The ongoing controversy among US physicians over newly-implemented "Maintenance of Certification (MOC)" requirements created by the private organization, the American Board of Medical Specialties (ABMS) and its 24 subsidiary sub-specialty boards has breached another ethical front: paying for peer-reviewed publications in support of their expensive and proprietary MOC process.
In the Fall of 2013, the ABMS single-handedly funded an entire supplement devoted to the MOC process in the Journal of Continuing Education in the Health Professions. This journal is published quarterly by the Alliance of Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME of the Association for Hospital Medical Education. Not surprisingly, the articles published were uniformly favorable about the MOC process despite evidence to the contrary. The American Medical Association (who also stands to benefit from the process politically) was quick to provide a free link to the full pdf of the supplement from its AMA Wire news bulletin.
Interestingly, the literature review of the MOC process performed by Lipner et al. (page S20 of the supplement) admitted the limitations of their review:
"First, we did not consider certification by other entities other than ABMS boards; these results may not generalize to other certification bodies. Second, we did not use a formal system to judge the quality of the methodology used in the studies. Third, a meta-analysis to compared effect sizes across different data types was not done; designs were extremely diverse, and it may not be possible with the information available."
Given these limitations, the "value" of the MOC process, based on the data, is totally subjective. Despite these glaring limitations, the article concludes:
The main goal of certification is physician accountability to the public (editor: note that the "patient" and "doctor" are not mentioned). We have shown that a substantial body of evidence supports the value of certification and MOC in meeting that goal but the evidence is not unequivocal. In response, the ABMS have begun to enhance their programs to be more authentic and relevant to practice while maintaining their rigor and continuing to study the program’s validity."
If the way the ABMS "enhances" the value of its proprietary MOC process is to pay for peer-reviewed publications that ignore the serious limitations mentioned by the authors themselves, then those directly impacted by the MOC process (like myself) have an obligation to question the validity and ethics of the ABMS’s self-promotional practice.
I welcome the ABMS’s response regarding their practice of paying for publications in support of the MOC process in the comment section of this blog.
-Wes
