Large Majority of Family Physicians Participating In Voluntary Maintenance of Certification

In the May/June issue of Annals of Family Medicine which publishes on May 9, 2011, researchers report that the great majority of family physicians in the United States have current board certification and are actively engaged in the voluntary Maintenance of Certification process instituted by the American Board of Family Medicine in 2003 as a means to improve quality of care and continually assess clinical performance. Even so, this analysis into the geographic, demographic and practice characteristics associated with variations in MOC participation also reveals that family physicians practicing in poorer and underserved areas are more likely to have lapsed board certification and to have missed initial MOC certification requirements.

Researchers found that 85 percent of the 70,323 family physicians studied had current board certification, and 91 percent of all active board-certified family physicians eligible for MOC were participating in MOC. Physicians who worked in poorer neighborhoods (OR=1.105), were U.S.-born (OR=1.444) or foreign-born international medical graduates (OR=1.221), or were solo practitioners (OR=1.460) were more likely to have missed initial MOC requirements. Moreover, they found that family physicians over the age of 55 were almost twice as likely as their younger colleagues to have allowed their certification to lapse and were less likely to participate in MOC. The authors conclude that the widespread penetrance of MOC means it is a viable mechanism for the dissemination of information and has the potential to make a meaningful, national impact on health care quality. The authors note that as more studies link quality of medical care to board certification, it is troubling that physicians who have not maintained certification tend to be practicing in underserved areas or caring for underserved populations. High levels of health care disparities and the need for high-quality care in those areas, they assert, make it even more pressing to understand the barriers to participation in MOC by these physicians.


In an accompanying editorial, American Board of Pediatrics' Senior Vice President for Quality and Maintenance of Certification, Paul V. Miles, M.D., points out there are few other examples of voluntary programs that require investments of physician time and money that can match the documented levels of MOC compliance. At a time when there is widespread interest in how to change physician practice, MOC appears to be a strong potential driver for change, he asserts. He notes, however, that there is considerable room for improvement and calls for medical boards to identify and test focused interventions to improve participation, particularly among older physicians as well as those in solo practice and in underserved areas. Moreover, he calls for future research to determine whether physician participation in MOC is improving patient outcomes and closing gaps in quality of care.



Family Physician Participation in Maintenance of Certification
By Imam M. Xierali, Ph.D., et al
The Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, D.C.


Maintenance of Certification: The Profession's Response to Physician Quality
By Paul V. Miles, M.D.
American Board of Pediatrics, Chapel Hill, North Carolina


Angela Sharma
Annals of Family Medicine