The Association of American Physicians and Surgeons (AAPS) said its suit against the ABMS charges the group with restraint of trade through its "burdensome" maintenance of certification (MOC) program. AAPS accused ABMS and 24 other physician groups -- including the American Board of Radiology, which is named in the complaint -- of using the MOC program to generate tens of millions of dollars in revenues.
AAPS alleges that ABMS entered into agreements with the 24 corporations to impose recertification requirements on physicians that are little more than moneymaking programs not justified by any significant improvements in patient care.
"The MOC is becoming increasingly onerous and costly for physicians across the nation, and it's also tied to a concerted long-term effort to get enacted as part of maintenance of licensure so that physicians who do not recertify will not be allowed to practice their profession," said Dr. Jane Orient, executive director of AAPS and a private practice physician in Tucson, AZ, in an interview with AuntMinnie.com.
Though ostensibly nonprofit, the corporations that administer MOCs often pay high salaries, often in excess of $700,000 per year, to their executives, the AAPS statement alleges. But the recertification demands take physicians away from their patients and result in hospitals denying patients access to their physicians, the group said.
MOC a moving target
Traditionally, physician licensure was permanent once doctors passed their boards. But beginning in the 1980s, ABMS began offering time-limited certificates -- at first for 10 years, and then seven years; now the process is variable depending on the specialty, Orient said.
"Some of them are requiring participation in a process much more often than that, which involves a very expensive proctored examination," Orient said. "And increasingly there are other requirements, for example, collecting a lot of data from your patients, getting recommendations, filing a plan to improve your quality, and so on, that end up costing physicians thousands of dollars and take a lot of time away from taking care of patients, or from doing the type of study they feel is most valuable."
An ABMS spokesperson said that the group's board members are in a meeting out of town and are unable to comment immediately on the lawsuit. The board members have been unable to confirm that they have been served with a lawsuit and therefore cannot comment on it specifically.
As a matter of general information, however, the spokesperson pointed AuntMinnie.com to a page on the organization's website citing studies that support the utility of MOC programs. The average direct cost to physicians for MOC program fees was only $300 a year, according to the page.
Orient countered that the fees and the administrative burdens associated with MOCs add up quickly.
"Most surveys show that a very high percentage of physicians think the [MOC] process is unjustified, unnecessary -- and a lot of those who have been through it say they will never do it again," she said, adding that many physicians approaching retirement say they will retire rather than endure another round of recertification.
A recent AAPS survey found that only 9.5% of 167 respondents thought MOCs were a good thing that they would support. An earlier survey found that only 22% of physicians who had been through the recertification process would voluntarily do so again, AAPS said in its statement.
Radiology MOCs are administered and maintained solely by the American Board of Radiology (ABR), whose website makes it clear that it considers MOCs indispensable in radiology practice.
"The ABR believes in the value of Maintenance of Certification," the website states. "All current ABR trustees participate in MOC, as will all future trustees and volunteers." MOC is recommended for all diplomats who are currently enrolled in the MOC process if their certificates were issued in 2012 or later.
"Of course" ABR believes in the value of certification, Donna Breckenridge, ABR's communications director, told AuntMinnie.com. ABMS "establishes a framework" for the various specialties, she said, but has little to do with designing specifics for each program and certainly not for radiology, which unlike other specialties is focused on images. As a result, the ABR's MOC programs are likely very different from those of other medical specialties.
ABR issues MOCs in several specialties and subspecialties, including diagnostic radiology, radiation oncology, medical physics, neuroradiology, nuclear and pediatric radiology, and vascular/interventional radiology. Most of radiology's MOC programs began in the 1990s, with the exception of diagnostic radiology and physics, which began in the 2000s, Breckenridge said.
How long certification lasts varies depending on when the MOC was issued. Some are on a 10-year cycle, others are for shorter time periods, and certain aspects of certification are verified as frequently as annually or every three years -- again depending on the program and the date of initial certification, Breckenridge said. The $300 annual average fee cited by ABMS is true for radiology as well, she said.
"Those with nonlimited (lifetime) certificates should consider MOC as an investment that will instill public confidence, demonstrate their commitment to continuing education, and promote the best interests of the patient," the ABR's website states.
Orient cited many costs in addition to the exam fees.
"There's travel time; there's time away from the practice when your revenue drops to zero; there's time for studying that takes away from patient care, rest, and other types of studies that you find more valuable; and it also costs money for all these CME courses you have to have," she said.
In short, the AAPS statement charges that MOCs are little more than moneymaking schemes that reduce access for patients to physicians, are against public policy, and are harmful to the timely delivery of medical care in an era in which physician shortages are increasing.
One case cited in the suit was a family practice physician with an unblemished record who was eliminated as a staff member at his hospital "because he chose not to invest the time and money in recertification," Orient said.
This physician runs a charity clinic that has logged more than 30,000 visits, but now none of those patients can see him at the local hospital because he has lost his certification, she said.
"This could happen to radiologists more than others because most of them are affiliated with a hospital," Orient added. "A family physician could just take care of his patients in the office."
Orient said she is hopeful the suit will be successful.
"I think the chances are good," she said. "I think one way it could be stopped is if physicians just say, OK, if it's voluntary, we're not going to volunteer to do it. And it needs to be fought at the state level and at licensure boards to keep [MOCs] from being enacted as a requirement to keep your license to practice."
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