Oklahoma will become the first state to protect physicians without maintenance of certification (MOC) from losing their licenses, reimbursement, employment, or hospital admitting privileges.
Starting November 1, the effective date of Senate Bill 1148, hospitals and other employers will be prohibited from discriminating against physicians who opt to forego MOC, a process by which the American Board of Medical Specialties (ABMS), a private umbrella organization overseeing 24 specialty boards, recertifies them in their field of specialization.
Physicians will still be required to adhere to state licensing standards set by the Oklahoma Board of Medical Licensure and Supervision, which include earning 60 continuing medical education units every three years.
‘Govern Our Own’
SB 1148, sponsored by state Sen. Brian Crain (R-Tulsa County) and state Rep. Mike Ritze (R-Wagoner County), passed each chamber without receiving a single nay vote and was signed into law by Gov. Mary Fallin (R) on April 11.
Ritze, a licensed family practice physician, says doctors who meet Oklahoma’s strict licensure and continuing education requirements should not be coerced by ABMS into obtaining a maintenance of certification.
“We have to govern our own to make sure we have excellent quality and safe care, and one of those ways is licensing,” Ritze said. “Once you’re licensed and pass all the tests, you can become certified by your discipline—family practice, for example. All this costs time and money.”
‘Feather in the Cap’
Dr. Meg Edison, a board-certified pediatrician who has written about Oklahoma’s SB 1148 at the website Rebel.MD, says taking an initial ABMS exam and subsequently fulfilling MOC requirements are potentially irrelevant achievements.
“After completing residency, it’s like a feather in the cap to demonstrate that you have the academic mastery of your specialty,” Edison told Health Care News. “However, passing this exam and getting initial board certification has never been linked with better patient care or physician competency, as there are many things that go into making a good physician that a test cannot look for.”
MOC Claims of Quality ‘Unfounded’
Edison says although MOC is technically voluntary, ABMS has pressured insurers and hospitals to ban doctors who decline to pursue MOC.
“ABMS claims board certification and MOC are voluntary,” Edison said. “The truth is it is not voluntary. The ABMS has long lobbied the federal government, hospitals, and insurers to require board certification, claiming it is a marker of quality—with zero evidence to that claim. Insurers and hospitals know these claims of quality are unfounded, but they want to use board certification as a marketing tool: ‘All our doctors are board certified.'”
Loosen the Noose
ABMS is wielding its power to coerce doctors into an expensive and time-consuming recertification process, Edison says.
“ABMS is free to tighten the noose by ramping up costs and increasing testing requirements,” Edison said. “We’re trapped. If we don’t comply, we lose our jobs and can’t care for our patients. The power that these unaccountable outside boards have within each state to dictate what we learn and the research we perform on our patients is staggering.”
‘Enough Is Enough’
Edison voluntarily surrendered her pediatrics board certification on December 17, 2015, according to a January 11, 2016, open letter to the American Board of Pediatrics (ABP). She says her story has received almost 100,000 hits at Rebel.MD.
“Board certification should always be voluntary, just like the ABMS claims it is,” Edison told Health Care News. “Legislation like [SB 1148] just ensures it will always be voluntary.”
Ritze says he cosponsored SB 1148 because Oklahoma’s doctors won’t tolerate further ABMS coercion into MOC.
“A lot of doctors just said enough is enough,” Ritze said. “We are losing doctors to Obamacare, retirement, and doctors [are] saying ‘enough!’ We already monitor our own well enough and have had quality and safety and everything necessary. This was just the straw that broke the camel’s back.”
Model for the Country?
Other states may soon follow Oklahoma’s lead by prohibiting hospitals from banning doctors who forego MOC.
“We’ve been inundated by other states wanting to know how we passed the legislation,” Ritze said. “Michigan and Missouri are probably next. Kentucky has proposed legislation. I think you’ll probably see a landslide of states stepping up after our model legislation.”
Edison says SB 1148 exemplifies how lawmakers in other states can redirect power from ABMS to those actually providing and receiving health care.
“This is a model for the entire country,” Edison said. “Every state needs to do the same and protect their doctors and patients.”
Jenni White ([email protected]) writes from Oklahoma City, Oklahoma.
“Oklahoma’s Continuing Medical Education (CME) Requirements,” Oklahoma Board of Medical Licensure and Supervision, January 1, 2016: https://www.heartland.org/policy-documents/oklahomas-continuing-medical-education-cme-requirements
Matthew Glans, “Are Maintenance of Certification Programs a Money Grab?” Research & Commentary, The Heartland Institute, April 22, 2016: https://www.heartland.org/policy-documents/research-commentary-are-maintenance-certification-programs-money-grab
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