APA Urges ABPN to Advocate for Elimination of MOC Part 4

APA is recommending to the American Board of Psychiatry and Neurology (ABPN) that Part 4 of the Maintenance of Certification (MOC) program be eliminated.

In a letter to ABPN President Larry Faulkner, M.D., APA President Paul Summergrad, M.D., and CEO and Medical Director Saul Levin, M.D., M.P.A., said APA members have found Part 4—which requires physicians to demonstrate continuous improvement in medical practice—“onerous, cumbersome, and not meaningful.”

They urged the ABPN, which operates under criteria established by the American Board of Medical Specialties (ABMS), to support APA’s position and advocate to the ABMS that Part 4 be eliminated.

The letter was the result of a motion, spurred by the Assembly Executive Committee and made at the Board of Trustees meeting in March, reflecting concerns over the limited evidence base for Part 4.

Also at its March meeting, the Board established a joint Board-Assembly work group to evaluate the broad issue of MOC in psychiatry and its relationship to maintenance of state licensure and requirements of other accrediting bodies.

In an interview with Psychiatric News last year, Faulkner explained that the ABMS has mandated that all medical specialties require physicians to demonstrate competence in four categories for maintenance of certification: professional standing, self-assessment and lifelong learning, cognitive expertise, and performance in practice.

“Performance in practice” refers to a requirement that physicians build into their routine practice the capacity to assess their performance continually against guidelines for best practices and make improvements to meet those guidelines.

“The performance-in-practice issue is a controversial and difficult one to develop,” Faulkner told Psychiatric News. “It boils down to a quality-improvement process. In general, physicians are going to have to demonstrate that they have looked at their practices and identified issues that need to be improved.”

Faulkner added at the time that the ABPN was striving to make Part 4 as “user friendly” as possible. “The challenge for the board and for APA is to come up with some ideas for how psychiatrists can look at their cohort of depressed patients, for instance, and make sure they are providing state-of-the-art treatment and make improvements where they are necessary,” he said. “But it’s definitely going to require some serious collaboration with APA and other organizations.”

In the letter to Faulkner, Summergrad and Levin expressed appreciation for the “ABPN leadership’s efforts to create alternative pathways for meeting this requirement,” but added that “neither our members nor the APA Board of Trustees support the continuation of Part 4 of MOC.”

They stated, “We know well that the ABPN has a vitally important mission, and we reiterate our broad support for ABPN certification and for the assurance of the quality and competence of psychiatrists, which ABPN certification conveys to our colleagues and the public. But we do hope the ABPN and the ABMS will reconsider Part 4 of MOC and act upon our call to eliminate it.” ■