The Maintenance of Certification (MOC) requirements established by the American Board of Medical Specialties (ABMS) and its
member boards, such as the American Board of Surgery (ABS), have been in place for approximately 12
years. Since then, MOC has been the source of considerable controversy and conflict.
The American College of Surgeons (ACS) leadership and our colleagues at the ABS, other boards, and
other medical associations understand that the existing MOC process is burdensome for many practicing
clinicians and are taking steps to address these concerns. Some individuals feel that these efforts have
proven ineffective and are now calling upon state
legislatures to take action. I believe that this approach
is foolhardy and that the profession itself is best positioned to resolve these issues.
Standards and controversy
Over the years, the ABS requirements for MOC
have called for diplomates to submit information
on the following every three years:
•Professional standing as evidenced by a full and unrestricted medical license and hospital or surgery
•A total of 90 hours of Category 1 Continuing
Medical Education (CME) credits relevant to
the physician’s practices over a three-year cycle,
with at least 60 of the 90 credit hours including
•Practice assessment demonstrated through partic-
ipation in a local, regional, or national outcomes
registry or quality assessment program
In addition, diplomates must successfully complete
a recertification examination every 10 years. This high-
stakes recertification exam is the source of much
of the debate, with some surgeons and other physi-
cians arguing that it does little to measure whether
a clinician is able to provide quality care.
In a memorandum sent July 7 to all diplomates
from ABS chair Mary E. Klingensmith, MD, FACS,
and ABS executive director Frank R. Lewis, MD,
FACS, the ABS announced that MOC reporting
requirements for the first three components will
change immediately to reporting only every five
years instead of three, and self-assessment CME will
be reduced by 50 percent. In 2018, diplomates will
be offered alternatives to the 10-year exam.
The ACS has a long history of advocating for and
setting standards relating to quality patient care,
and a key qualification for Fellowship in the College is certification from an ABMS surgical specialty
board, an American Osteopathic Surgical Specialty
Board, or the Royal College of Surgeons of Canada.
The College’s Statements on Principles reaffirm that
Fellows should engage in many of the activities outlined in the MOC requirements. Specifically, the
College expects Fellows to commit to lifelong learning through self-study, formal CME, and periodic
assessment of their clinical practices.
The College maintains that board certification
and MOC are valid means of verifying that surgeons have the educational background and competencies needed to provide quality care. This verification process is integral to ensuring that health
care professionals have the rare privilege of self-regulation.
Some physicians have sought legislative remedies
for their complaints about the MOC process. In
April 2016, Oklahoma enacted legislation that prohibits failure to comply with MOC mandates as a
reason to exclude a physician from hospital staff
appointment or from insurance company panels.
Other states have since followed suit. Perhaps the
most sweeping legislation has been introduced
in Texas, where state Senate bill S.B. 1148 would
restrict the ability of the medical profession to set
professional standards and would implement a state
registration system for any entity that provides
MOC to physicians.
by David B. Hoyt, MD, FACS