1. The NBPAS alternative to MOC
Paul Teirstein, M.D.
Chief of Cardiology
Scripps Clinic
Director Scripps Prebys
Cardiovascular Institute
Scripps Health

2. Disclosure Statement of Financial Interest
Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organization(s) listed below.
Affiliation/Financial Relationship Company
President (unpaid) National Board of Physicians and Surgeons (NBPAS.org)
Course Director/speaker Numerous CME conferences
Grandfather: Internal Medicine, Cardiology
Not grandfathered: Interventional cardiology (recertified once) 2

4. Initial ABMS Member Board Certification vs MOC
I fully support initial ABMS member board certification
The NBPAS, requires it!
I am proud of my initial ABIM board certifications in 3 specialties
Providing initial board certification is huge contribution.
The ABMS and its member boards should be proud of it…but also be content with it.
SCRIPPS CLINIC

5. NBPAS is a new alternative for continuous physician certification.
NBPAS relies on ACCME accredited CME for life-long learning instead of computer modules and repeat testing.
Interest in the NBPAS.org alternative is spreading rapidly.
This grass roots movement is now in discussions with hospitals, physician groups and payers to accept NBPAS continuous certification

6. Anti-MOC Movement Update Key Points:
Many ABMS member boards including the ABIM (by far the largest board) have made improvements in MOC.
The revised ABIM MOC program now replaces one large waste of time every 10 years with 5 smaller wastes of time every 2 years.
MOC used to be really onerous, now its just really annoying…and still brings ABIM $26M/yr (of their total $57M revenue)
NBPAS (alternative certification using CME) has certified >6,000 diplomates
Payers and hospitals still are not accepting alternative certification
NBPAS is fighting this by
Promoting awareness at meetings like this
Meeting with FTC and discussing anti-competitive aspects of MOC
Working state by state to promote anti-MOC legislation

7. Despite all the apologies, emails and discussion about modernizing MOC and recertification:
There is still no evidence MOC, recertification, or take home computer modules improves patient outcomes
The proposed new tests (secure or take-home) still can not be tailored to individual physician practices
The work of MOC lacks meaning = busy work
Appearance of a financial motivation underlying the MOC requirements
Be aware that many physicians making decisions about MOC are grandfathers and have never had to do MOC!

8. Are there data supporting MOC?
ABIM/ABMS argue there are data supporting the value of MOC. However, close examination of the reports cited by ABIM/ABMS reveals they support the opposite conclusion.

11. The poster child for conflicts of interest

13. Initial certification Vs. MOC?
Almost all the studies in the literature evaluate board certification, not recertification or MOC!
Initial ABMS certification is earned, for the most part, by spending several years in an ACGME credentialed training program.
The initial certification exam provided by the ABMS is simply the “final exam” which is obviously a much smaller part of the educational process.
Should it be surprising that successfully completing 3 years of training in an ACGME credentialed cardiology fellowship makes a doctor better at treating MIs?
It is absurd to equate the busywork of MOC…clicking on computer modules for hours each year…to the many years of training required for initial certification

14. One of the few studies examining lapsed certification found no impact on patient outcomes following coronary intervention

19. Study limitations: Non-randomized
Propensity matching followed by a regression analysis
Beware of unmeasured confounders
Exercise caution interpreting small differences

20. Propensity matching followed by regression analysis
Statistician's comment:
Highly adjusted analysis

22. Should we worry about COI in a non-randomized trial?
Were the endpoints pre-specified?
Was the small difference in cost discovered after looking at multiple potential endpoints?
Where there any differences favoring the grand-fathered cohort that were not published?

23. What about the cost of MOC to the physician?
Costs (for one specialty) begin at $190 – 256/year plus module fees.
Costs increase significantly if you have boards in multiple specialties
On top of this are costs for review courses, travel to review courses
Time away from practice

25. Which brings us to the finances of ABIM
ABIM IRS Form 990 tells the story
ABIM annual revenue is $55M (that’s per year)
Directors are very well paid
We have all had to tighten our belts in medicine
Patients are NOT demanding MOC…but they ARE demanding better “value”…better care, lower costs
Recently, most physicians, have spent an enormous amount of time cutting costs in their practices and hospitals
Physicians are now asking for a better value from the ABIM.

