What are some important qualities of a good supervisor (boss)?

Do you think this is a good idea?

Regardless of how the MOC issue is resolved, the recent focus on the ABIM has shed a bright light on how medicine is regulated in the United States. The ABIM is a private, self-appointed certifying organization. Although it has made important contributions to patient care, it has also grown into a $55-million-per-year business, unfettered by competition, selling proprietary, copyrighted products. I believe we would all benefit if other organizations stepped up to compete with the ABIM, offering alternative certification options.

Sandhya K. Rao, Alexa B. Kimball, Sara R. Lehrhoff, Michael K. Hidrue, Deborah G. Colton, Timothy G. Ferris, David F. Torchiana. . (2017) The Impact of Administrative Burden on Academic Physicians. 92:2, 237-243.

The ABIM is now under fire. Some 63% of respondents to the 2010 Journal feature opposed MOC. In a survey by the American College of Cardiology (ACC), nearly 90% of the respondents opposed the new MOC requirements, and ACC leaders are now engaged in discussions with the ABIM to change MOC. The ABIM has been formally criticized for the new requirements by several important physician groups, including the American College of Physicians and the American Association of Clinical Endocrinologists (which has formally asked the ABIM to “suspend its new MOC requirements”). The Association of American Physicians and Surgeons filed a lawsuit against the American Board of Medical Specialties (the parent organization of the ABIM) for restraining trade and causing a reduction in patient access to physicians. At a recent American Medical Association meeting in Chicago, delegates voted to oppose making MOC mandatory as a condition of medical licensure.

Do you agree or disagree that progress is always good?

The ABIM claims that a majority of certified physicians have already signed up for MOC, which they interpret as support for the program, but MOC is mandated by the ABIM for recently certified physicians and perceived as a job-security requirement by many others — physician interest is either required or motivated by fear. Indeed, in a 2010 Journal feature that allowed physicians to express their opinions on MOC, many respondents commented that “the exercise was only marginally relevant to their day-to-day practice and that it took their time away from patients and other learning activities.” These problems are especially frustrating in light of other ongoing tasks that hospital-based physicians are required to complete. For example, to maintain my hospital privileges I must complete 14 separate computer modules on various subjects either annually or every 2 years. In addition, my annual bonus is tied to my performance on practice-improvement activities, including formal surveys of patient satisfaction, low-density lipoprotein cholesterol control, blood-pressure control, and various core measures for hospitalized patients. Adding continuous ABIM MOC activities, which have no documented efficacy, to this already overwhelming list is onerous and diminishes the time physicians have for patient care.

What are the important qualities of a good son or daughter?

There are many opinions about how MOC should be changed. My main recommendation would be to allow 25 annual hours of CME to be substituted for the current MOC requirements that need to be met every 2 years. Doing so would eliminate, or make optional, the busywork modules that have little practical value, including all medical knowledge, practice-improvement, and patient-safety modules. The charges for these new MOC activities should be nominal — perhaps $100 per year for tracking a physician's annual CME attendance. I also believe that the ABIM website should be vastly simplified so that administrative tasks become less onerous. Finally, I believe that the ABIM should work to cut its costs and, correspondingly, substantially reduce the initial certification and recertification fees paid by physicians.

The most important aspect of a job is the money a person earns.

Which one of these characteristics is most important to you?

James H. Ford, Karen A. Oliver, Miriam Giles, Kathryn Cates-Wessel, Dean Krahn, Frances R. Levin, . . (2017) Maintenance of certification: How performance in practice changes improve tobacco cessation in addiction psychiatrists’ practice. 26:1, 34-41.

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Lane F. Donnelly, Vincent P. Mathews, David J. Laszakovits, Valerie P. Jackson, Milton J. Guiberteau. . (2016) Recent Changes to ABR Maintenance of Certification Part 4 (PQI): Acknowledgment of Radiologists’ Activities to Improve Quality and Safety. 13:2, 184-187.


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Although the ABIM argues that there is evidence supporting the value of MOC, high-quality data supporting the efficacy of the program will be very hard, if not impossible, to obtain. In fact, close examination of the reports cited by the ABIM reveals that the data are ambiguous at best: in a meta-analysis of 33 studies, 16 described a significant association between certification status and positive clinical outcomes, 14 found no association, and 3 found a negative association. Moreover, the authors of the meta-analysis concluded that the research methods of most published studies on this topic are inadequate. Almost all published studies evaluate initial board certification, not recertification or MOC, and the rigorous requirements for initial certification should not be equated with the busywork required for the MOC every 2 years. One of the few studies examining lapsed certification showed no effect of physicians' certification status on patient outcomes after coronary intervention. Two very recent studies found no association between recertification and performance or quality measures; one, conducted by ABIM members, found a minor reduction in cost of care. No study provided level A data, and these findings relate only to recertification, not the controversial new MOC requirements.

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Laura D. Knight, Nicholas I. Batalis, Cassie L. Boggs, Amy Martin, Maneesha Pandey, Mark Shelly. . (2015) The Changing Landscape of Maintenance of Certification: History, Value and Evidence Base, and Future Impact on Forensic Pathology. 5:4, 571-589.

Here are seven possible reasons why the Chinese are getting a bad name for being terrible tourists.

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