ABMS Executive Defends Importance of MOC Part 4 in Assembly Address

"I absolutely believe we should keep the performance-in-practice component of Maintenance of Certification (MOC)," said American Board of Medical Specialties (ABMS) President and Chief Executive Lois Margaret Nora, M.D., J.D., during a special address to the APA Assembly Sunday morning at APA’s 2015 annual meeting in Toronto. However, Nora did note that the MOC process itself and the Part 4 performance-in-practice component (also referred to as "Improvement in Medical Practice") needs to be improved and refined.

According to Nora, the ABMS plans to respond to physician concerns over Part 4 by a "relaxation" of requirements and an expansion of activities that count toward fulfilment of performance in practice. "With the appropriate flexibility, I believe that performance in practice will be embraced by physicians," Nora said. ("Performance in practice" refers to a requirement that physicians build into their routine practice the capacity to assess their performance continually against guidelines for best practices and make improvements to meet those guidelines.)

Up to now it has been a chilly embrace. In an interview with Psychiatric News last year, Larry Faulkner, M.D., president of the American Board of Psychiatry and Neurology (ABPN), explained that the "the performance-in-practice issue is a controversial and difficult one. … It boils down to a quality-improvement process. In general, physicians are going to have to demonstrate that they have looked at their practices and identified issues that need to be improved."

But Part 4 has been the object of widespread physician concern and even anger. At the March meeting of the APA Board of Trustees, the Board voted to write a letter to Faulkner requesting that ABPN advocate to the ABMS that Part 4 be eliminated. (ABPN operates under criteria established by the ABMS).

The letter was the result of a motion, spurred by the Assembly Executive Committee and made at the Board of Trustees meeting in March, reflecting concerns over the limited evidence base for Part 4. Also at its March meeting, the Board established a joint Board-Assembly work group to evaluate the broad issue of MOC in psychiatry and its relationship to maintenance of state licensure and requirements of other accrediting bodies.

Note: Just prior to the start of APA's annual meeting, the ABPN announced that the feedback module in Part 4 will become optional as of January 1, 2016. The Part 4 Clinical Module component (chart review) will remain a requirement, and additional approved activities are now available on ABPN’s website. This change is in compliance with current MOC standards as mandated by the ABMS.

For more on APA’s efforts to eliminate Part 4 of MOC program, see the Psychiatric News article “APA Urges ABPN to Advocate for Elimination of MOC Part 4.”

(Image: David Hathcox)