29. NBPAS rationale: Physician dissatisfaction with MOC
There is no evidence MOC improves patients outcomes
Tests can not be tailored to individual physician practices
Work of MOC lacks meaning
MOC = busy work
Complicated ABMS board websites
Appearance of a financial motivation underlying MOC requirements

30. NBPAS provides an alternative for maintenance phase of certification
The National Board of Physicians and Surgeons (NBPAS.org)
NBPAS provides an alternative for maintenance phase of certification
NBPAS believes CME is the most meaningful method available for “keeping up.”
NBPAS replaces computer knowledge modules and secure exams with accredited, continuing medical education (CME).
Acceptable CME must be accredited by the ACCME…independent of commercial interests.

31. What is Wrong with MOC Exams
Arguments against testing:
The exam questions are often not relevant physician’s practice. Questions often relate to parts of their specialty they do not practice.
We have to study for recertification exams. But we only study what we don’t know…we don’t know what we don’t use, and after the test we will soon forget
The questions are often outdated. Most of the studying is done to learn the best answer for the test, which is very often not the current best practice.
Testing often uses “Guidelines” as gold standard but there is a long history of Guidelines changing and often reversing
Closed book tests are no longer relevant. We care for patients with input from colleagues and the internet.

32. Detailed criteria for NBPAS certification:
■ Candidates must have been previously certified by an American Board of Medical Specialties member board or the AOA. Currently, NBPAS certifies physicians in non-surgical ABMS specialties.
■ Candidates must have a valid, unrestricted license to practice medicine in at least one US state. Candidates who only hold a license outside of the U.S. must provide evidence of an unrestricted license from a valid non-U.S. licensing body.
■ Candidates must have completed a minimum of 50 hours of continuing medical education (CME) within the past 24 months, provided by a recognized provider of the Accreditation Council for Continuing Medical Education (ACCME). CME must be related to one or more of the specialties in which the candidate is applying. Re-entry for physicians with lapsed certification requires 100 hours of CME with the past 24 months.  Fellows-in-training are exempt.
■ For some specialties (ie interventional cardiology, electrophysiology, surgery), candidates must have active privileges to practice that specialty in at least one US hospital or outpatient facility licensed by a nationally recognized credentialing organization with deeming authority from CMS (ie Joint Commission, HFAP, DNV).
■ A candidate who has had their medical staff appointment/membership or clinical privileges in the specialty for which they are seeking certification involuntarily revoked and not reinstated, must have subsequently maintained medical staff appointment/membership or clinical privileges for at least 24 months in another US hospital licensed by a nationally recognized credentialing organization with deeming authority from CMS (ie Joint Commission, HFAP, DNV).

33. ■ License to practice medicine in at least one US state.
Abbreviated criteria for NBPAS certification:
■ Previous certification by an American Board of Medical Specialties member board. (NBPAS does require a test, just not a repeat test).
■ License to practice medicine in at least one US state.
■ Complete a minimum of 50 hours of ACCME accredited continuing medical education (CME) within the past 24 months
■ Procedural specialties (ie surgery, interventional cardiology, electrophysiology), require active privileges to practice that specialty in a licensed US hospital or outpatient facility
■ Clinical privileges in your specialty have not been permanently revoked.

34. NBPAS Fees and Application
NBPAS is a not for profit 501(c)(3) organization
Board members are high profile, thought leaders representing most ABMS/AOA specialties
Fees are very low, only cover costs
Physician management and board members are unpaid
Governance: transparent, not-for-profit, two year board terms, COI protections, no physician pay

35. NBPAS Board Members
The majority of NBPAS board members are well respected, high profile members of the academic medical community

