Maintenance of Certification
Physicians who plan to renew a specialty board certification should know about changes to the recertification process for American Board of Medical Specialties member organizations. This page contains information that may be helpful for physicians planning to recertify.
Licensure and Professional Standing
Lifelong Learning and Self-Assessment
- Proof of Continuing Medical Education (CME) credit over the period of certification. This ranges from an average of 15-50 credits per year.
- Self-assessment or learning modules which focus on various aspects of clinical care. Some Member Boards require completion of one or more specialty-specific modules. Additionally, many Member Boards require diplomats to complete Communication and Patient Safety Modules. Timeframe for completion of these modules vary as well, with many Member Boards requiring completion of a module at specified intervals during the certification period.
- Literature review of specialty-specific articles that provide evidence-based, up-to-date data germane to current clinical practice. Typically, post-review self-assessment tests or other attestation of completion must be completed with a required minimum performance on post-review activities such as post-tests.
Practice Performance Assessment
Physicians are asked to participate in various activities that document quality patient care and participation in practice improvement based on personal practice characteristics or data. Based on specialty requirements, physicians may be required to complete one or more of the following activities:
- Verification of clinical activity (e.g., surgical cases) by logging in data into a secure portal accessed from the Member Board website.
- Verification of activity working in quality improvement or quality assurance. A physician may be required by their Member Board to provide documentation regarding their work in this area as proof of their ongoing efforts to improve the quality of their laboratory, division or department.
- Peer attestations of performance, including interpersonal and communication skills, professionalism, ethics, and effectiveness in practice.
- Practice assessment and improvement activity in which practice data is gathered on a small number of patients, the data is reviewed and compared to standards, and feedback is given by the Member Board on performance. Other Member Boards require this review and comparison but the physician is required to design and implement a change to improve practice and data is again gathered and reviewed. These changes can include implementing clinical reminders, improvements in clinical knowledge, or making changes to a clinical or system process. Some boards require self-designed activities while others offer activities supported by interactive websites that explain each step of the process. Some boards allow these activities to be completed in groups rather than individually. Many Member Boards offer modules designed for physicians who practice in a variety of clinical situations and who may be interested in specific areas of clinical work. Additionally, many Member Boards allow reciprocal credit for a practice improvement module offered by another Member Board.
- Patient safety and clinical communication web-based modules that focus on improvement of knowledge in these specific content areas. Some Member Boards require completion of patient and/or peer communication surveys.
- Non-clinical web-based modules for physicians who no longer have a clinical practice or see a very limited number of patients on their own (i.e., researchers, teaching faculty who do not see patients on their own, etc.)
- Patient surveys regarding various aspects of clinical practice from the patient perspective. These surveys have been implemented by some Member Boards and are under development by others.
- Though all boards are moving toward some type of practice assessment and improvement activity, not every board requires completion at this time. Some boards do not require participation in Part IV activities for those physicians who no longer see patients, while others provide alternate activities for these physicians.
- Refer to the Overview of Member Board Requirements for more information.
The ABMS MOC® program is an active process of assessment and continuous professional development (also called Continuous Certification) that requires participants to keep pace and demonstrate ongoing competency with advances in the field of medicine throughout their entire careers. In 2000, the ABMS Member Boards began the process of moving toward a continuous, competency-based recertification process using the same six core competencies adopted by the Accreditation Council of Graduate Medical Education (ACGME).
To ensure this ongoing professional development, the ABMS adopted a four-part process for maintaining certification: Part I: Licensure and Professional Standing, Part II: Lifelong Learning and Self-Assessment, Part III: Cognitive Expertise, and Part IV: Practice Performance Assessment.
Individual Member Boards differ in their specific requirements for each of the four parts. See the Overview of Member Board Requirements for a comparison of the basic requirements from each Member Board. Many Member Boards are in the process of transitioning to increased requirements for MOC. Each website of these Member Boards indicates the specific requirements according to the year of initial board certification.
