Maintenance of Certification (MOC) is an initiative of the American Board of Medical Specialties (ABMS), an organization of 24 approved medical specialty boards including the American Board of Psychiatry and Neurology (ABPN).
While the APA does not have the authority to ban or stop MOC, the APA is continually working on behalf of members to reform MOC, advocate against additional requirements, ensure requirements are relevant to psychiatric practices and establish a fair process for psychiatrists who demonstrate meaningful learning and improvement.
APA's Advocacy Priorities on MOC
- Ensure MOC status is not used for licensure, hospital privileges, or insurance paneling.
- Ensure psychiatrists receive credit for quality and practice improvement activities they are already completing within the scope of their own practice.
- Address concerns about the fees associated with maintaining certification.
- Reduce the burden of MOC as a contributor to physician burnout.
- Equip APA members with easy to use activities to meet the requirements of MOC in an efficient and cost-effective manner and that lead to improvement in patient care.
APA Actions to Advocate for Change to MOC
In 2021, the APA Board of Trustees reaffirmed its previous position that MOC should not be used as a condition of employment, insurance paneling, or state licensure and approved the following actions:
- Acknowledge NBPAS as an alternative to ABPN’s maintenance of certification program and provide information about NBPAS on its website. NBPAS is recognized at far fewer hospitals than ABPN certification, but is an alternative for some psychiatrists. APA will make members aware of this and other potential limitations of holding only NBPAS certification.
- Publicize to APA membership, and bring to the attention of the ABPN leadership, results of the APA survey of member reactions to ABPN MOC, areas of APA member dissatisfaction with MOC, and, on behalf of our members, ask ABPN to respond to these concerns.
- Work with ABPN to develop a society-based alternative to ABPN’s MOC program. If permitted by ABPN, this would allow APA to develop a MOC program which would be administered by the APA and be fully recognized by ABPN for meeting MOC requirements.
- Study the feasibility of APA developing its own certification and MOC programs, separate from ABPN and NBPAS. This study will include an examination of financial, legal, and ethical aspects of establishing its own certification board.
- Continue to create MOC products so that members participating in MOC will have access to high-quality, relevant, and low cost MOC products.
- Support the continued development of MOC products for members and support the PsychPro registry by accepting $2,000,000 in unrestricted educational grants from ABPN which will be used for the benefit of APA members. A similar grant was awarded to the American Academy of Neurology (AAN) for this same purpose. These funds will be used to create new and low-cost MOC products which will help APA members participating in MOC meet program requirements and continue to support the APA PsychPro Registry. This decision is consistent with the acceptance of previous unrestricted grants from ABPN in 2016, 2018, and 2020.
In 2019, the APA pushed back on ABMS's "vision" for MOC
The ABMS Vision Initiative Commission has released a draft report from their two-year study of the future of Maintenance of Certification (MOC). The APA responded to the report by saying that the Commission failed to improve the MOC process for physicians. Read APA's comments here .
In 2017, the APA Board of Trustees voted to approve the following motion:
Legislation tying licensure, hospital privileges and credentialing and/or participation on insurance panels to completion of MOC is not reasonable and would result in fewer qualified physicians available for patient care and further exacerbate already difficult access to care issues.
APA is supportive of legislation that has been introduced in 25 states and passed in 12 that eliminates MOC as a condition of employment, hospital admitting privileges, reimbursement, licensure and/or malpractice coverage.
The Board of Trustees voted unanimously in October 2015 to approve a letter relaying the following feedback to the ABPN:
- The APA does not agree that there should be an exam every ten years for MOC.
- Certification of lifelong learning should be an integrated, ongoing process relevant to actual practice.
- APA will work with ABPN to improve the certification of lifelong learning process – APA will recommend members for a committee to do this.
- Should there be an exam at any point; most questions should be related to the psychiatrist's subspecialty with the inclusion of some relevant general psychiatry questions.
- No psychiatrist should be forced to maintain her/his underlying general and subspecialty certification through more than one certification process.
The Board of Trustees voted to approve the following motion in April 2015:
The APA Board of Trustees, acting on the recommendation of the Assembly Executive Committee and representing over 36,000 psychiatrists, supports the elimination of Part IV of MOC. Therefore, the Board of Trustees recommends to the ABPN that it lobby and advocate the ABMS to eliminate Part IV of MOC, that the APA reaffirms its commitment to lifelong learning and quality improvement and support for the highest scientific and ethical standards of medical practice and that the APA will establish a joint Board and Assembly Work Group with the charge to evaluate the broad issue of maintenance of certification for psychiatry and its relationship to maintenance of state licensure and other accrediting bodies. The goal of the work group is to return timely reports to the Board and Assembly including recommendations, if appropriate, for any positions the APA should take regarding any and all parts of Maintenance of Certification.
APA has Made an Impact for our Members
The APA engages with ABPN in a face to face meeting each year to provide feedback from our members and advocate for further reforms. The APA President, President-Elect, Speaker of the Assembly, and other members of the Assembly attend these meetings. As a result of our engagement, the APA has helped accomplish the following things:
- As a result of an APA Assembly action paper, APA relayed concerns about the Patient Surveys, and subsequently, the ABPN removed the requirement in Part 4 of MOC. It is still an option, but not a requirement.
- As a result of an APA Assembly action paper, APA asked that other activities psychiatrists already engage in, such as QI projects, be allowed to count for Part 4. In 2015, ABPN agreed to add new methods to meet MOC requirements, including QI projects.
- Each year, APA has expressed member concerns to ABPN about fees — most especially on Initial Certification. In turn, ABPN announced a 5% reduction in Initial Certification fees for 2018. They have reduced all fees over the past decade for both Initial and MOC exams.
- In 2015, APA formally asked ABPN to advocate to ABMS for the elimination of MOC Part 4 until a program that is research verified to improve physician practice could be developed and put in place.
- In 2017, the ABPN announced an alternative to the 10-year secure proctored exam. Starting in 2018, eligible diplomates will be able to participate in an optional, journal-based, self-assessment program instead of taking the 10-year exam. Diplomates will be able to complete journal articles over a period of time and chose articles from an approved library which best align with their practice. This program is the result of years of advocacy to the ABPN from APA leadership and members, and it aligns with an action paper passed by the Assembly in 2017.
Get Involved, Provide Feedback, Help Advocate
The APA has established a standing committee of the APA Assembly and a member-wide MOC caucus to critically evaluate MOC and inform APA’s strategy for MOC reform. The APA will continue to participate in and provide feedback at ABPN meetings, including the ABPN’s annual Critical Issues Forum, to assert the needs of our members.
Please send us your feedback and let us know if you would like to participate in the MOC caucus. Contact us at [email protected].