MOC Part IV

MOC stands for Maintenance of Certification and Part IV refers to the Practice Performance Assessment component of MOC. Here are the 4 parts of MOC defined by the American Board of Medical Specialties.

• Part I Licensure and Professional Standing: Hold a valid, unrestricted medical license
• Part II Lifelong Learning and Self-Assessment: Educational and self-assessment programs determined by your Member Board
• Part III Cognitive Expertise: Demonstrate your specialty-specific skills and knowledge
• Part IV Practice Performance Assessment: Demonstrate your use of best evidence and practices compared to peers and national benchmarks

Depending on your medical specialty, you may have noticed recent changes to Part IV. In fact, these changes have generated significant confusion (and controversy) among physicians who are not accustomed to the routine practice of individual performance assessment and quality improvement.

The American College of Cardiology Foundation has put together a nice MOC Part IV Activity Decision Tree. You'll notice that if you're not currently engaged in direct patient care, you may contact ABIM to see if you are entitled to a waiver for Part IV.

ABMS Board Eligibility Periods and Transition Dates

Last week, the American Board of Medical Specialties (ABMS) published their "ABMS Board Eligibility Periods and Transition Dates." Most physicians have between 5 to 7 years to remain "board eligible" before they must either: 1) become board certified, or 2) start over. I'm over-simplifying, but gone are the days of being grandfathered into a "board eligible" status (BE or board eligible was never formally recognized by the ABMS until now).

When you see a job advertisement that specifies that a physician must be BE or BC, you'll know what they're talking about:

BE = board eligible
BC = board certified

The ABMS Board Eligibility Policy can be viewed here.

Career outcomes of medical school graduates who failed USMLE Step 1 on the first attempt

What happens to medical students who struggle with USMLE Step 1? Do they have a different career outcome compared to their peers who don't struggle with standardized exams? The following is an abstract from a journal article titled, "Academic and professional career outcomes of medical school graduates who failed USMLE Step 1 on the first attempt."

This study sought to determine the academic and professional outcomes of medical school graduates who failed the United States Licensing Examination Step 1 on the first attempt. This retrospective cohort study was based on pooled data from 2,003 graduates of six Midwestern medical schools in the classes of 1997-2002. Demographic, academic, and career characteristics of graduates who failed Step 1 on the first attempt were compared to graduates who initially passed. Fifty medical school graduates (2.5 %) initially failed Step 1. Compared to graduates who initially passed Step 1, a higher proportion of graduates who initially failed Step 1 became primary care physicians (26/49 [53 %] vs. 766/1,870 [40.9 %]), were more likely at graduation to report intent to practice in underserved areas (28/50 [56 %] vs. 419/1,939 [ 21.6 %]), and more likely to take 5 or more years to graduate (11/50 [22.0 %] vs. 79/1,953 [4.0 %]). The relative risk of first attempt Step 1 failure for medical school graduates was 13.4 for African Americans, 7.4 for Latinos, 3.6 for matriculants >22 years of age, 3.2 for women, and 2.3 for first generation college graduates. The relative risk of not being specialty board certified for those graduates who initially failed Step 1 was 2.2. Our observations regarding characteristics of graduates in our study cohort who initially failed Step 1 can inform efforts by medical schools to identify and assist students who are at particular risk of failing Step 1.

Adv Health Sci Educ Theory Pract. 2012 Apr 7.

Authors: McDougle L, Mavis BE, Jeffe DB, Roberts NK, Ephgrave K, Hageman HL, Lypson ML, Thomas L, Andriole DA.

PMID: 22484965

ACRP Certification

Find out what more than 25,000 clinical research professionals already know. Earning your designation demonstrates you have achieved the clinical research industry's premier Certification. This career milestone will validate your clinical research knowledge, skills, and application — apply for Certification today.

CCRA® — Certified Clinical Research Associate
CCRC® — Certified Clinical Research Coordinator
CPI® — Certified Physician Investigator

Benefits of Certification include:

• Evidence of experience and qualifications of a research team
• Validation of competency when considering a new employee
• Reduction of risk to research subject
• Recently, evidence has indicated that regulators believe ACRP Certification Programs result in fewer errors, lower costs, more rapid turnaround, and greater safety in clinical trials when Certified professionals are involved. 