36. The NBPAS Advisory Board Members are physicians who value patient care, research, and life long learning. Board members (all unpaid) believe continuous physician education is required for excellence in patient care.
NBPAS Board Members:
Paul Teirstein, M.D., President NBPAS, Chief of Cardiology, Scripps Clinic
John Anderson, M.D., Past President, Medicine and Science, American Diabetes Association, Frist Clinic, Nashville, TN
David John Driscoll, M.D., Professor of Pediatrics, Mayo Clinic College of Medicine
Daniel Einhorn, M.D., Immediate-Past President, American College of Endocrinology; Past President, American Association of Clinical Endocrinologists
Bernard Gersh, M.D., Professor of Medicine, Mayo Clinic College of Medicine
C. Michael Gibson, M.D., Professor of Medicine, Harvard Medical School
Michael R. Jaff, D.O., Massachusetts General Hospital, Professor of Medicine, Harvard Medical School
Paul G. Mathew, M.D., FAHS, Director of Continuing Medical Education, Brigham & Women’s Hospital/Harvard Medical School, Department of Neurology
Jordan Metcalf, M.D., Professor and Research Director, Pulm. & Crit. Care, Oklahoma University Health Sciences Center
J. Marc Pipas, M.D., Professor of Medicine, Dartmouth Medical School
Jeffrey Popma, M.D., Professor of Medicine, Harvard Medical School
Harry E. Sarles Jr., M.D., FACG, Immediate Past President for the American College of Gastroenterology
Hal Scherz, M.D., Chief of Urology- Scottish Rite Children’s Hospital, Assoc Clinical Professor of Urology Emory University
Karen S. Sibert, M.D., Associate Clinical Professor: UCLA Health; President-Elect: California Society of Anesthesiologists
Gregg W. Stone, M.D., Professor of Medicine, Columbia University College of Physicians and Surgeons
Eric Topol, M.D., Chief Academic Officer, Scripps Health; Director, Scripps Translational Science Institute
Bonnie Weiner, M.D., Professor of Medicine, University of Massachusetts Medical School
Mathew Williams, M.D., Chief, Division of Adult Cardiac Surgery, New York University Medical Center

37. NBPAS website NBPAS.org Website is simple to navigate
Contains links publications, lay press articles, videos of debates on MOC
Contains links to explanatory sample letters to send to hospital administrators and colleagues
Contains links to downloadable PowerPoint presentations
Contains advocacy materials

38. Simple application takes <15 minutes to complete

39. In just over 2 years of operation with only word of mouth and social media:
Over 6,000 physicians have been certified by the NBPAS
A growing number of hospitals (>60) have changed their bylaws to allow NBPAS as an alternative certification for maintaining hospital privileges

40. Four common misconceptions
Board certification was created to provide a measure of competence over and above the minimal requirements of state licensing. NBPAS requirements simply mimic most state licensing requirements
NBPAS requires initial ABMS member board certification which is not required by state boards
NBPAS only disputes current ABMS MOC pathways
NBPAS provides an alternative, more meaningful pathway for life-long learning

41. Four common misconceptions
Supporting an alternative certifying organization like NBPAS will open the door to numerous competing boards, standards will erode and certification will lose meaning
NBPAS requires initial ABMS certification, therefore NBPAS actually supports ABMS and requires a rigorous secure test
NBPAS disputes ABMS approach to MOC and provides an alternative only to maintenance of certification.

42. Four common misconceptions
NBPAS requirements are not rigorous enough. A rigorous certification process is needed to protect the public from bad doctors.
This debate is about how to best pursue life-long learning, not initial certification. The is no evidence (or even general belief) that current ABMS MOC programs protect the public from bad doctors.
Most, if not all of the recent scandals in medicine involved board certified physicians.

44. Four common misconceptions
We have to do something to be accountable to the public. MOC is quick, easy, inexpensive and we learn something.
This response almost always comes from a physican who is a diplomate of a board that does not require the kind of MOC mandated by most other boards. For example, some of the surgical boards have a very reasonable and easy MOC process. It is nothing like the MOC required by internal medicine specialties, family practice, anesthesiology etc.

