The American Board of Emergency Medicine’s (ABEM) improvements to its Maintenance of Certification (MOC) program may not grab national headlines, but the board has taken a methodical and diplomate-focused approach to the evolution of MOC, spearheaded by leaders who are also active members of the field of emergency medicine.
ABEM President Barry N. Heller, MD, a practicing emergency physician and assistant clinical professor of medicine at UCLA David Geffen School of Medicine, brings a passion for the specialty to his work at the organization. Elected President in August, Dr. Heller is no stranger to the ABEM. He has been a member of the Board of Directors since July 2008 and has served on the Executive Committee since 2012.
He recently shared with ACEP Now his objectives for his presidency and his vision for the future of the organization.
What are your goals during your term as ABEM President?
Dr. Heller: First and foremost, I want to continue ABEM’s commitment to delivering the best possible physician assessment for initial and continuous certification. ABEM multiple-choice question examinations focus on complex cognitive skills such as clinical synthesis and diagnostic processing, not purely fact recall. This emphasis carries over into the design of the In-training Examination and the ConCert (Continuous Certification) Examination. After nearly a decade of development and the commitment of substantial financial resources, ABEM recently introduced the Enhanced Oral Certification Examination (eOral) format. The eOral format creates a more authentic experience to the current oral examination. The amount of effort the ABEM Board, its hundreds of volunteers, and ABEM staff have expended on this project has been herculean. The psychometric rigor of the process and the enthusiasm with which the eOral format has been received have been very encouraging.
I also want to explore ways to increase the value of ABEM’s MOC program to our diplomates. When you examine the cost and time commitment emergency physicians spend in MOC, it’s fairly modest. The annualized cost of MOC is $265, which is about $5 per week. ABEM has kept the cost of the Lifelong Learning and Self-Assessment (LLSA) activity fixed for the past four years and the ConCert Examination unchanged for the past three years. ABEM’s participation in the Physician Quality Reporting System (PQRS) MOC bonus program through the Centers for Medicare & Medicaid Services added nearly $4 million in available revenue for emergency physicians. ABEM also provides low-cost CME opportunities with the LLSA through ACEP and the American Academy of Emergency Medicine (AAEM). All of the revenue from the CME activity goes to ACEP and AAEM as the accredited CME providers.
I recognize that the MOC program is not perfect. We, the ABEM Board of Directors, are continually looking for ways to improve the value, relevance, cost, and meaning to our diplomates. As one prong of this approach, we are watchful of changes made by other boards to their MOC programs. For example, we are closely watching how the American Board of Anesthesiology is changing from an every-10-year exam to weekly online quizzes. If this pilot is successful, we could see how this approach might be applied in the ABEM MOC program.
What is your vision for ABEM, especially as it impacts other organizations?
BH: There are so many challenges facing the specialty and plaguing emergency physicians. I believe that our specialty is made stronger by working in collaboration with the various membership organizations serving our specialty. We all need to find ways to work in harmony with one another and not waste time bickering over differences. When that happens, we lose, the specialty loses, and ultimately, our patients do not get the best that our specialty has to offer. ABEM can serve as a convener of the emergency medicine community, much as we have done with the EM Model Task Force. More recently, we brought together every key EM organization for an MOC summit to explore ways of improving the program and had a similar summit on the issue of board eligibility last fall.
ABEM works to promote its mission to ensure the highest standards in emergency medicine. It has been energizing to collaborate with so many organizations in emergency medicine. For example, ABEM appreciates the opportunity to work with ACEP on the development of clinical quality measures that are relevant and are aligned with the ABEM MOC program. The potential for working with ACEP to participate in the Clinical Emergency Data Registry in order to reduce the reporting requirements for Part IV Practice Improvement activities is quite exciting. If we can build the appropriate interface, reviewing and reacting to one’s clinical performance reports would automatically be reported to the ABEM MOC program. This would obviate the need for a separate attestation and aligns with ABEM’s desire to lessen the burden of MOC reporting for our diplomates.
“I also want to explore ways to increase the value of ABEM’s MOC program to our diplomates. When you examine the cost and time commitment emergency physicians spend in MOC, it’s fairly modest.”
What initially drew you to the specialty of emergency medicine and ABEM, in particular?
BH: I was lucky enough to have been in a traditional rotating internship, with one month in obstetrics, neurosurgery, emergency medicine, and so on. I say I was lucky because I think the loss of opportunities to see all these different disciplines significantly complicates the decision to choose a specialty in today’s environment. After several months working on different services, I came to the emergency department, and I was amazed at how much I enjoyed the many aspects of emergency medicine that make it so attractive to all of us. Furthermore, the role models I encountered in the ED, people such as Bob Rothstein, MD, our first emergency department chair [at Harbor-UCLA Medical Center in Torrance, California], made an even bigger impression and convinced me that this specialty was the best match for me.
My initial impression of ABEM was when I took the oral exam; it was a remarkable examination. I was impressed with the sophistication of the examination structure as well as the logistics of its administration. It was clear to me that ABEM was focused on quality, and I wanted to learn more about the Board. I also wanted to give something back to the specialty that had served me so well. I had two great mentors who encouraged me, Howard Bessen, MD, and Bob Hockberger, MD. They are two great leaders in our field, and both served on the ABEM Board of Directors. My connection with ABEM started in earnest when I became an oral examiner. Advancing through the organization has been a professionally rewarding experience.
Where do you see ABEM heading?
BH: As medicine changes, especially in the area of physician quality reporting, ABEM needs to create a relevant, sensible way to help physicians stay current and to assure the public that emergency physicians are doing so. One attribute that I bring to ABEM is the perspective of the community physician. I’ve been clinically active at the same community hospital for 32 years. ABEM has over 32,000 diplomates, and most of them do not work in a residency program. It is important to remember the challenges that all of our diplomates face in trying to deliver the best care possible and demonstrating their continuing competency and commitment to improvement.
I see ABEM continuing its refinement as the gold standard in certification and applying best practices to every type of physician assessment. The transition from an episodic physician testing organization to one of continuous physician assessment will be ongoing. The most important goal for ABEM is to be true to our mission statement: to ensure the highest standards in the specialty of emergency medicine. I also hope that we can continue to improve our specialty so that, in addition to being the best in our field, we can always end our shifts with the feeling that we have done something useful. By listening to physicians and creating better links with the tremendous organizations supporting our specialty, I think we can achieve our mission.