Since 1992, the Association of Clinical Research Professionals (ACRP) has been the leading certifier of clinical research professionals with almost 24,000 professionals holding a designation from our accrediting bodies to date.

Clinical Informatics Becomes a Board-certified Medical Subspecialty Following ABMS Vote

September 22, 2011
AMIA to offer prep courses for clinicians who sit for Board Exam

Washington, DC—Today, AMIA—the association for informatics professionals—announces the success of a multi-year initiative to elevate clinical informatics to an American Board of Medical Specialties (ABMS) subspecialty certified by an examination administered by the American Board of Preventive Medicine and available to physicians who have primary specialty certification through the American Board of Medical Specialties. Joining such subspecialties as pediatric anesthesiology, medical toxicology, sports medicine, geriatrics medicine, and cardiovascular disease, clinical informatics (CI) certification will be based on a rigorous set of core competencies, heavily influenced by publications on the subject that were developed by AMIA and its members, many of whom have pioneered the field and supported CI’s new status as an ABMS-recognized area of clinical expertise. The goal for the first board exam is to have it available in Fall 2012, with the first certificates awarded early in 2013. To prepare physicians who wish to sit for this examination, AMIA is developing preparatory materials both as online and in-person courses starting Spring 2012.

"It is entirely appropriate and timely to certify clinical informatics as a specialized area of training and expertise in an era when more and more clinicians are turning to data-driven, computer-assisted clinical decision support to provide care for their patients," said AMIA’s Board of Directors Chair Nancy M. Lorenzi, PhD, of Vanderbilt University Medical Center. “Clinical informatics blends medical and informatics knowledge to support and optimize healthcare delivery."

Clinical Informatics emerging as an ABMS-approved medical specialty

Right now, you can get a master's degree in informatics. You can complete a fellowship in informatics. However, there is no established "Clinical Informatics" medical speciality recognized by the American Board of Medical Specialties (ABMS). That's about to change.

According to a story on InformationWeek Health Care:

A committee of the American Board of Medical Specialties (ABMS) on July 27 recommended that clinical informatics be defined as a subspecialty of the American Board of Preventive Medicine and the American Board of Pathology, the two specialty boards that cosponsored the proposal. The ABMS board of directors and the ABMS assembly are expected to approve the recommendation in late September.

...board-certified physicians... will be eligible to sit for the board exam in clinical informatics... physicians currently working in the clinical informatics field will not have to go through a training program to sit for the board exam... there will be a pathway to board certification that doesn't require training in a certified program if candidates have significant experience in the field...

Residency, board certification, or medical license not required for these non-clinical jobs

The other night during our NonClinicalJobs conference call with Dr. Steven Peskin, someone asked whether board certification was a requirement for non-clinical jobs within the pharmaceutical industry. Depending on the type of job, board certification, residency, or medical licenses are not required.

In general, an active medical license will not be required for most jobs where you are directly employed by a pharmaceutical company.  Some physicians who work for a pharma company may choose to moonlight once/month, so you'll need a medical license if you plan to do that.

Residency and/or board certification (active or previous) may be required for certain positions that require you to oversee certain areas of specialization. Keep in mind that some cardiovascular clinical studies may get managed by an internist who works within a pharmaceutical company. Or, a clinical study involving orthopedic surgery may be managed by a pharmaceutical VP of Medical Affairs who is a general pediatrician. Therefore, if you're a generalist, you may have the opportunity to expand into specialty areas. If you're already a specialist, then you may not have an easy time expanding into other specialty areas that don't specifically overlap with your specialty (eg, if you're a psychiatrist, you probably won't oversee oncology studies).

Take a look at some of these jobs:

• Medical Officer
• Drug Safety
• Medical Science Liaison  
• Clinical Research

Remember that many of these pharmaceutical jobs are filled by professionals who have a PharmD or PhD. Therefore, residency training is often not a requirement for many positions in the pharmaceutical industry.

Private tutoring

Do you enjoy teaching? You may wish to consider some non-clinical private tutoring opportunities in your area. If you're retired and you miss those teaching days, then this may be the perfect opportunity for you to consider.

