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Representatives from the American Board of Internal Medicine (ABIM) touted the benefits of recent changes to its maintenance of certification (MOC) program in , though criticism of the program continues.

Among its top changes are the introduction of the Longitudinal Knowledge Assessment (LKA), which it enacted in 2022 as an alternative to 10-year recertification exams, and reduced costs associated with the LKA.

About 80% of diplomates are "choosing the LKA over the traditional long-form MOC examination," according to Robert Roswell, MD, of Hofstra University in New Hyde Park, New York, who is also on the ABIM board of directors, and colleagues. They added that the LKA doesn't require preparation, takes only about 4 hours per year to complete, and provides instant feedback.

The LKA is also less expensive, at $220 per year to maintain one certificate, and $120 per year for each additional certificate, though they didn't state the original price of the traditional assessment.

As part of the LKA, ABIM also expanded content generation to more than 1,000 volunteers, whom include a "majority of practicing physicians from the community who work in a broad range of settings." This follows a change in 2014 in which ABIM appointed new governance members to better represent the "range of practice types and physician experience within each discipline," the authors wrote.

They blamed growing discontent with MOC on several factors: doctors being "overwhelmed by bureaucratic requirements of prior authorization, required institutional trainings in everything from workplace safety to billing and coding, and collectively recovering from the massive and ongoing trauma that is COVID-19."

In the past year, several organizations have expressed dissatisfaction with the program, and one specialty even announced it would break with ABIM and form its own specialty board. Five cardiovascular societies -- the American College of Cardiology, the American Heart Association, the Heart Failure Society of America, the Heart Rhythm Society, and the Society for Cardiovascular Angiography & Interventions -- said they will form .

Late last year, the Infectious Diseases Society of America sent a letter to ABIM calling for several changes to MOC, including a reduction in fees, changes to LKA questions, and eliminating redundant CME requirements.

Oncologists have also raised concerns about MOC, notably via a Change.org petition last summer led by hematologist/oncologist Aaron Goodman, MD, of the University of California San Diego, which called for an end to the program.

In addition, the American Society of Clinical Oncology launched a last year to better understand its membership's feelings about certification, and the American Society of Hematology also urging "immediate actions" to establish a new and improved MOC program.

Amid the criticism, ABIM chief Richard Baron, MD, announced plans to retire in September 2024.

Paul Teirstein, MD, chief of cardiology at the Scripps Clinic in La Jolla, California, who along with other academic physicians started the National Board of Physicians and Surgeons in 2015 as an alternative board for continuous certification, called MOC "a blatant money grab by ABIM."

"The LKA is the latest in a long string of apologies and 'restarts' for the ABIM's MOC," Teirstein said in an email to 番茄社区. "True, the LKA is less onerous than initial MOC requirements, but what is its value? Over the course of 5 years, doctors must answer 600 open-book multiple choice questions which they can look up on Google, ChatGPT, or UpToDate."

Westby Fisher, MD, an electrophysiologist in Illinois and a long-time critic of MOC, told 番茄社区 that the program "has nothing to do with patient care quality or safety, but has everything to do with capturing the multi-billion dollar (annually) U.S. physician continuous professional development market for themselves."

In 1936, ABIM was jointly formed by the American Medical Association and the American College of Physicians, according to Roswell and colleagues. For more than half a century, board certification only involved an initial certifying exam. In 1990, however, ABIM began requiring periodic re-assessment of medical knowledge to maintain certification, and MOC was born.

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