Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Monday, March 16, 2015

An MOC Step?

Email today from the APA:

Dear Colleague:
The APA Board of Trustees is aware of members’ significant concerns over the “Part IV: Improvement in Medical Practice” portion of the American Board of Psychiatry and Neurology (ABPN) Maintenance of Certification (MOC) Program. Therefore, yesterday, the APA Board voted unanimously in support of the following motion:
  • The American Psychiatric Association (APA) Board of Trustees, acting on the recommendation of the Assembly Executive Committee, and representing over 36,000 psychiatrists, supports the elimination of Part IV of Maintenance of Certification (MOC).
  • Therefore, the Board of Trustees recommends to the American Board of Psychiatry and Neurology (ABPN) that they lobby and advocate the American Board of Medical Specialties (ABMS) to eliminate Part IV of the MOC,
  • that the APA reaffirm its commitment to lifelong learning and quality improvement and support for the highest scientific and ethical standards of medical practice, and
  • that the APA will establish a joint Board and Assembly Work Group with the charge to evaluate the broad issue of maintenance of certification for psychiatry and its relationship to maintenance of state licensure and other accrediting bodies. The goal of the work group is to return timely reports to the Board and Assembly including recommendations, if appropriate, for any positions the APA should take regarding any and all parts of MOC.
APA CEO and Medical Director Saul Levin, MD, MPA, and I have sent a letter to the ABPN, which is clear about the confusing and cumbersome nature of the program and the substantial concern which our membership and the Board of Trustees has regarding the evidence base of Part IV of MOC. At the same time, the Board further reaffirmed the APA’s “commitment to lifelong learning and quality improvement and support for the highest scientific and ethical standards of medical practice.” I look forward to being able to share the Board-Assembly Work Group’s findings in the near future.
We highly value our collaborative relationship with the ABPN and will work with them, other groups and, of course, our members to resolve the widespread concern about these issues.

Summergrad, MD
Paul Summergrad, MD
American Psychiatric Association

To remind people, Step IV consists of the Performance In Practice (PIP) modules, the 5 peer reviews, and the 5 patient reviews, which I wrote and complained about in one of my earliest posts, Alphabet Soup, back in November of 2012. Currently, we are no longer required to do both the peer and patient reviews (and I consider these last to be a boundary violation), but rather, one or the other, or a couple of other possibilities which I was going to cut and paste from the ABPN page, but for some reason the chart won't load on my computer. I think two of them are a 360 degree review and 5 resident reviews.

So now, the APA has FINALLY jumped on the bandwagon, when they see that there are other certifying boards (like the National Board of Physicians and Surgeons, see my post, Another Board) out there that don't require crazy PIP modules that have no evidence to support their utility. The PIP modules are a money-maker for the APA, or at least they have been, so I assume the motivation for getting rid of them as a requirement comes from the fact that the APA is losing membership and money, and may lose more if its members recall that the APA did absolutely nothing to prevent the institution of these requirements, to begin with. Only now are they establishing a Board and Assembly Work Group.

I guess I'll take what I can get from the APA, and maybe this is better than nothing. But they've done poorly by their constituency with regard to MOC in the past, and I don't see any reason to assume they'll do any better in the future, unless supporting their constituency happens to coincide with their own interests, whoever "they" are.