Earlier this Spring, two states--Oklahoma and Kentucky--passed legislation freeing physicians from requirements to maintain specialty board certifications in order to keep their licenses and hospital privileges.
The fight over "MOC" has been heating up across the country in recent years.
In many states, specialists are mandated to renew their certifications periodically in order to maintain their licenses to practice. In other states there are no explicit requirements, however hospitals and managed care plans require recertification in order to participate in preferred provider networks or acquire hospital privileges.
A number of physicians groups have argued that maintenance of certification has become extremely burdensome, expensive, and time-consuming. Some practitioners within the holistic and functional medicine fields add that most specialty certification exams include nothing about prevention, nutrition, lifestyle change and other aspects of holistic practice. They resent having to spend large sums of time and money to re-learn concepts and modalites that are not relevant to how they practice.
Specialty board certification has a long history in this country. Originally, recertification was voluntary, and the process was promoted as a way to help physicians stay abreast of their rapidly evolving fields, and to promote a culture of quality improvement across the healthcare landscape.
But like many things that started out with good intentions, the certification process quickly became burdensome. Some states, as well as hospitals and health plans began setting requirements and mandates, and the costs of staying board-certified started to rise.
On April 12, Oklahoma governor Mary Fallin signed SB1148, a state bill that eliminates MOC requirements in that state. The new law states that nothing in Oklahoma’s medical licensure laws, “shall be construed as to require a physician to secure a maintenance of certification as a condition of licensure, reimbursement, employment or admitting privileges at a hospital in this state.”
"Right to Care"
The Oklahoma move came just a week after Kentucky's legislature passed a similar law pre-empting requirements for board-certification as a prerequisite for licensure in that state. Similar bills are under review in several other states including Missouri and Michigan.
The politics around the MOC issue are complex and contentious. Freedom from onerous MOC requirements has become a rallying cry among right-leaning libertarian physicians who believe that obligatory certification has made specialty boards fat, lazy, and narrow-minded.
"Our complaint isn’t against ABMS and their subspecialty boards. They can do what they want and require what they want of their diplomates. We cannot change that. Our complaint is with being forced to participate in an ever-changing process they claim is voluntary," writes Dr. Meg Edison, on Rebel.MD, a libertarian physicians' blog.
"We should be free to care for our patients, free to pursue novel clinical research, and free to choose our own continuing education. If ABMS and the subspecialty boards are providing a quality educational product at a good value, doctors should be free to participate. If doctors do not see educational value in ABMS MOC products, they should be free to pursue education elsewhere without fear of losing their jobs or ability to practice."
Edison, a pediatrician, hailed the Oklahoma move as a major victory. "One small step for Oklahoma, one giant leap for physicians."
She and others in the anti-MOC movement, frame the issue in terms of "right to care," a principle similar to the one invoked by anti-union critics promoting "right to work" legislation.
But MOC requirements also have critics from the leftward end of the political spectrum, who view the specialty boards as tools of the pharmaceutical industry that serve to perpetuate reductionistic, drug-based thinking throughout the healthcare system.
Oklahoma's Gov. Fallin, a Republican who also served a term in the US House of Representatives from 2007-2011, has a long track record for taking strong, culturally-conservative stances on many issues including same-sex marriage and the death penalty. Her name has been floated in Republican circles as a potential running mate for Donald Trump.
But the anti-MOC bill in Oklahoma passed unanimously, with support from Democrats and Republicans alike.
The controversy over specialty certification comes at an interesting time for the holistic amedical community. A number of groups, most notably the American Board of Integrative Medicine (ABOIM) has been fighting for recognition as a legitimate medical specialty.
But recognition is one thing, requirement is another. Critics of MOC are not necessarily dismissing the value of specialty certifications. Rather they believe it should be up to physicians themselves to choose whether to seek and maintain certification or not.