Is Maintenance of Certification Our Next Tuskegee? | Dr Wes

Dr Wes—a cardiac electrophysiologist and clinical teacher at the University of Chicago—takes the American Board of Internal Medicine to task over their newly mandated Maintenance of Certification (MOC) process. He argues that this new process violates the ethical standards promulgated in the 1979 Belmont Report.

This is a long, well-written critique of the ABIM’s MOC and well worth the time to read it. A few thoughts:

  • I find the comparison of the MOC to the Tuskegee Syphilis Study wholly inappropriate. Internal medicine physicians today are a far cry from poor African American sharecroppers from the rural South in the 1930s. Drawing corollaries between the two is disingenuous. Those in the Tuskegee Study were never told they had a disease, thus they had no recourse and many died due to a treatable disease. Physicians have been told about the MOC process and can formally address their complaints through the ABIM or, as Dr Wes is doing, seek redress through public discussion and pressure on the ABIM. I think it is suitable to frame the discussion within the principles outlined in the Belmont Report, but grossly inappropriate to make a comparison to the Tuskegee Syphilis Study.
  • The unproven nature of the MOC process could be translated to virtually all board exams. Little to no evidence exists demonstrating the value of USMLE Step Exams and speciality board exams. We need to critically evaluate how we demonstrate competency in medicine.
  • The costs for all of these unproven exams and certifications is staggering. The ABIM MOC program fee is $1,940 plus an additional $775 exam fee. For a subspecialist, the MOC fee is $2,560. Why do subspecialists have to pay $500 more?!? Seems like brazen profiteering off their colleagues.