45. 6.4% if remove “slightly agree”

47. In January, 2015, 10 days after launching the NBPAS,
ABIM apologizes to its 200,000 diplomats

48. ABIM Apologizes-a good first step February 2015
Part IV is suspended. Very good decision
Other changes, however, are not meaningful: Changing public reporting language of diplomat status, freezing fees, and promises to consider further changes
We were still left with parts 2 and 3 that are onerous, time wasting and expensive (self assessment modules and repeat secure testing)

49. ABIM --- additional changes announced – summer 2015
Streamlining recertification for tertiary subspecialists, which previously required interventional cardiologists and other subspecialists to re-take and pass multiple examinations…but beware of unintended consequences
Eliminating punitive labels from the ABIM website, such as “not meeting MOC requirements.”
Accepting different types of traditional CME as counting for some of the MOC requirements.

51. The end of the 10 year recertifying exam! Should we celebrate?
NOT SO FAST!!!

52. The work of MOC lacks meaning = busy work
The end of the 10 year recertification exam…time to celebrate???
The revised MOC program replaces one large waste of time every 10 years with 5 smaller wastes of time every 2 years.
There is no evidence the new MOC program will improve patient outcomes. Ie, it will still be a waste of time and money.
The work of MOC lacks meaning = busy work
The cost of MOC is still $ per diplomate per year yielding $40-60M in revenue each year for ABIM.
By requiring annual activities to fulfill MOC, ABIM is still able to preserve its large annual revenue stream.

53. ”It simply keeps them in business
 ”It simply keeps them in business. There's still no evidence it produces better medicine or doctors.”
--- NBPAS board member

55. Professionalism includes managing conflicts of interest
ABMS believes in “professionalism” and the “privilege of self-regulation”
Professionalism includes managing conflicts of interest
>200,000 ABIM diplomates x $250 = >$50M
ABMS is reinventing MOC but should ABMS member boards be allowed to self-regulate?
Aren’t they too conflicted?
Is this “self-regulation” or regulation by the ABMS member boards?

56. As you evaluate alternative proposals for MOC, ask yourself:
Is this new plan really going to help our patients?
Or, is this new plan just “checking the box” to quiet the critics?
Does the proposed plan create an MOC pathway that is less time consuming for the doctors (so they stop complaining) while still providing a mechanism for the not-for-profit board to charge an annual fee?

57. Insurance Companies and MOC
Medicare does NOT require board certification or MOC
But many private payers require ABMS member board certification and MOC in their contracts with providers
Therefore, the major academic hospitals that employ physicians usually require MOC for hospital privileges
Why would the payers even care about MOC???
Payers are certified just like physicians
The certification body for 90% of the payers is the NCQA
One of the metrics NCQA evaluates is the number of physicians a payer contracts with who are board certified and do MOC.
SCRIPPS CLINIC

58. SCRIPPS CLINIC

60. Like Fiddler on the Roof… It takes a Village
Payers ---BCBS/Anthem etc
Require MOC because
NCQA – HEDIS
Uses MOC as a quality metric because
ABMS
Requires MOC
Founder and CEO of NCQA is a board member of ABMS
What holds this cozy village of fiddlers together
Is it Tradition? No its…
Tuition! ie MONEY
Who are they fiddling with?
Physicians!
The updated musical
SCRIPPS CLINIC

61. Criticism of MOC has now gone mainstream
Numerous organizations are now publically critical of MOC
California ACC
National ACC
American College of Physicians (ACP)
Washington State Medical Association
Georgia chapter of AMA
Other physician societies:
ie The American Association of Clinical Endocrinologists (AACE), California Neurology Society, etc
AMA
SCRIPPS CLINIC

62. 2016 AMA annual meeting (June) in Chicago goes Anti-MOC
AMA House of Delegates approved resolution 309 stating:
"RESOLVED, That our American Medical Association call for the immediate end of any mandatory, secured recertifying examination by the American Board of Medical Specialties (ABMS) or other certifying organizations as part of the recertification process for all those specialties that still require a secure, high-stakes recertification examination.”

