Primary care physicians’ perceptions of practice improvement as a professional responsibility: a cross-sectional study

Abstract

Continuous quality improvement is a component of professionalism. Maintenance of Certification (MOC) is a mechanism in the USA for physicians to keep current with medical knowledge and contribute to practice improvement. Little is known about primary care physicians’ perceptions of the practice improvement (Part IV) components of MOC. We aimed to determine primary care physicians’ perceptions of their professional responsibility to participate in Part IV MOC. This was a cross-sectional study of primary care physicians using the American Medical Association Masterfile. We developed a nine-item survey, designed from expert consensus and literature to determine views on Part IV MOC as a professional responsibility. We surveyed 1500 randomly selected primary care physicians via mail from November 2014 to May 2015. The response rate was 42% (627 of 1,500): 47% (273 of 585) were family practitioners and 49% (289 of 585) were internists. Factor analysis revealed a two-factor survey, with five items pertaining to positive views of MOC Part IV and four items pertaining to negative views. Internists were more likely to view MOC Part IV as time consuming (82.0% vs. 70.3%, P = .001), expensive (50.9% vs. 38.8%, P = .004), and not relevant to practice (39.1% vs. 23.8%, P < .001). Family medicine practitioners were more likely to view MOC Part IV as improving patient care (64.5% vs. 48.8%, P < .001) and maintaining professional responsibility (48.7% vs. 32.5%, P < .001). Regardless of specialty, most physicians viewed MOC Part IV as time intensive, not beneficial for career advancement, and not a professional responsibility. Family medicine practitioners demonstrated more positive views of MOC Part IV. The difference between family medicine practitioners and internists could be related to the ABIM MOC controversy. Future changes to practice improvement requirements could focus on limiting time requirements and on clinical relevance.Abbreviations: ABIM: American Board of Internal Medicine; AMA: American Medical Association; CQI: continuous quality improvement; IRB: institutional review board; MOC: Maintenance of Certification; QI: quality improvement

Doctors' attitudes to maintenance of professional competence: A scoping review

“…In multiple studies, doctors reported a lack of impact on practice as a result of participation in MPC 21,48,49,66,67,70,72,82,91,111,120,121,124 . Conversely, in several other studies, doctors felt that they gained knowledge relevant to their practice and that participation in MPC activities could or did result in improved patient care 40,60,62,74,79,85,90,93,98,100,113,122,123,125–134 …”

“…Participation in quality improvement was a particularly unpopular requirement of MPC 48,49,63,69,115,124,134,141,147 . A few studies, however, did find that doctors perceived value from participation in quality improvement activities 80,92,114,122,123,148,149 .…”

“…Time, cost, lack of resources, the difficulty for specific groups of doctors and the complexity of the process were the main barriers to meeting the requirements of MPC. MPC was often described as time consuming, 25,26,46,48,49,62,71,72,96,106,113,127,134,151 and multiple doctors felt that they did not have the time to complete the process 21,48,49,58,60,61,66,68,71,74,81,124,139,144,146,157–159 . The cost involved in MPC were considered prohibitive 21,39,48,49,58,61,63,67,71,74,81,102,104,117,119,144 .…”

Identification of Alternative Physician Assistant Recertification Models: An Analysis of the Landscape and Evidence Surrounding Approaches to Recertification in the Health Professions

“…A general survey of internists and family physicians revealed mixed opinions regarding the balance of burden and relevance and the potential to improve or advance clinical practice of practice improvement (Part IV) requirements, with most acknowledging the time intensive nature of the requirements and lack of benefit for career advancement. 88 Surveys of pediatricians and neuroradiologists revealed greater confusion about requirements, greater burden related to activities, and lower impact ratings for practice improvement (Part IV) requirements compared to self-assessment (Part II) MOC requirements. 58,89 Most family physicians, internists, and dermatologists participating in web-based practice improvement (Part IV) modules rated them as relevant to their clinical practice and likely to either change or reaffirm their clinical practice.…”

Developing a CPD model for Eswatini- A Participatory Action Research study.

“…In planning we looked at approaches to CPD that are workplace based and have been associated with improved patient outcomes(16, [23][24][25]. A number of activities where considered including the development of a learning plan, quality improvement projects, peer review of patient charts, the use of a diary and re ective practice.…”