By Brian Casey, AuntMinnie.com staff writer

May 20, 2016 -- The American Board of Radiology (ABR) has announced plans to eliminate the maintenance of certification (MOC) exam, its controversial requirement that board-certified radiologists undergo testing every 10 years to remain credentialed.

In a May 18 email sent to ABR diplomates, the ABR confirmed that it is eliminating the requirement that radiologists pass a traditional proctored test offered at exam centers every 10 years. Instead, the ABR will employ a "continuous assessment" online system that "leverages advances in technology," said the email, which was signed by ABR President Dr. Milton (Mickey) Guiberteau.

A representative of the ABR confirmed to AuntMinnie.com that the MOC exam is being eliminated, but declined to provide any details on the system that will replace it.

"The exam is going away," the spokesperson said.

Intensely unpopular

The 10-year MOC exam was part of a major change in physician certification adopted by the American Board of Internal Medicine (ABIM), the American Board of Medical Specialties (ABMS), and other physician specialty groups like the ABR. The test basically eliminated the old system in which physicians were credentialed for life once they passed their board exams, as long as they met annual continuing medical education (CME) requirements.

Instead, under MOC, physicians receive a 10-year certification that has to be renewed every decade by passing an exam. Diplomates also have other requirements, such as completing practice quality improvement (PQI) projects.

The MOC exam has been intensely unpopular with physicians, who objected to the requirement that they undergo testing again, as well as to the fees involved in the new program. Indeed, a 2015 study in the Annals of Internal Medicine estimated that the MOC program would cost physicians over $5 billion to meet its requirements over the next decade.

Dissatisfaction with MOC even led to the formation of a new group, the National Board of Physicians and Surgeons (NBPAS), that sought to create an alternative physician recertification path that did not require a 10-year exam. Another group, the Association of American Physicians and Surgeons (AAPS), filed a lawsuit in 2013 against the ABMS and other physician groups -- including the ABR -- accusing the groups of using MOC to generate tens of millions of dollars in revenues.

The opposition was so strong that it led the ABIM to begin revisiting the MOC program, and the group last year took the unprecedented step of apologizing for some of the MOC requirements. In September 2015, the ABIM issued a report that recommended replacing the 10-year MOC exam with assessments that were more meaningful and less burdensome.

Parallel course

The ABR's move this week appears to parallel the course set by the ABIM. In its May 18 email, the ABR said it is developing an online assessment platform in which ABR diplomates will create practice profiles of subspecialty areas that most closely fit their area of practice. They will then receive weekly emails with links to questions that are relevant to their areas of practice. The questions can be answered individually or in small batches, the email said.

Radiologists will be given immediate feedback on whether their answers are correct, as well as a critique of answers and related educational material. The feedback will help them guide their CME plan for "lifelong learning, an essential component of professional development."

The email noted that the proposed system has been "well-vetted" by the American Board of Anesthesiology, to the "overwhelming" satisfaction of its members. The ABR said that the changes will not affect its initial certification exams for diagnostic radiology, radiation oncology, medical physics, interventional radiology, and other subspecialties.

The email further explained that "it will take considerable time" for the ABR to implement the new system to replace the MOC exam, with a pilot of the new format expected to be launched in late 2018, followed by a rollout to ABR diplomates in mid-2019.

Given the new program's phased implementation, what will happen to radiologists who are required to take the 10-year MOC exam before the new format goes into effect? The ABR's email said that diplomates who are required to pass the exam by March 2, 2017, are still required to take and pass the test this year. Anyone else is exempt from fulfilling the 10-year exam requirement, although they still must comply with other elements of the recertification program.

"This is a work in progress, and some details, including the launch timeline, may well change over the next year," Guiberteau noted in the email.


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