A: I think what has been lost in the discussion about state legislative initiatives is that the importance of certification has held up incredibly well. States where the anti-MOC faction has had success usually involve a physician leading the movement. Interestingly, many of the anti-MOC arguments made by physicians, such as the amount of time spent on MOC, have been rejected by public lawmakers. I’m not saying these are not valid concerns. It’s just that, as physicians, we need to be careful about how we come across to the public and to policymakers. We don’t want to create the impression of a battle between medical self-interests and the public’s best interests.

There’s also very little discussion about states such as Oklahoma, which last year passed an anti-MOC bill that was unenforceable. When the bill was reintroduced this year, it was soundly defeated. In Michigan, anti-MOC bills were unsuccessful last year and have been reintroduced this year but are losing ground. Finally, the degree to which the bill passed in Texas will affect emergency medicine is uncertain.

Within the AMA, the Emergency Medicine Section has been a strong supporter of ABEM certification. Unfortunately, what’s been driving many of the AMA resolutions is not the desire to innovate or improve MOC but to return to lifetime certification. I think that sends a terrible message to the public, especially when research demonstrates that self-directed CME is largely ineffective. A big risk here is our ability to self-regulate. Medicine has lost its battles over cost control, access to care, and quality. We have been slow to address the issue of the aging physician, and now, some hospitals have started mandatory testing programs and making policies aimed at age-based forced retirement. Many of the anti-MOC initiatives surrender professional self-regulation to the government. That’s a horrible precedent. I think our best defense against government control is effective self-regulation through ongoing certification. That’s not just an ABEM concern; it should be a concern of every physician in every specialty.

Q: In what way is ABEM responding? Do you see changes coming to the ABEM MOC program, especially to the ConCert Exam?

A: What’s important to ABEM, and the specialty, is that ABEM wants to get any option or innovation right the first time. ABEM is actively exploring an option to the ConCert Exam, though I suspect that many physicians will still want to take the exam. During the past two years, several ideas have been floating around within our specialty about revising the ConCert, and we need to look closely at these ideas. ABEM has been actively examining pilots being conducted by other ABMS boards. Keeping in mind that ABEM certification will be time-limited and require episodic recertification, any changes will be a topic for open discussion with the entire emergency medicine community.