The official ABMS Member Boards and Associate Members are American Board of Allergy and Immunology, American Board of Anesthesiology, American Board of Colon and Rectal Surgery, American Board of Dermatology, American Board of Emergency Medicine, American Board of Family Medicine, American Board of Internal Medicine, American Board of Medical Genetics, American Board of Neurological Surgery, American Board of Nuclear Medicine, American Board of Obstetrics and Gynecology, American Board of Ophthalmology, American Board of Orthopedic Surgery, American Board of Otolaryngology, American Board of Pathology, American Board of Pediatrics, American Board of Physical Medicine and Rehabilitation, American Board of Plastic Surgery, American Board of Preventive Medicine, American Board of Psychiatry and Neurology, American Board of Radiology, American Board of Surgery, American Board of Thoracic Surgery and American Board of Urology.
The ABMS is the organization that partners with its 24 member boards in developing and overseeing clinical competency standards for board-certified physicians. ABMS and its Member Boards were created as a public service that would enable patients to determine whether their physicians were appropriately trained and knowledgeable in their specialties. The ABMS provides information regarding certification to consumers and professional organizations.
MOC is analogous to the AMA PRA Category 1 Credit™ system used in CME, in that MOC recommends the same kinds of desirable physician attributes that certified CME has had since the ACCME revamped its accreditation criteria in 2006 to focus on changes in competence, performance and patient outcomes. This allows physicians to demonstrate that they’re participating in programs and educational activities that are linked to competency and tagged to their scope of practice.
Most Member Boards require proof of CME activities for Part II of MOC. The CME team at IU School of Medicine can help satisfy this requirement in several ways:
- IUSM CME can help you track CME credit information and provide you with data. If you’ve participated in CME-certified activities either in live conferences or self-study formats through Indiana University, visit our transcripts page to acquire a credit summary or transcript of your involvement. Certificates of participation can be printed from here.
- Busy clinicians can take advantage of Point of Care CME that allows you to claim credit for literature searches that you are doing already to find the answers to clinical questions. All you have to do is document your clinical question and references to claim CME credit.
- If you choose to do a small quality improvement project in your clinic or hospital, you can earn up to 20 CME credits through our Performance Improvement CME program. By providing some basic documentation about your quality improvement project, you can earn credit for the work you did. Additionally, some Member Boards allow Part IV MOC credit for a self-designed improvement project. Read more about Part IV and visit your Member Board website to determine if your project satisfies Part IV MOC requirements.
IU School of Medicine CME provides this information as an introduction about the MOC process. For information particular to your specialty, visit the Overview of Member Board Requirements. Still have questions? Contact IUSM CME at email@example.com and we can link you with someone in your specialty who can help answer your questions about MOC.
The American Board of Medical Specialties (ABMS) chose the term “Maintenance of Certification” (also called “Continuous Certification”) to reflect their focus on a continuous process of professional development that spans the entire certification period. Traditional recertification requires a diplomate (a physician who has received initial board certification) to apply for recertification near the end of the specified certification period and pass a secure recertification examination. MOC goes beyond this requirement to include continuing education and assessment activities throughout the recertification cycle.
Studies are underway to help answer the question of whether or not this type of continuous quality improvement as applied to professional development will translate into better outcomes for patients. To date, this information is not yet available. However, the ABMS is leading the transition to a physician-driven process that will be credible to the many outside stakeholders interested in quality clinical care, including patients, insurers, businesses and government. The ABMS is working with its Member Boards to ensure that physicians and the medical profession, as opposed to outside regulators, develop the process by which physician performance is assessed and reported.
Whether or not a physician holds a time-limited or time-unlimited certification depends on their specialty and when they were initially certified. Those physicians who hold time-unlimited certification may have no requirements for recertification. The transition to full MOC compliance varies according to how many years diplomates have left on their current certificates at the 2007 initialization of MOC. Those with fewer years remaining on their certificates have fewer requirements to fulfill since requirements are proportioned based on time remaining. Once all the diplomates have entered a new cycle, the requirements will be the same for everyone.