63. The ABMS published opposition to AMA call for end to recertifying exams - paraphrased
ABMS opposition statements are in red, NBPAS response in black:
Consumers, patients, hospitals expect physicians to be up to date: True, but there is neither evidence nor general consensus that MOC is a valid method of inspiring or assessing a physicians competence.
CME by itself is not sufficient to verify that a physician is up to date: Perhaps, but neither are MOC activities and MOC compared to CME is onerous and costly. CME is the method used by state licensing boards and most believe it is the best method we have.
National certifying and recertifying examinations are a critical component of our profession’s commitment to self-regulation and to the public trust: a) There is no evidence nor general consensus that this statement is true and b) this is not “self-regulation,” this is regulation by the ABMS
ABMS Member Boards and the AMA Council on Medical Education have been working together to modernize the Boards’ recertifying processes: True, but a) there is no evidence nor general consensus that the proposed changes will improve patient care and b) this is self-regulation by the ABMS member boards which have a powerful financial conflict of interest that seriously impairs their ability to self-regulate.
SCRIPPS CLINIC

64. Anti-MOC Legislation Scorecard
Passed
In process
Failed
States TBD 8 9 4 32
Status
State
Bill #
Most Recent Action
Effective Date
Oklahoma
OK SB1148
Signed 4/11/2016
4/12/16
Missouri
MO HB1816
Signed 7/5/2016
7/5/16
Kentucky
KY SB17
Signed 4/8/2016
Jul-16
Maryland
MD SB989/HB1054
Signed 5/4/2017
1-Oct-17
Georgia
GA HB165
Signed 5/8/2017
May-17
Tennessee
TN SB298
Signed 5/25/2017
1-Jul-17
Maine
ME LD1200
Enacted Unsigned 6/13/2017
Jun-17
Texas
TX SB1148
Signed 6/15/2017
1-Jan-18
In Process
Alaska
AK HB191
Introduced 3/22/2017
Massachusetts
MA HB2446
Referred To Committee 1/23/2017
Oregon
OR HB3081
Referred To Committee 3/6/2017
Rhode Island
RI SB754/HB5671
SB Introduced Senate 4/12/17 HB Held for Study 3/15/17
South Carolina
SC HB4116
Introduced 4/6/2017
California
CA SB487
Hearing Sked 4/12/2017
New York
NY A.B. 9066
Referred to Committe on January 21, 2016
Ohio
OH H.B.273
Referred to Committe onJune 20, 2017
New Jersey
NJ S.B. 3362
Introduced 6/26/2017 & Referred to committee
Florida
FL SB1354 HB723
SB Failed Senate 5/4/2017 HB Failed House 5/4/2017
Withdrawn
Arkansas
AR HB1857
Withdrawn 3/23/2017
Dead
Michigan
MI HB5090
Prefiled 12/2/2015
Mississippi
MS SB2493
Died in Committee
Several states have recently passed anti-MOC bills and other states have anti-MOC bills pending.
NBPAS keeps a running scorecard on anti-MOC legislative activities on the “Advocacy” page of our website (NBPAS.org)

