Eyeworld

9 January 2018 EW ASCRS NEWS are not lazy. We actually like to work, but we like to do meaningful work," he said. "The problem is we don't think doing the MOC is meaningful." Dr. Hill said by the end of 2017 he had more than 90 hours of CME, not because he needed the credits, but again, because he thinks staying as current as possible is the right thing to do. For Dr. Hill, the crux of the issue is relevance. "There is a disconnect between what we do every single day and the maintenance of certification and a written exam," he said. "Written exam vs. an expert in the field tell- ing you what current best practices are? The difference is like day and night as far as I'm concerned." EW References 1. Cook DA, et al. Physician attitudes about maintenance of certification: A cross-spe- cialty national survey. Mayo Clin Proc. 2016;91:1336–1345. 2. Drolet BC, et al. Fees for certification and finances of medical specialty boards. JAMA. 2017;318:477–479. 3. Sullivan T. Anti-MOC laws picking up steam across the United States. Policy and Medicine. June 28, 2017. www.policymed.com/2017/06/ anti-moc-laws-picking-up-steam-across-the- united-states.html. Accessed Nov. 21, 2017. 4. Teirstein PS, et al. Boarded to death—why maintenance of certification is bad for doctors and patients. N Engl J Med. 2015;372:106–8. 5. Sharp LK, et al. Specialty board certification and clinical outcomes: the missing link. Acad Med. 2002;77:534–42. 6. Holmboe ES, et al. Assessing quality of care: knowledge matters. JAMA. 2008;299:338–40. 7. Fiorilli PN, et al. Association of Interventional Cardiology board certification and in-hospital outcomes of patients undergoing percutane- ous coronary interventions. J Am Coll Cardiol. 2014;63:2904–2905. 8. Leet TH. Certifying the good physician: a work in progress. JAMA. 2014;312:2340–2. 9. Teirstein PS, et al. The role of maintenance of certification programs in governance and professionalism. JAMA. 2015;313:1809–10. Editors' note: The physicians have no financial interests related to their comments. Contact information DeStafeno: jdestafeno@cceceye.com Hill: hill@doctor-hill.com Teirstein: Teirstein.Paul@scrippshealth.org an exam is written, by the time it's delivered, it's out of date. Dr. Hill, who has never had to do MOC because he was grandfa- thered in with ABO certification before 1992, became certified by NBPAS because "I thought it was the right thing to do," he said. NBPAS, of which Dr. Teirstein is founder and president, was formed in 2015 as an alternative certifica- tion board with continuing physi- cian education through CME at its core. Certification with NBPAS, as stated on its website, requires "(1) previous certification by an ABMS member board, (2) 50 hours of ac- credited CME within the preceding 24 months, (3) a valid, unrestricted license to practice medicine, (4) for procedural specialties, active privileges to practice that specialty at an accredited hospital, and (5) no history of hospital privileges in the desired specialty being perma- nently revoked." 9 Physicians with a currently lapsed certification must have completed 100 hours of CME within the last 2 years for NBPAS certification. These features of certification, Dr. Hill said, act as checks and bal- ances. "No one is skating by and not doing something, it's just we're not doing that. We're not doing mainte- nance of certification, which I think doesn't make as much sense as going to a good meeting and paying atten- tion, where everything is current as of this week. In an exam, questions are out of date the moment they're written," he said. The cost of NBPAS certification is $169 for first-time MD applicants and $189 for DO applicants. Renew- ing certification is $145 for MDs and $165 for DOs. According to the NBPAS FAQs, hospital acceptance of NBPAS certification for admit- ting privileges is generally decided by a vote of the hospital's Medical Executive Committee and its Board of Directors. NBPAS' website states that more than 60 hospitals accept NBPAS certification as of June 2017. When it comes to a system of maintaining one's certification, in general, Dr. DeStafeno said he thinks most physicians would likely recer- tify at some points in their career— they just don't want to be forced to do so. Dr. Teirstein in his presenta- tion to the CMA expressed a similar sentiment. "Doctors, in general,

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