ORLANDO -- Family physicians gathered here for the American Academy of Family Physicians Congress of Delegates wrangled for more than an hour over the "high stakes test" required for maintenance of certification (MOC) -- a somewhat puzzling harangue given the AAFP's almost 50 year commitment to mandatory recertification.
And it was that legacy requirement for recertification at 6-year-intervals that pulled the delegates back from the brink of a demand to ditch the "American Board of Family Medicine's (ABFM) mandatory high stakes examination as part of the ABFM recertification process."
More than one delegate warned that taking away the high stakes exam would also weaken physicians' arguments used to rein in scope of practice by nurse practitioners and other non-physician providers. By taking away MOC, and "relying instead on just the ability to prove that we attended educational sessions, we unravel arguments that were put together in opposition to expanding NPs' scope of practice," said a Colorado delegate.
Arizona delegate Andrew Carroll, MD, put it bluntly: "We don't want a race to the bottom."
An AAFP reference committee that reviewed the anti-MOC resolution signaled its sympathy with the resolution, but recommended that the delegates skip the demand to end the high stakes exam. In its place the committee called for asking the ABFM to change its MOC process to "reduce significantly both the annual expense and the time and work burden to a minimum ... and to improve [for those who miss a mandatory recertification exam] significantly (and without punitive measures) the reentry process for all previous diplomates who have maintained their licensure and lifelong learning through continuing medical education with the hope that changes will incentivize their return to the maintenance of certification process ... "
The reference committee also recommended the inclusion of language directing the AAFP leadership to ask the the American Board of Medical 51˶ (ABMS), which MOC opponents consider the villain of the piece, to back off any moves to block the ABFM from smoothing the sharp edges of its MOC process.
Lucius Lampton, MD, representing the Mississippi delegation, which was the sponsor of the original resolution, argued in favor of the resolution's original language, which included the demand to end use of the high stakes exam MOC component.
The AMA, Lampton said, was already on record demanding an end to the high stakes exam and "it is time for us to join with that [position]. ... physicians can contemplate nothing worse than a high stakes exam ... if we can approve this resolve we can send our board in the direction of reform."
Such a move, he argued, would assure AAFP members that "we don't have anything to fear rather than being asked at age 55 or 65 to fail a high stakes exam and be forced off the board at the hospital only to be replaced by an NP who does not have to take a high stakes exam."
"I going to take [the high stakes exam] next year at age 67," said Michael Grady, MD, a delegate from Oregon. He said his concern -- or fear -- was that "as we get older we tend to contract our practices. I do more geriatric and nursing home practice now," a change that suggests he doesn't need the broad range of knowledge covered by the high stakes test.
Yet, "the insurance company already let me know I'm not going to be re-certified unless I take this test. ... The ability to take computerized tests also is not a fair measure of practice skill or competence," Grady added.