ABU: MOC is clinically relevant, helpful to urologists

Q: What does Maintenance of Certification, or MOC, actually mean?

Maintenance of certification is a more hands-on or recurrent type of interaction between the diplomate and the Board that is designed to ensure that the physician is remaining up to date clinically. Instead of a long interval between examinations, such as 10 years, as the Board of Urology currently has, some type of interaction between the diplomate and the Board would be occurring more frequently, such as every 2 years. This process consists of an intervention that would educate the physician about changes that have occurred in urology.

A: MOC will go into effect in 2006 or 2007, pending approval by the American Board of Medical Specialties (ABMS).

Q: What is the genesis of the MOC movement?

A: The genesis of the MOC movement is not unique to the ABU in any way. A number of national organizations have, over time, addressed the issue of quality of care in American medicine. The national government has been involved in issues such as the number of duty hours, both residents and to some degree, practitioners, should be working. There have also been collaborations between industry and government, such as the Leapfrog Group, which looks at ways of improving medical care and reducing the number of medical errors shown to occur in American medicine.

At the state level, medical licensing boards have become more active. Some states are trying to tie licensure of the physician to an "estimation of competency" that shows the physician is up to date and practicing appropriately. This is highly variable from state to state.

The Accreditation Council for Graduate Medical Education (ACGME), which is involved with residency training, and the ABMS, which is the parent organization of all the boards, are working to keep whatever changes that might occur in medicine under the control of physicians, rather than a non-physician governing body. The ACGME created a series of competencies, which are various skills that residents and probably all physicians should be evaluated on or taught, including things like ethics, an understanding of the system they practice in, and so forth. The ABMS created the concept of Maintenance of Certification, a more frequent interaction with the diplomates of all the boards that would ensure that diplomates have a better handle on changes in medical care.

Thus, MOC is an attempt to improve the quality of medicine by making current information available to clinicians and making sure they understand that it is critical to their practices. A classic example is the use of beta-blockers to prevent cardiac problems in certain at-risk patients who are undergoing surgery. If you look at the data, nowhere near 100% of eligible patients are treated this way. In fact, it may be in the 60% to 70% range.

Q: Is it fair to say that the ABU and the ABMS are taking charge of a process that they can manage, as opposed to letting someone manage it for them?

A: Yes, I think that's one way of looking at it. Another way to look at it is, saying there aren't any problems in American medicine is a bit like putting your head in the sand. If we can do something prospectively to improve it, that should benefit patient care as well as our own discipline.