Specific components have been developed and are being implemented to better evaluate the competence of all practicing physicians. Each individual Member Board is defining its own program to comply with the requirements of MOC. Changes to, and probably additional, requirements can be expected in the future. Some Member Boards have implemented their Part II and Part IV requirements already while others are finalizing the development of theirs.
In addition to the personal benefits of demonstrating one’s professional development in medical knowledge, life-long learning and quality improvement for the provision of good clinical care, there are several other potential reasons why a diplomate may want to participate in MOC:
- ABMS and Member Board provide information to patients and other public stakeholders who seek documentation that their physician is practicing the highest quality care. Physicians who choose not to participate will be listed as not participating in MOC in Member Board and ABMS databases.
- Some insurers are using participation in MOC as a measure of quality and participation may be tied to performance-based reimbursement strategies in the future.
- State licensure boards are actively looking at Maintenance of Licensure (MOL) programs, and the ABMS and its Member Boards are working with the Federation of State Medical Boards to assure that participation in MOC will qualify for MOL.
- In certain states, malpractice carriers have already started to give discounted premium rates to physicians participating in MOC.
- The Healthcare Reform Act of 2010 contained language specifically acknowledging the ABMS.
MOC is a voluntary process for time-unlimited certificate holders. Currently held certification will not be revoked. Diplomates will be reported in ABMS and many individual Member Board databases as “Not participating in MOC.” There are other reasons for participating in MOC, however, even on a volunteer basis. Please see “Why should I participate in MOC and what will happen if I choose not to?”
If diplomates entered MOC upon certifying or recertifying in a general specialty such as Internal Medicine, they must be current in fulfilling those MOC requirements to be eligible to certify or recertify in another specialty. However, once that is achieved, they are not required to take the recertification exam in general Internal Medicine if they do not wish to maintain this general certificate.
Diplomates who are no longer in active practice and do not treat patients in any capacity may have different requirements for MOC. Some Member Boards require only the completion of Parts I, II and III. Other Member Boards have designed Part IV activities specifically for diplomates with little or no patient care responsibilities such as those involved in research or administration. Some Member Boards require the diplomate to attest that he or she is no longer actively participating in any direct patient management.
The first step is to visit the website of your individual Member Board click on the MOC link (called Continuous Certification by some Member Boards). You may be required to log in and create an account if you do not already have one. Most Member Boards suggest starting MOC activities at the beginning of your certification period given the emphasis on continuous improvement. Different MOC activities have variable time requirements for completion. Some Member Boards require that activities be completed at specified intervals throughout this period.
If your certification has lapsed, it may be possible to regain certification. Many Member Boards provide specific information on their websites to those wishing to re-establish their board certification.
Individual Member Boards have requirements which are grouped into four categories as outlined by ABMS:
- Part I – Licensure and Professional Standing: Medical specialists must hold a valid, unrestricted medical license in at least one state or jurisdiction in the United States, its territories or Canada.
- Part II – Lifelong Learning and Self-Assessment: Physicians participate in educational and self-assessment programs that meet specialty-specific standards that are set by their member board.
- Part III – Cognitive Expertise: Physicians demonstrate, through standardized examination, that they have the fundamental, practice-related and practice environment-related knowledge to provide quality care in their specialty.
- Part IV – Practice Performance Assessment: Medical specialists are evaluated in their clinical practice according to specialty-specific standards for patient care. They are asked to demonstrate that they can assess the quality of care they provide compared to peers and national benchmarks and then apply the best evidence or consensus recommendations to improve that care using follow-up assessments.
Participating in MOC is typically associated with additional costs that cover the 4-part process. Some Member Boards charge an overall fee that includes the MOC examination and educational materials while others have separate fees for each item as well as an MOC enrollment fee. Check the specific Member Board website for details regarding fees.