Dr Sidney Weissman made some interesting observations in his December 2010 commentary regarding the American Board of Psychiatry and Neurology’s (ABPN) Maintenance of Certification (MOC) program.1 The MOC program is a work in progress and we welcome constructive feedback about how it might be improved. However, we would like to address several of Dr Weissman’s misperceptions regarding the goals and requirements of the ABPN MOC program.
By way of background, the American Board of Medical Specialties (ABMS) comprises 24 Member Boards—one of which is the ABPN—that are committed to the ABMS MOC® program. Each Member Board develops its own program on the basis of the needs of its specialty and subspecialties while adhering to the standards established by consensus of all the Member Boards. In devising this program, the ABPN collaborates with its affiliated professional organizations, including the American Psychiatric Association (APA), to encourage the development of a variety of self-assessment, continuing medical education, and performance improvement modules that physicians can use to compare their clinical practices with standards of care (eg, practice guidelines).
Dr Weissman states that “MOC is meant to ensure that diplomates maintain the competency they had when they graduated from residency.” In fact, a primary goal of the ABMS MOC program is lifelong learning, and the 4-part process was developed to encourage continuous improvement and expansion of competencies beyond what was required for graduation from residency. Diplomates are expected to not only possess the up-to-date competencies to provide quality patient care but also demonstrate that they do so with their own patients.
Regarding the ABPN MOC Part IV requirements for patient and peer feedback, the program requires board-certified physicians to seek regular input from patients and peers about the manner in which they relate and how they might improve their clinical practice. This is entirely different from requiring that the practitioner’s work be reviewed, as Dr Weissman maintains. The ABPN Web site (www.abpn.com) contains straightforward model forms for patient and peer feedback that physicians might use to meet this requirement. Physicians are asked to obtain feedback from 30 patients and 30 peers over the course of 10 years. Furthermore, physicians themselves select the peers and patients to complete these surveys, collect and analyze the feedback, and decide what structural or process changes, if any, they might want to make to improve the quality of care they provide to their patients.
The MOC program is a complex process . . . and a work inprogress . . .
Much of the experience to date suggests that psychiatric patients are very willing and able to provide their opinions about the care they receive. There is also growing sentiment about the importance of teamwork and collaboration to the delivery of quality patient care and that professional peers might actually be in the best position to provide physicians with constructive criticism and recommendations for improvement, especially in the humanistic aspects of their performance. In our current era of patient advocacy, patient-centered care, and transparency, it seems likely that pressures will only increase on physicians to consider the perspectives of patients themselves when they deliver clinical services. It would indeed be unfortunate and ironic for the medical specialty that justly takes pride in its special emphasis on the importance of the physician-patient relationship to attempt to separate itself from the rest of medicine in this regard and to deny its patients the opportunity to provide input into their care.
While Dr Weissman’s concerns about “issues of transference” are certainly relevant, it is also true that transference issues are part of all aspects of clinical practice. It remains to be seen whether patient surveys will provoke anything special in this regard.
As Dr Weissman notes, quality improvement programs are hardly unique and already exist at many psychiatric facilities. The ABMS and its Member Boards—including the ABPN—are concerned about redundancy and wish to reduce the burden on physicians. Therefore, we are working toward synergies when these programs exist.
For instance, several of the ABMS Member Boards are involved with a pilot project with the Mayo Clinic that provides physician MOC Part IV credit for their meaningful participation in quality improvement activities at the Clinic. In addition, the ABPN and other Member Boards are considering other ways in which they might recognize the current quality improvement activities of diplomates. When programs do not exist, however, it is incumbent on the Member Boards to make sure that resources are available to diplomates so that they can readily fulfill the requirements for the MOC program.
The ABMS, the ABPN, and all the Member Boards have made great strides during the past decade to implement increasingly rigorous standards of care while also providing health care institutions, insurers, and consumers with the information they need to evaluate the commitment to quality of their physicians within a given specialty. We concur that the various Member Boards’ MOC programs must continually evolve to provide tools for meaningful continuous professional development.
The ABPN recognizes that its MOC program is a complex process and a work in progress and encourages debate about how the elements of its MOC program might be improved to make them more relevant and less burdensome. The ultimate challenge for the ABPN is to design its MOC program in a manner that is credible enough to the public and external organizations so as to be of value to its diplomates, yet convenient enough so that they will choose to participate in it. That is not an easy balance to achieve, and it will only be possible with the help and input of informed diplomates.
Kevin B. Weiss, MD, President and CEO
American Board of Medical Specialties
Larry R. Faulkner, MD, President and CEO
American Board of Psychiatry and Neurology
1. Weissman S. Does maintenance of certification ensure maintenance of competency? Psychiatr Times.2010;27(12):17.