Labeled MOC for Maintenance of Competence or Maintenance of Certification, these programs aim to insure up-to-date competence of board certified physician specialists on staff at hospitals and clinics. They gained prominence after 1999 surveys reported significant numbers of hospitalized patients dying from medical errors. The ABCMO program to insure specialist competence, Maintenance of Specialist Competence (MSC) is found in Article 19 of the ABCMO Bylaws.
While optometry has areas suitable for specialist post-graduate training and specialist certification, only two specialties, medical optometry and low vision, have established hospital-based residency training programs and only medical optometry has a national test of competency (Advanced Competence in Medical Optometry) required by a specialty board that issues specialty certifications.
Background and Development of MOC Programs
In 1999 many medical specialist certification boards issued lifetime certifications but others required continuing education, training and/or testing programs before renewing the time-limited board certifications they issued. Medical specialist certifications are earned by completing medical or osteopathic school, receiving an initial state license “to practice medicine” and then entering post-degree residency training in a specialty of medicine and then passing a specialist examination approved by a recognized specialist certifying board.
Note: To the general public a “specialist” implies a person offering a specific service and a “professional” charges for that service.
But, at Joint Commission accredited health facilities a “specialist” means a licensed physician, dentist, optometrist or podiatrist who has had advanced training and competence in a specialty within their profession.
Like physicians, dentists and podiatrists, optometry is an independent licensed profession and not a specialty within another profession and holding a license to practice does not certify one is a specialist.
Physician specialties developed first, prior to WWII, and were supported by hospital organizations as medicine was developing more complex treatments better performed within hospitals. Because these procedures carried more risks, hospitals began to require board certified medical specialists join their staff to perform them. Only later did dentistry, podiatry and finally optometry develop specialties and certifying boards.
The development of specialties arose at the clinical level when medical practitioners began traveling to, and working with, known specialists as a “resident’. Residency programs grew in numbers after WWII when returning veterans used their GI benefits to seek specialty training. By 1980 medical specialization had become the norm and about 80% of today’s medical school graduates become board certified specialists.
But, following the 1999 surveys finding error-caused death rates among hospitalized patients, questions arose as to whether medical specialist certifications should all be issued with expiration dates and renewals of certifications require proof of additional education and training in the specialty to maintain competence.
In 1999, the Institute of Medicine (IOM), one of the National Academies, completed a survey and then issued a report that recommended changes in how specialists renew their certifications. The IOM survey estimated as many as 98,000 hospital patients died each year from medical errors and led to questioning whether lifetime specialty certifications should be stopped and new certifications be issued with expiration dates (10 years was suggested) with standards to be met for renewals of certifications to insure physician specialists stayed up-to-date.
The IOM Committee on Quality of Health Care in American published its recommendations in “To Err is Human: Building a Safer Health System”.
Among the IOM recommendations were these ^
- Implement periodic re-examinations and re-licensing of doctors, nurses, and other key providers, based upon both competence and knowledge of safety practices; and
- Work with certifying and credentialing organizations to develop more effective methods to identify unsafe providers and take action.
The IOM and other studies had produced a general consensus that physician specialty boards should:
- Issue initial board certifications that carried expiration dates.
- Renewals should require evidence the physician specialist has maintained initial competence and kept pace with developments and techniques in their specialty.
In the past 19 years some physician specialty boards have, in the opinion of those they certified, gone too far by setting up expensive and time consuming MOC programs for renewals of certification. A number of specialist groups have also felt their MOC programs were overpaying administrators, providing overly opulent offices, holding board meetings at luxury resort settings or motivated by greed.
As a result, some years ago, the American Board of Medical Specialists that oversees the 24 MD specialist boards, created a review and advisory group that, since then, has been striving, via a series of meetings and surveys, to overhaul and establish standards by which their 24 specialty boards conduct MOC and renewal of specialist certifications.
But to date a comprehensive set of standards to be met by ABMS specialty boards has not been published and it is not yet clear what those revised standards will be.
Having witnessed the backlash against physician specialty MOC, our initial MSC was designed to be simple and inexpensive. It required a signed statement be on file from specialists in medical optometry that they would fill all their non-specified CME hours (required by their state licensing board for license renewals) with COPE approved CME hours dealing with diagnosis and treatment of medical conditions affecting vision.
In other words, pledge they would stay current with developments in medical optometry by filling all CME hours required for license renewals with courses directed at the diagnosis and treatment of medical conditions affecting vision. They would still have to fill any mandatory, non-medically-related CME hours required by their state licensing board.
Resulting Changes to MSC
After January 2021, a “Proof of Attendance” at COPE approved courses addressing diagnosis and treatment of medical conditions affecting vision will be required to fulfill MSC renewals of certification. Complete details will soon be placed in Article 19 of the bylaws and Proofs of Attendance will be required starting January 1, 2021.
These Proofs of Attendance can be a copy of the statement of type of CME hours attended at COPE courses over the last 1 or 2 years (depending on license renewal cycle time) that is sent by COPE to the specialist.
To Err is Human: Building a Safer Health System (ISBN 0-309-0837), Committee on Quality of Health Care in America, Institute of Medicine, The National Academies, June 2000, National Academy Press, Washington, DC 20418. Full text available at www.nap.edu/readingroom. Report can be purchased at The National Academies Press.
^These recommendations were directed only at board certified medical (allopathic and osteopathic) specialists treating hospitalized patients since the deaths occurred within hospitals. The IOM did not study or make recommendations about medical practitioners at private offices and clinics.
#No studies or recommendations were made regarding dentists, optometrists and podiatrists in general practice.
*Some optometry commentators mistakenly concluded the 1999 IOM study of board certified medical and osteopathic specialists would lead to requirements that general practice optometrists be required by insurance companies and vision panels to be “board certified” and enroll in MOC programs for recertification. That has not happened. But a certification board for general practice optometrists (ABO) was formed and only 4% of general practice optometrists have chosen to be certified by it.