175.023 Initial Guiding Principles on Maintenance of Certification


Initial Guiding Principles on Maintenance of Certification: The Texas Medical Association believes in the following guiding principles regarding maintenance of certification: 


  1. Good medical practice necessitates a commitment by each physician to life-long learning.
  2. Physicians have a social contract to maintain professional competency throughout their professional careers.
  3. Action is needed to maintain the privilege of self-governance and decrease the potential for governmental interference.
  4. Maintenance of certification (MOC) should be a meaningful process deeply rooted in best practices, responsive to participating physicians, and highly valued by physicians and the public. 


Impact of MOC

  1. MOC should not be a mandated requirement for licensure, credentialing, hospital privileging, payment, network participation, or employment (TMA Policy 175.021).
  2. MOC should not be a revenue-generating enterprise for the specialty boards but rather a service provided to its diplomates. MOC programs should have fiduciary responsibility to their diplomates.
  3. The American Medical Association should continue to monitor MOC processes to ensure they do not have a detrimental impact on the physician workforce, resulting in shortages and access barriers, due to a high loss rate of physicians unwilling or unable to participate in the MOC process (current AMA policy). 


MOC Operational Characteristics 

  1. The MOC process should be based on evidence and designed to identify performance gaps and unmet needs, providing direction and guidance for improvement in physician performance and delivery of care.
  2. The MOC process should use multiple options to recognize and accommodate different learning styles for physicians.
  3. The MOC process should be designed with sufficient flexibility to accommodate the broad variety of physician practice characteristics, including nonclinical activities such as teaching, leadership roles, administrative, and research.
  4. Physicians with lifetime board certification should not be required to seek recertification but should be afforded the opportunity for voluntary recertification.
  5. High-stakes exams, including closed-book exams, should not be mandated as part of the MOC process.
  6. Charges to physicians in relation to the MOC process should not be cost prohibitive but should be reasonable, not resulting in a barrier to practice.
  7. Changes to the MOC process should undergo a vigorous evaluation to ensure the requirements are relevant, feasible, reasonably affordable, and accessible.
  8. Individual boards should develop MOC requirements in conjunction with evaluation and feedback from its diplomates.
  9. ABMS boards should make a diligent effort to inform diplomates about changes in MOC requirements, including the rationale or evidence behind the changes, and allow sufficient time for diplomates to make any changes necessary to comply with those requirements.
  10. MOC requirements should be updated to reflect ongoing changes in health care delivery systems and medical practice, including the establishment of new fields of medicine.
  11. The MOC process should be evaluated periodically to measure physician satisfaction, knowledge uptake, intent to maintain or change practice, and assess the impact on individual practices and the specialty as a whole.
  12. Diplomates should have flexibility in selecting sources of MOC-related continuing medical education (CME) programming and should not be mandated or limited to participation in CME provided by American Board of Medical Specialties member boards.
  13. Physicians should be exempted from MOC for no less than five years after attainment of initial board certification.
  14. Patient satisfaction programs such as the Consumer Assessment of Healthcare Providers and Systems patient survey are neither appropriate nor effective survey tools to assess physician competence in many specialties and should not be part of the MOC process.
  15. The MOC program should be a tool for process improvement and should not be constructed as a punitive measure to the detriment of physicians’ practices. Careful consideration should be given to the use of physician-specific data to be publicly released regarding MOC participation.
  16. The MOC program should use commonly accepted practices for identifying core competencies applicable across specialties but also should provide the flexibility necessary to reasonably reflect the distinct characteristics of each specialty.
  17. The MOC process should be streamlined to prevent overburdening physicians with more than one board certification by removing duplicative requirements. MOC requirements for diplomates with added qualifications should be applicable to the diplomate’s primary area of practice (CME Rep. 6-A-17).


Last Updated On

June 20, 2019