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Maintenance of Licensure (MOL) Maintenance of Certification (MOC) Continuing Medical Education (CME)


the DOC MOLestation



the Regulators Prosper


of American Physicians and Surgeons Vol. 17 Number 3 Fall 2012



of Licensure (MOL) is a system of continuous professional development for physicians that supports, as a condition for license renewal, a physicians commitment to lifelong learning that is relevant to their area of practice and contributes to improved health care. MOL is an umbrella term that is used to describe the various educational activities that physicians participate in to improve clinical and practice management skills.


Maintenance of Certification (MOC) is the process of keeping physician certification up-to-date through one of the 24 approved medical specialty boards of the American Board of Medical Specialties (ABMS). The Maintenance of Certification program provides an ongoing process that was designed to help physicians keep abreast of advances in their fields, develop better practice systems, and demonstrate a commitment to lifelong learning. Through ABMS Maintenance of Certification (MOC) process, board certified physicians in 24 medical specialties build six core competencies for quality patient care for their medical specialty. These competencies were first adopted by the Accreditation Council for Graduate Medical education (ACGME) and ABMS in 1999. Physicians in Ohio are not required to be board certified. Board certification is a voluntary process.






The Federation of State Medical Boards (FSMB) is a national non-profit organization representing the 70 medical and osteopathic boards of the United States and its territories. Federation of State Medical Boards (FSMB) MOL Core Components

The framework for MOL adopted by the FSMBs House of Delegates in 2010, recommends that state boards require physicians to periodically demonstrate participation in three components of effective lifelong learning in medicine.

Reflective Self-Assessment (What improvements can I make): Physicians must participate in an ongoing process of reflective self-evaluation, self-assessment and practice assessment, with subsequent successful completion of appropriate educational or improvement activities. Assessment of Knowledge and Skills (What do I need to know to be able to do?): Physicians must demonstrate the knowledge, skills and abilities necessary to provide safe, effective patient care within the framework of the six general competencies as they apply to their individual practice. Performance in Practice (How am I doing?): Physicians must demonstrate accountability for performance in their practice using a variety of methods that incorporate reference data to assess their performance in practice and guide improvement.

FSMB: Maintenance-of-licensure changes will not burden doctors, by Humayun Chaudhry, DO President and CEO Federation of State Medical Boards AMEDNEWS.COM/OPINION October 22, 2012

New systems implemented by state medical boards to encourage lifelong learning should not duplicate programs already in place or be burdensome to physicians.

The vast majority of physicians pursue CME and training to keep their knowledge and skills current and already will be in substantial compliance with MOL.
Additionally, physicians would not be required to take an examination to comply. By implementing MOL, state medical boards will encourage individual practice improvement efforts and serve as the foundation for a culture of continuous professional development encompassing the entire medical regulatory system.


evidence of improved medical care with MOC or MOL



Facilitated by a non-physician (former Senior Program Officer from Robert Wood Johnson Foundation)

Maintenance of Licensure: Medical Regulation with a Sheathed Sword by Richard A. Whitehouse, Esq.
Currently, Ohio and other medical boards rely upon continuing medical education as a mechanism to insure some semblance of continued competency. But, this alone is not enough, as there may be no relationship between the CME taken and the actual nature of the physicians practice. Beyond this, the best that medical boards have offered in augmenting their regulatory efforts are complaint-driven programs limited to quality intervention, remediation, or rehabilitation. [Ohio needs more regulation in order to] do even more to provide the public with meaningful assurance that licensure renewal does indeed connote continued competence. Ohio and state medical boards across the country are currently embracing a new approach to ensure that physicians can better fulfill this professions obligation in a matter transparent to the public. Whitehouses closure is chilling: If the best outcome in battle is achieved with unsheathing the sword, so too should medical boards strive to achieve their goal of public protection in such a manner as to avoid disciplinary battle whenever possible. Among other things, this means doing more to ensure the ongoing competency of physicians to avoid human and systems-based errors. MOL accomplishes this, thereby saving the sword of discipline for cases of reckless behavior. It is a better approach to protecting the public and preserving the integrity of the medical profession


of American Physicians and Surgeons 2012 Survey of Physicians 85 responses

55% ---- Irrelevant to their practice 50%---- Process was onerous 3%---- Valuable protection for patients 68%---- will quit before doing MOC again


Board of Internal Medicine (ABIM)


Revenue from Certification and MOC:



K. Cassel, M.D.

Founding Director of Robert Wood Johnson Clinical Scholars Program Founding Director of Center for Health Policy Research One of 20 scientists chosen by President Obama to serve on Presidents Council of Advisors on Science and Technology


ABIM Executive Director,

Christine K. Cassel, M.D. Compensation: $861,691 35 hour work week


A. Stockman, III, M.D. President, American Board of Pediatrics, Inc. 2010 Compensation: $873,321

49 hours/week


American Board of Pediatrics is the first of the 24 ABMS member boards to implement continuous certification, issuing certificates which state that ongoing certification is contingent upon meeting the requirements of MOC.


