Recertification has become a cause of consternation for many psychiatrists. The rules have changed midstream—multiple times—and they may still change before all the dust settles down.

I, like many of my colleagues who became board certified in the distant past, had thought myself "safe," since the date of my original board certification gave me "grandparent status," or certification for life. But psychiatrists a few years behind me in residency received time-limited certificates and must recertify every 10 years through a process designated by the American Board of Medical Specialties for maintenance of certification (MOC). My professional activities led me to seek further certification in psychosomatic medicine, but if I choose to recertify in 2019, I will have to participate in MOC despite my "grandparented" status. To recertify or not to recertify? I will have to resolve my recertification ambivalence in time to complete performance in practice modules, get peer and patient feedback, and earn self-assessment CMEs.

To compound matters even further, the Federation of State Medical Boards (FSMB) may be moving from the traditional licensure renewal process to a Maintenance of Licensure (MOL) process. Should this happen, having board certification may be even more important.

Multiple forces are shaping the face of medical practice, and there has been a significant acceleration in the need for physicians to demonstrate their competence. Although none of the MOL and MOC requirements is under APA control, as a professional organization APA has been looking out for members' interests and lobbying the regulatory bodies to recognize the impact as well as unintended consequences of rapidly evolving change on individuals and the profession.

The APA Board of Trustees created a work group of which I am chair to examine the MOC process and to propose strategies to help members understand and prepare for these changes. As part of the work group's deliberations, we have also been tracking the FSMB recommendations for MOL versus the traditional process of license renewal. I'd like to present the policy trends our work group identified in the course of its deliberations.

Medical regulation arose after Abraham Flexner's 1910 report with the creation of the FSMB and the American Board of Medical Specialties (ABMS) under which our specialty board, ABPN, resides. FSMB and ABMS have recommended modifications in the licensure and certification process over the last decade, and both organizations are now phasing in substantial changes.

In 2003, the FSMB formed an MOL committee to encourage state medical boards to develop strategies to ensure physician competency throughout their professional careers The FSMB has endorsed the following guiding principles in regard to maintenance of licensure:

• MOL should support physicians' commitment to lifelong learning and facilitate improvement in physician practice.

• MOL processes should be administratively feasible and should be developed in collaboration with other stakeholders. The authority for establishing MOL requirements should remain within the purview of state medical boards (SMBs).

• MOL should not compromise patient care or create barriers to physician practice.

• The infrastructure to support physician compliance with MOL requirements must be flexible and offer a choice of options for meeting requirements.

• MOL processes should balance transparency with privacy protections.

A report from the MOL Implementation Group of the FSMB has made the recommendation that all SMBs should implement an MOL process within a ten-year period.

The FSMB has nearly a dozen state medical and osteopathic boards prepared to implement pilot MOL projects in 2012. This decision, once fully implemented, will differ from MOC, which is a voluntary process. One can practice without board certification, whereas licensure is essential to medical practice.

The ABMS has been expanding recertification requirements for its member boards beyond the basic cognitive exam to include self-assessment, performance in practice, and peer and patient review.

Both the AMA and the specialty boards (including ABPN) have stated that if physicians are current with MOC, they should fulfill any new or emerging MOL requirements. However, since the MOL requirements may be determined by each state medical board, the potential for diversity in requirements exists.

The APA work group on MOC has discussed myriad topics related to the MOL/MOC debate. We have considered the opposition expressed in the APA ballot referendum, discussed member concerns at the MOC caucus at this year's annual meeting, studied the ABPN transitional timeline for changes, and reviewed APA's lifelong learning strategies for assisting members in meeting the requirements. Our work group discussions have been regularly communicated to the Board. APA leaders meet regularly with ABPN officials and have brought these issues to their attention.

The general categories into which members' concerns fall include cost, clinical and ethical aspects of the patient feedback requirements, confidentiality, monitoring and audit procedures, procedural issues for psychiatrists in subspecialty areas or nonclinical practice, and APA's ability to protect members' interests.

The work group made the following recommendations to the APA Board of Trustees:

• APA should develop a monitoring and reporting system on MOC/MOL issues to update members on regulatory changes that are occurring within FSMB/ABMS/ABPN and other entities that exercise control over the practice of medicine and psychiatry.

• APA should address specific concerns with outside entities including the ABPN and AMA delegation.

• APA should support specific activities that are protective and accountable to membership such as: a request for a detailed summary of the Ethics Committee's deliberations on the patient-feedback issues, provision of guidelines for psychiatrists to facilitate their compliance with implementation of the changes, and continued support of the Caucus on MOL/MOC.

• The Board of Trustees and the Assembly should consider the impact of MOC/MOL in the context of physician workforce needs as well as clinical care.

I hope this has provided background on what is and will remain a complex process.

The following are resources for those who plan to recertify: The ABPN Web site at <www.abpn.com> explains the requirements for the four-part certification process as well as what to do should you miss the requirement or fall behind. The APA Lifelong Learning and CME Center at <http://apaeducation.org/ihtml/application/student/interface.apa/index.htm> helps members track their CME requirements, provides self-assessment examinations, and has developed performance-in-practice modules to meet Part 4 requirements (see MOC Programs Available From APA).

Stay tuned to your professional organization and your state organization and district branch (DB) to keep abreast of any status changes as they occur or better yet become a participant in the process by working with APA or your state association or DB regarding the implementation of these changes in a way that will protect our members and profession.

Mary Helen Davis, M.D., is chair of the APA Board of Trustees Work Group on Maintenance of Certification.