MOC/ board certification – does it even matter anymore?

I’m a pediatrician that started practicing BEFORE MOC existed, when being board certified actually meant something.

Being a “board certified physician” meant you had passed the equivalent to a PhD thesis: you had finally reached a pinnacle in your medical career. After a minimum of 11 YEARS of higher education, graduating medical school and completing years of additional supervised training called residency – you earned the privilege of sitting for your specialty exams/certification – and you passed.

Passing boards meant you were now considered an EXPERT in your chosen field of medicine.

Passing boards meant you were worthy, trained, and trusted to independently care for patients.

Passing boards meant you were now an official attending physician.

At the top.


Once a trainee, now a master.

Being “board certified” used to mean something special.

MOC was initially introduced as voluntary. Billed and promoted as a way to show everyone you were still at the top of your game. Participating meant you were a team player, and everyone – even those physicians “grandfathered in” – aka exempt from MOC – we’re encouraged to play.

If you chose not to participate – no harm, no foul.

Until the boards realized not enough physicians were willing to sign up and pay to play. All of sudden, the board members unilaterally decided MOC was no longer optional, and in 2003 pediatricians not grandfathered in, were required to participate in MOC.

“In 2000, the American Board of Medical Specialties (ABMS) partnered with the Accreditation Council for Graduate Medical Education (ACGME) to adopt six core competencies for physicians. These competencies became the foundation of improvements in initial certification and in MOC, which emerged in 2003.” This description is from ABP’s website.

On the surface, this process appears to be in place to make sure physicians are keeping up to date with the latest medical advances, developments, and standards of practice. What the ABMS fails to recognize and mention is that in order to remain licensed to practice medicine, physicians are already required by their state medical boards to complete continuing medical education (CME). Minnesota’s medical licensing board requires 75 hours of CME every 3 years. Participation in MOC fulfills this requirement, but so does completing alternate physician chosen CME.

Again, this MOC requirement appears to be in place to protect patients and to make sure physicians are keeping up to date with the latest and greatest medical developments. Physicians, by nature, are driven, resilient, overachievers. We strive to do best for our patients. By default, we are engaged, continuous learners and seekers of knowledge. We are strong willed, independent, fierce leaders. We had to be in order to be accepted into and make it through our vigorous medical training. We physicians are accomplished learners and do not need micromanaged suggestions in order to stay up to date and current in our specialty.

So physicians have a choice, right? Participate in MOC or choose your own CME?

Unfortunately, for most, the answer is No.

Since it’s introduction, MOC has morphed into being required and tied to hospital & insurance credentialing.

FAIL to PAY the ABP, and you are no longer “in good standing” and will be unable to continue caring for your hospitalized patients because you are now no longer “certified”. One day you’re rounding in the hospital, and the next you are unqualified? Did our years of education, training, and experience suddenly disappear because we refused to pay to play?

MOC IS EXTORTING PHYSICIANS, and is in turn harming patients in the process.

And, if you fail to pay for MOC, you will be banned from receiving insurance payments for your already performed services, and your patients will no longer be able to see you. Why? Because once again you are “no longer certified”.

To date, published studies have found no association between MOC/OCC and improved patient outcomes from participation in MOC. There are, however, thousands of physicians dissatisfied with the patriarchal monopoly, as proven by this recently circulated petition. Additionally, over $411,000 has been raised via a GoFundMe campaign in order to help with legal efforts to end MOC nationwide. Interested in learning more about the history/corrupt for profit driven practices of the ABMS? Visit Dr. Wes Fisher’s blog.

While MOC is expensive, burdensome, & unnecessary, what I find absolutely egregious is that the ABMS has done nothing to protect patients from non-physicians legislating their way into increasing their “scope of practice”; essentially akin to practicing “medicine” without any of the required medical education, training, or a medical license! Due to these lobbying efforts, 29 states now allow nurse practitioners “full practice authority” to “practice at the top of their license”.

Is this not an exact situation the boards were initially formed to prevent?!?

89 years later – almost a century after initial formation – isn’t it ironic the ABP is failing to act on the very premise for which it was founded?

The lack of action on the part of the ABMS in all specialties is likewise reprehensible. While our medical boards continue to extort us, they are colossally failing at protecting our patients, and continue to disrupt needed patient care. If curious as to how patients are being harmed, please read “Patients At Risk” by Drs. Niran Al-Algba and Rebekah Bernard. As a patient, please remember It’s Ok to Ask for the credentials of whoever’s wearing that white coat.

Frustrated with the mandated MOC programs, in 2014, over 20,000 physicians signed a petition to provide an alternative pathway, and NBPAS was formed.

On November 2, 2021, it was announced that NBPAS meets all national accreditation standards for health plans. This update clarified to all health insurers that NBPAS performs Primary Source Verification and therefore meets the NCQA and URAC requirements for health plans – meaning NBPAS is an accepted alternative to MOC – so MOC is no longer needed to receive health plan payment reimbursements!

In December 2021, I applied, met all standardized requirements, and officially certified as a NBPAS diplomate.

My hope is that every single physician chooses to participate in NBPAS, and in turn petitions their hospitals to accept NBPAS as an alternative to MOC. If every single physician does so, we have power to stop the extortion and make MOC/OCC obsolete.

As Gary Keller describes the incredible power of the “Domino Effect” in his book The One Thing, we too can create massive change by collaborating together.

To learn more about NBPAS, I invite you to listen to the replay of an informational/Q&A session hosted by Practicing Physicians of America, with NBPAS board member Dr. Paul Mathew that took place on February 6, 2022.

Link to replay:

2 thoughts on “MOC/ board certification – does it even matter anymore?

  1. Well done Christina! We must continue to call out MOC for the sham that it is. I still do not understand why after 31 years in practice and having passed rheum boards in 1990, 2000 and 2010, my qualifications to practice ( as determined by insurers and hospitals) depended on passing an exam in 2020. I said no and retired instead of donating more dollars to ABIM. I refused to submit to the hypocrisy that I have spoken out against so many times.

    1. Completely understand and agree! And congratulations on your retirement! I find it absolutely ludicrous that we pay hundreds of thousands of dollars (in addition to working our a**es off!) to EARN the privilege to care for patients and are then extorted by the very boards that are supposed to protect and uphold the standards of our profession of medicine. Yet rather than fighting for physicians and protecting patients from non-physicians creating shortcuts, changing verbiage, lobbying, & continuously creating further means to dupe patients into thinking they are capable of delivering the same standard of care – we are made to PAY to be able to continue to serve those patients for which we care! It’s racketeering, extortion, and a money making scheme that goes against and completely undermines why medical boards were created in the first place.

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