Who Is Maintaining Certification in Internal Medicine—and Why? A National Survey 10 Years after Initial Certification

3 January 2006 | Volume 144 Issue 1 | Pages 29-36

Background: The American Board of Medical Specialties (ABMS) adopted a framework, called Maintenance of Certification (MOC), for all certifying boards to evaluate physicians' competence throughout their careers, with the goal of improving the quality of health care. The MOC participation rates of the American Board of Internal Medicine (ABIM) show that 23% of general internists and 14% of subspecialists choose not to renew their respective certificates.

Objective: To study U.S. internists' perceptions about the forces driving them to maintain certification.

Design: Mail survey.

Setting: A nationally representative sample of certified internists in the United States.

Participants: Physicians originally certified in internal medicine, a subspecialty, or an area of added qualifications in 1990, 1991, or 1992.

Results: The overall rate of response to the survey was 51%. Although 91% of all participants are still working in internal medicine or its subspecialties, this percentage is notably lower among general internists (79%). Of those still working in the field of internal medicine or its subspecialties, approximately half report being required to maintain their specialty certificate by at least 1 employer, but only approximately one third of those who completed or enrolled in MOC report this requirement as a reason for participating. Those who completed or enrolled in MOC do so more for positive professional reasons than for monetary benefits or professional advancement. The most common reasons for not participating are the perceptions that it takes too much time, is too expensive, and is not required for employment.

Limitations: Respondents were volunteers from an early cohort of diplomates entering the program, and those with less positive attitudes may have responded at higher rates. Results are based on self-reported data, and misconceptions about program requirements may have led to some inaccurate responses.

Conclusions: The relatively large percentage of general internists who left internal medicine mostly to work in another medical field explains why rates of MOC participation for general internists seem lower than those for subspecialists (77% vs. 86%). Although positive professional reasons clearly have a compelling internal influence on program participation, it is less clear whether employers' requirements are an equally compelling external influence. Although half of all respondents report that MOC is required by 1 of their employers, only one third of those who participate in the program describe it as a reason for participating.

Editors' Notes Context Maintenance of certification (MOC) by the American Board of Internal Medicine (ABIM) requires participation in its Continuous Professional Development program. Understanding the attitudes and perceptions of internists regarding the MOC process would be helpful in increasing participation in quality improvement efforts. Contribution Diplomates whose ABIM certificates were dated to expire by December 2002 were surveyed regarding reasons for participating or not participating in the program. The most common reasons for participation were to improve professional image and to update knowledge. Nonparticipants perceived MOC as too time-consuming. Implications In general, physicians seem to value the MOC process for its effort to improve quality of care and patient safety. —The Editors

 

Author and Article Information

From American Board of Internal Medicine and American College of Physicians, Philadelphia, Pennsylvania.

Acknowledgments: The authors thank F. Daniel Duffy, MD, and Louis J. Grosso, MEd, from the American Board of Internal Medicine; Linda Harris from the American College of Physicians; and Leslie D. Goode, MHS, from Maine Health Access Foundation.

Grant Support: None.

Potential Financial Conflicts of Interest: Drs. Lipner and Cassel and Mr. Fortna are employed by the American Board of Internal Medicine. Drs. Bylsma, Arnold, and Tooker are employed by the American College of Physicians.

Requests for Single Reprints: Rebecca S. Lipner, PhD, American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106.

Current Author Addresses: Drs. Lipner and Cassel and Mr. Fortna: American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106-3699.

Drs. Bylsma, Arnold, and Tooker: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.

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