Family Physician Participation in Maintenance of Certification

Abstract

PURPOSE The American Board of Family Medicine has completed the 7-year transition of all of its diplomates into Maintenance of Certifi cation (MOC). Participation in this voluntary process must be broad-based and balanced for MOC to have any practical national impact on health care. This study explores family physicians' geographic, demographic, and practice characteristics associated with the variations in MOC participation to examine whether MOC has potential as a viable mechanism for dissemination of information or for altering practice. METHODSTo investigate characteristics associated with differential participation in MOC by family physicians, we performed a cross-sectional comparison of all active family physicians using descriptive and multinomial logistic regression analyses.RESULTS Eighty-fi ve percent of active family physicians in this study (n = 70,323) have current board certifi cation. Ninety-one percent of all active board-certifi ed family physicians eligible for MOC are participating in MOC. Physicians who work in poorer neighborhoods (odds ratio [OR] = 1.105; 95% confi dence interval [CI], 1.038-1.176), who are US-born or foreign-born international medical graduates (OR = 1.444; 95% CI, 1.238-1.684; OR = 1.221; 95% CI, 1.124-1.326, respectively), or who are solo practitioners (OR = 1.460; 95% CI, 1.345-1.585) are more likely to have missed initial MOC requirements than those from a large, undifferentiated reference group of certifi ed family physicians. When age is held constant, female physicians are less likely to miss initial MOC requirements (OR = 0.849; 95% CI, 0.794-0.908). Physicians practicing in rural areas were found to be performing similarly in meeting initial MOC requirements to those in urban areas (OR = 0.966; 95% CI, 0.919-1.015, not signifi cant).CONCLUSION Large numbers of family physicians are participating in MOC. The signifi cant association between practicing in underserved areas and lapsed board certifi cation, however, warrants more research examining causes of differential participation. The penetrance of MOC engagement shows that MOC has the potential to convey substantial practice-relevant medical information to physicians. Thus, it offers a potential channel through which to improve health care knowledge and medical practice. INTRODUCTIONM aintenance of Certifi cation (MOC) was approved by the American Board of Medical Specialties (ABMS) in 2000 and adopted by ABMS member boards to promote improvement in the quality of care delivered by certifi ed physicians. The move by ABMS member boards from assessors of competency to agents of quality improvement required a transition from encouraging lifelong learning and performing intermittent recertifi cation to more continuous assessment of professionalism, lifelong learning, cognitive expertise, and performance in practice. This new approach is also an effort to increase public accountability by boards and the physicians they certify. Whether these aims are being met requires regular assessment of the MOC process...

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