65. State
Bill ID
Summary
Action/Date
Alaska
HB 191
Nothing in this chapter may be construed to require a physician to secure a maintenance of certification as a condition of licensure, reimbursement, employment, or admitting privileges at a hospital in this state.
Introduced 3/22/2017 Referred to Health and Social Services
Arkansas
HB 1857
TO PROHIBIT DISCRIMINATION AGAINST A 16 PHYSICIAN FOR A DECISION TO NOT 17 PARTICIPATE IN ANY FORM OF MAINTENANCE OF 18 LICENSURE OR MAINTENANCE OF 19 CERTIFICATION.
Prefiled Mar2, 2017 | Reported by Comm with Ammendment Mar 9, 2017 | Withdrawn by Author 3/23/2017
California
SB 487
This bill would expand those specified provisions to include a provision that the award or maintenance of hospital or clinical privileges, or both, shall not be contingent on participation in a program for maintenance of certification, and, in the case of a public hospital, as defined, a provision that physicians and surgeons providing substantial direct patient care, as defined, may limit hospital committee voting rights on issues affecting patient care to those physicians and surgeons providing substantial direct patient care.
Introduced Senate and First reading Feb16, 2017| Referred to Committees Mar 2, 2017 | Hearings either Postponed or rescheduled Mar 20, 27,28, Apr 12!
Florida
SB HB 723
SB 1354 prohibits the medical board, osteopathic board, the Department of Health, health care facilities, and insurers from requiring physicians to maintain board certification in a subspecialty as a condition of licensure, reimburrsement, employment, or admitting privileges. The bill specifies that this prohibition does not impact the board's ability to require continuing medical education.
SB 1354 Prefiled March 1 |Withdrawn May 4, 2017 Died in Banking and Insurance HB723 Failed House on May 7,2017 Died in Health and Human Services Comm
Georgia
HB 165
Practicing Medicine Certification | House Bill 165 would eliminate the maintenance of certification requirement for those who wish to practice medicine in Georgia. HB 165 passed with a vote of 52 to 1.
Jan 26, 2017 Initiated | Mar 1, 2017 House Passed | Mar28,2017 Senate Passed | 8 May Signed by Governor | Effective Date 1 July 2017
Kentucky
SB 17 (BR 125)
AN ACT relating to physicians.     Create a new section of KRS to to prohibit the Board of Medical Licensure from requiring any maintenance of certification and related continuing education requirements for licensure as a physician The board shall not require any form of maintenance of licensure as a condition of physician licensure, including requiring any form of maintenance of licensure tied to maintenance of certification.
Jan 06, introduced in Senate      Jan 07, to Licensing, Occupations, & Administrative Regulations (S)      Jan 26, reported favorably, 1st reading, to Calendar      Apr 08, signed by Governor (Acts, ch. 53)
Maine
LD 1200
Nothing in this chapter may be construed to require an osteopathic physician or surgeon licensed under this chapter to secure a maintenance of certification as a condition of licensure, reimbursement, employment or admitting privileges at a hospital in the state.
Introduced 27 March, 2017 |Referred to Committee 27 March, 2017 | Passed Senate on May 30, 2017 Passed to Be Enacted, in Concurrence. Passed Senate on May 30, Passed to Be Enacted, in Concurrence
Maryland
SB 989 HB 1054
FOR the purpose of prohibiting the State Board of Physicians from requiring, as a 5 qualification to obtain a license or as a condition to renew a license, certification by 6 a certain accrediting organization that specializes in a specific area of medicine or 7 maintenance of certification by a certain accrediting organization that includes 8 certain reexamination as a requirement for maintaining certification; and generally 9 relating to physician licensure by the State Board of Physicians.
Introduced Feb 3, 2017 | Passed Senate Mar 16, | Passed House Apr 4, Signed by the Governor on May 4, 2017
The NBPAS legislative scorecard contains a lot of information and can be found on

66. The Current Legislative Scorecard
Oklahoma
Missouri
Kentucky
Maryland
Georgia
Tennessee
Maine
Texas
Alaska
Massachusetts
Oregon
Rhode Island
South Carolina
California
New York
Ohio
New Jersey
The 8 states in green have passed anti-MOC legislation
The 9 states in blue have anti-MOC legislation pending

67. Strong bill = AMA proposed “model legislation”
Several states have recently passed anti-MOC bills and other states have anti-MOC bills pending
Strong bill = AMA proposed “model legislation”
Key excerpts:
A facility licensed under this chapter shall not deny physician hospital staff or admitting privileges or employment based solely on the absence of maintenance of certification
A health insurance entity, as defined in [state law], shall not deny reimbursement to, or discriminate with respect to reimbursement levels, or prevent a physician from participating in any of the entity's provider networks, based solely on a physician's decision not to participate in maintenance of certification

68. Strong bill = Florida as introduced
We need Strong Anti-MOC Bills Examples of Strong Vs. Intermediate Vs. Weak Anti-MOC Bills:
Strong bill = Florida as introduced
A health care facility or an insurer may not require maintenance of certification or recertification as a condition of licensure, reimbursement, employment, or admitting privileges for a physician who practices medicine and has achieved initial board certification in a specialty or subspecialty pursuant to this chapter.