There are always medical students who are looking for tutors because they struggle with USMLE Step 1 or Step 2. There are other medical students who are seeking tutors because they're struggling with their course work (students always seemed to struggle especially with physiology). Don't live near a medical school? Then you may not have too many clients, but you'll still run into that occasional student who may return home to study for the boards.

When I was a college student at MIT, I began making some extra income by tutoring high school students (science, math, SAT prep, etc.). Then, when I was in medical school, I spent some time tutoring college students (biology, chemistry, MCAT prep, etc.). When I graduated from medical school, I found myself tutoring medical students (primarily with USMLE Step I). So the cycle always seems to continue. Now, I offer career counseling services for physicians, so I'm still teaching (it's not tutoring, but it involves some elements of teaching).

If you like the personal interactions of tutoring, then you may wish to consider this as a part-time venture. It's a great non-clinical job if you want flexibility. You may find that in your area, the need for medical tutors is quite great. As a result, you could have a busy business in no time. You may also find that high school and college students may be very interested in your educational services. If you're a motivated entrepreneur, then you may be quite successful.

American Board of Quality Assurance and Utilization Review Physicians

How do you pronounce ABQAURP? It stands for the American Board of Quality Assurance and Utilization Review Physicians. They offer Health Care Quality and Management (HCQM) Certification through an online study course and then a certification exam. Once certified, you can hang a certificate that says, "Diplomate of the American Board of Quality Assurance and Utilization Review Physicians, Inc." The ABQAURP is the only Health Care Quality and Management organization with an exam developed, administered, and evaluated through the National Board of Medical Examiners (NBME). So, you may want to learn more if you have an interest in working in quality improvement, utilization management, managed care, risk management, case management and workers' compensation. 

The World of Medical Education

The world of medical education can be broken down in so many different ways.

First: professional vs. consumer health education

If professional, then: promotional vs. certified continuing education (or certified CME/CE)

Let's talk a bit more about professional health education since we all know about WebMD and Revolution Health.

The world of promotional education is governed by strict FDA guidelines. Plus, don't forget the PhRMA code. There is no off-label discussion within a promotional activity. Also, speakers are recruited directly by the pharma/biotech/device company. The content does not need to be fair-balanced and there is no governing body that certifies those activities for any type of continuing education credit.

In the world of certified CME/CE, the rules are completely different. Here, you can discuss off-label use of medications. As a faculty speaker, you are to have no communications with the pharma/biotech/device company. Also, you don't get paid directly from a drug company. The educational content must be fair-balanced and the ACCME acts as a governing body to provide rules and regulations regarding certified CME (the CE for nurses and pharmacists are governed by other bodies). The PhRMA code has rules regarding CME.

Surprisingly, many healthcare professional are not aware of the distinction between non-certified medical education and certified medical education. Since the rules are constantly changing, it's important to stay updated on the latest guidelines and codes. The PhRMA code just got revised and the ACCME guidelines are constantly in flux.

Non-ABSM Board Certification for Medical Doctors

The American Board of Medical Specialties (ABSM) has a list of general and subspecialty medical board certifications. Many consumers don't realize that there is no board certification as a "general practitioner." Family physicians and general internists may refer to themselves using that term since people are familiar with the phrase "GP."

Even healthcare professionals do not realize that "doctors" can get board certified in other fields that are not listed by the ABSM. For instance, the American College of Physician Executives (ACPE) offers board certification education. You can become board certified in medical management by the Certifying Commision in Medical Management (CCMM) and become a certified physician executive (CPE). You're probably a physician involved in serious management responsibilities if you're pursuing that board certification. Some doctors interested in non-clinical opportunities have also received this certification. You can also get board certified in medical quality by the American College of Medical Quality (ACMQ).

The American Board of Integrative Holistic Medicine (ABIHM) offers board certification in holistic medicine. Some people have very strong opinions about alternative medicine, so I won't get into that somewhat controversial topic right now. You can also become board certified by the American Board of Medical Accupuncture (ABMA).

Have you heard of the American Board of Environmental Medicine (ABEM)? They offer board certification. How about the American Board of Medical Physics (ABMP)?

You can become a fellow of the American Medical Informatics Association (AMIA). I do not believe they offer board certification at this time. However, I think that's likely to change in the future.

Well, that's enough for now. I'm sure there are others out there, so I welcome comments from those who know of other non-ABSM board certifications that are available to US physicians.