MOC, in order to maintain their American Board of Pediatrics (ABP) certification, pediatricians now must begin a process that includes the following:

Have an unrestricted and valid license to practice medicine in the United States. Participate in continuing learning and self-assessment programs Pass a written exam, which varies for general and specialty certificates Complete practice performance assessment and conduct peer and patient surveys

At you can receive a promotional flyer that stated: PASS THE ABIM RECERT EXAM WITH MedStudy. RECERT Core Curriculum material can be obtained for $465, which includes free shipping and 150 hours CME!. Additionally, for $175, one can receive Internal Medicine Board-Style Questions and Answers, which are advertised as being like a sneak preview of your recent exam. For $1,125 you can take the Internal Medicine Recertification Board Review Course, sponsored, of course, by ABIM.


Category I AMA PRA Category II



Every two years a physician must complete 100 hours of CME. At least 40 credits of CME MUST be earned in Category 1, although the total 100 credits MAY be earned in Category 1. Currently, the State Medical Board of Ohio offers 25 Category 1 credits to physicians who participate in ABMS MOC programs





50 hours/year 0 hours/year



Council for Continuing Medical Education (ACCME)



American Hospital Association Association of American Medical Colleges Association for Hospital Medical Education Council of Medical Specialty Societies

Activity Evaluation
Your Patient Has an Adverse Reaction to a Drug: How to Report to FDA's MedWatch Although optional, we encourage you to please complete the activHy evaluation form before proceeding to your certificate. This activity is designated for a maximum of 0.25 AMA PRA Category 1 Credit(s)m. Physicians should only claim credit commensurate with the extent of their participation in the activity. 1.Please select the amount of time you spent in this activity, rounding up to the nearest quarter hour. The amount you choose will determine the amount of credit you receive for this activity.15 minutes (0.25 credits) 2.Faculty was knowledgeable and effective. [Please use the "additional comments" field to provide further information.] o Strongly Agree o Agree o No Opinion o Disagree

o Strongly Disagree
3.The online format was appropriate for the subject matter and I was able to access all components of the activity without difficulty. [Please note any concerns in the "additional comments" field.] o Strongly Agree o Agree o No Opinion

o Disagree
o Strongly Disagree 4. This activity will assist in the improvement of my: [Check all that apply.] o Competence o Performance o Patient outcomes

5.I plan to make the following changes to my practice: [Check all that apply.] o Modify treatment plans o Change my screening/prevention practice o Incorporate different diagnostic strategies into patient evaluation o Use alternative communication methodologies with patients and families o Other [please explain in the "additional comments" field below] o None; the activity validated current practice 6. What is your level of commitment to making the changes stated above? o Very committed o Somewhat committed o Not very committed o Do not expect to change practice 7.What are the barriers you face in your current practice setting that may impact patient outcomes? [Check all that apply.] o Lack of evidence-based guidelines o Lack of applicability of guidelines to my current practice / patients o Lack of time o Organizational I Institutional o Insurance / Financial o Patient adherence / compliance o Treatment related adverse events o Other [Please use the "additional comments" field below to provide further information] 8.This activity supported achievement of each of the learning objectives. [Please use the "additional comments" field below to provide further information]. Describe the FDA MedWatch Program and implications of the program for patient safety

Activity Evaluation

Identify the types of adverse events and product problems or errors that should be reported using the FDA MedWatch Form 3500. Explain how to submit a report to the FDA MedWatch Program. 9. The material was organized clearly for learning to occur. o Strongly Agree o Agree o No Opinion o Disagree o Strongly Disagree 10.The content learned from this activity will impact my practice. o Strongly Agree o Agree o No Opinion o Disagree o Strongly Disagree o I am not currently in practice 11.Does this activity promote improvement in healthcare? o Yes o No 12.The activity was presented objectively and was free of commercial bias. (Please use the additional comments fields to provide further information o Strongly agree o Agree o No Opinion o Disagree o Strongly Disagree

13. I would recommend this activity to others o Agree o No Opinion o Disagree o Strongly Disagree

14. Please list CE/CME topics that would be of value to you

15. Additional Comments: