a positive impact of MOC programs, the MOC was perceived to result in time away from providing patient care (74.6%) and time away from family (74%). When asked about potential effects of requiring MOC, 77.7% reported physician burnout, 67.4% early physician retirement, and 63.9% anticipated an effect on reducing the overall number of practicing rheumatologists. CONCLUSION:The majority of rheumatologists do not believe there is significant value for MOC programs. There is evidence for lack of trust in board-certifying organizations, and rheumatologists believe MOC programs contribute to physician burnout, early retirement, and loss in the rheumatology workforce.

SUBMITTER: Sawalha AH

PROVIDER: S-EPMC6692078 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Evaluating the Perception Among Rheumatologists of Maintenance of Board Certification in the US.

Sawalha Amr H AH Coit Patrick P

Arthritis care & research 20190301 3

<h4>Objective</h4>There continues to be a debate about the value and purpose of maintenance of certification (MOC) programs in the US. The goal of this study is to assess the impact, value, and purpose of MOC programs in rheumatology.<h4>Methods</h4>A survey was sent to 3,107 rheumatologists in the US. The survey addressed how rheumatologists perceive the value and impact of MOC programs on rheumatology practice and patient care.<h4>Results</h4>A total of 515 rheumatologists completed this surve ...[more]

PMID: 30570838

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Project description:BackgroundThe board certification system serves as a quality assurance system for physicians, and its design and operation are important health policy issues. In Japan, board certification was established and operated independently by academic societies and has not been directly linked to reimbursement systems. The phenomenon of younger physicians seeking specialist careers has raised concerns about acceleration of the tendency of fewer physicians working in rural areas and the maldistribution of physicians. Little is known about the associations between physicians' geographical migration patterns and board certification status changes or between the continuation of urban/rural practice and the maintenance of board certification. This study aimed to identify these associations and to discuss their policy implications.MethodsWe analyzed 2012 and 2014 data from the Survey of Physicians, Dentists, and Pharmacists, a national census survey. To analyze geographical migration patterns, transitions in practice location (rural, intermediate, and urban) were analyzed by board certification status change (new, lost, consistently certified, and consistently uncertified). Logistic regression analysis was conducted to assess whether the odds of migrating to more urban/rural municipalities were associated with board certification status changes, adjusting for covariates, and whether practicing in a rural area was associated with maintaining board certification.ResultsAmong 18,726 newly board-certified physicians, 94.9% (13,435/14,150) of those working in urban areas before certification remained in urban areas, whereas 64.6% (393/608) of those working in rural areas stayed in rural areas. Those who were newly certified had higher odds of moving to more urban areas, adjusting for covariates. Those who stayed in rural areas showed lower odds of maintaining board certification, adjusting for covariates.ConclusionsNewly board-certified physicians are more likely to migrate to other types of areas, particularly more urban areas, than other physicians. Allocating more training quotas to rural areas could be one option for leveling the distribution of specialists. It also appeared that those practicing in rural areas have difficulty maintaining their certification, so the need to establish a support system for already-certified physicians in rural areas should be emphasized.

Project description:ImportanceSuccess on the internal medicine (IM) examination is a central requirement of the American Board of Internal Medicine's (ABIM's) Maintenance of Certification program (MOC). Therefore, it is important to understand the degree to which this examination reflects conditions seen in practice, one dimension of content validity, which focuses on the match between content in the discipline and the topics on the examination questions.ObjectiveTo assess whether the frequency of questions on IM-MOC examinations were concordant with the frequency of conditions seen in practice.Design, setting, and participantsThe 2010-2013 IM-MOC examinations were used to calculate the percentage of questions for 186 medical condition categories from the examination blueprint, which balances examination content by considering importance and frequency of conditions seen in practice. Nationally representative estimates of conditions seen in practice by general internists were estimated from the primary diagnosis for 13 832 office visits (2010-2013 National Ambulatory Medical Care Surveys) and 108 472 hospital stays (2010 National Hospital Discharge Survey).ExposuresPrevalence of conditions included on the IM-MOC examination questions.Main outcomes and measuresThe outcome measure was the concordance between the percentages of IM-MOC examination questions and the percentages of conditions seen in practice during either office visits or hospital stays for each of 186 condition categories (eg, diabetes mellitus, ischemic heart disease, liver disease). The concordance thresholds were 0.5 SD of the weighted mean percentages of the applicable 186 conditions seen in practice (0.74% for office visits; 0.51% for hospital stays). If the absolute differences between the percentages of examination questions and the percentages of office visit conditions or hospital stay conditions seen were less than the applicable concordance threshold, then the condition category was judged to be concordant.ResultsDuring the 2010-2013 IM-MOC examination periods, 3600 questions (180 questions per examination form) were administered and 3461 questions (96.1%) were mapped into the 186 study conditions (mean, 18.6 questions per condition). Comparison of the percentages of 186 categories of medical conditions seen in 13 832 office visits and 108 472 hospital stays with the percentages of 3461 questions on IM-MOC examinations revealed that 2389 examination questions (69.0%; 95% CI, 67.5%-70.6% involving 158 conditions) were categorized as concordant. For concordance between questions and office visits only, 2010 questions (58.08%; 95% CI, 56.43%-59.72% of all examination questions) involving 145 conditions were categorized as concordant. For concordance between questions and hospital stays only, 1456 questions (42.07%; 95% CI, 40.42%-43.71% of all examination questions) involving 122 conditions were categorized as concordant.Conclusions and relevanceAmong questions on IM-MOC examinations from 2010-2013, 69% were concordant with conditions seen in general internal medicine practices, although some areas of discordance were identified.

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Evaluating the Perception Among Rheumatologists of Maintenance of Board Certification in the US.

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Evaluating the Perception Among Rheumatologists of Maintenance of Board Certification in the US.

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