69. We need Strong Anti-MOC Bills Examples of Strong Vs
We need Strong Anti-MOC Bills Examples of Strong Vs. Weak Anti-MOC Bills:
Fairly strong bill = Texas as passed.
“(a) Except as provided by Subsection (b), the following entities may not differentiate between physicians based on a physician’s maintenance of certification in regard to: (1) paying the physician; (2) reimbursing the physician; or (3) directly or indirectly contracting with the physician to provide services to enrollees.” (The entities listed include licensed health facilities etc.).
Subsection (b) below weakens the bill slightly:
(b)An entity described by subsection(a) may differentiate between physicians based on MOC if the voting physician members of the…medical staff vote to authorize the differentiation.
Note: Some see (b) as a good thing since it does not limit power of hospitals to set criteria for joining the medstaff, yet ensures this power goes to the entire medstaff.

70. Your State Medical Association is Key to this Discussion!
How do we get other states to adopt laws similar Texas?
The best method of overcoming the insurance company, hospital MEC and other challenges is through state medical associations
The state medical associations takes on enormous importance for this issue.
Your state legislature takes its cue from your state medical association
If your state medical association supports a bill, the legislature will likely pass it

71. Advocacy emails from NBPAS to all its supports.
“Click here” to take 90 seconds to send a letter to your own state legislators.

72. One click and a letter like this goes to your two state representatives.
With just 2 e-blasts this spring, over 11,500 letters were sent to state legislators and it made a difference. Most bills now seem to be passing.

73. REGULATORY MONOPOLY: The anti-competitive aspects of MOC
Perhaps most disturbing are the anti-competitive aspects of MOC requirements.
While ABMS member board certification originated as mark of distinction, over the decades ABMS member board certification has virtually become a requirement to practice medicine in the United States. Medicare does not require ABMS member board certification (or MOC), but most private payers require physicians contracting with them have ABMS member board certification. Most hospitals now require ABMS member board certification for staff privileges.
Neither insurance companies nor hospitals accept alternative certifications. So, by requiring ABMS MOC to maintain certification, the ABMS member boards have made MOC a requirement to practice medicine.

74. REGULATORY MONOPOLY: MOC Discriminates Against Women and Minorities
ABMS has also restrained trade by applying its MOC program unfairly. Physicians certified prior to 1990 are “Grandfathered.” Approximately 40% of physicians are grandfathered at this time. Grandfathered physicians are given life-long certification and are exempt from MOC.
Grandfathering means ABMS requires MOC by younger physicians while exempting older physicians, thereby increasing barriers to entry and reducing competition. In addition to age discrimination, such policies are discriminatory towards women and minorities given the changing demographics in medicine.
As the practice of medicine has shifted to include more women and minorities, these are the groups that are being forced to participate in MOC.  Older physicians that are Grandfathered are mostly Caucasian males.

75. NBPAS goes to Washington
Jon Cuneo began his career as an attorney for the FTC and Pam Gilbert served as executive director of the U.S. Consumer Product Safety Commission, a sister consumer protection agency to the FTC. 
NBPAS representatives met with FTC to discuss the anti-competitive effects of MOC

76. To advertise “Board Certified” in California and Texas requires ABMS or equivalent certification
Many hospital attorneys view disclosing board certification on the hospital website as "advertising" and therefore require MOC to maintain hospital privileges.
The California law regarding physician advertising was well intended but was passed when board certification was life-long.
This law needs to be updated to require initial ABMS/AOA certification, not MOC or re-certification.
SCRIPPS CLINIC

77. Making a Difference… we all are lucky to be doctors
Reporter’s query: Hasn’t this anti-MOC activity taken a lot of your time? Wouldn’t it have taken less work just to do your MOC?
Doctors, in general are not lazy…just the opposite…we tend to be workaholics.
But we want to do meaningful work
We believe MOC is meaningless “make work”
We are here to work, but lets do meaningful work and make a difference.
Do something meaningful now and help the anti-MOC movement
SCRIPPS CLINIC

78. www.NBPAS.org Visit NBPAS.org
Physicians, go to NBPAS.org and apply for board certification.
Use the resources on NBPAS.org
Downloadable PowerPoints including this one and Sample letters
Spread the word
Join the NBPAS Advocacy Committee
Lobby you state medical association…its our most powerful tool to create change.
Lobby your hospital to accept NBPAS as an alternative board certification