APA Meets With ABPN to Press for MOC Reform

APA leaders, including members of the APA administration, Board of Trustees, and Assembly, continued to press for changes to how psychiatrists are assessed for continuing certification during a meeting in July with leaders of the American Board of Psychiatry and Neurology (ABPN).

ABPN President Larry Faulkner, M.D., said at the meeting that the American Board of Medical Specialties (ABMS) is revising its standards for what it is now calling “continuing certification” (replacing the term “maintenance of certification,” a change that is intended to align with terminology used by the ABMS). The new standards are expected to be released in 2021, and the ABPN will be required to follow them.

Faulkner told APA leaders that the ABPN would consider a proposal from APA for an alternative to the current continuing certification program based on one created by APA. However, ABPN participants were noncommittal about approving it, Faulkner told Psychiatric News. “If the ABPN does receive a proposal, it will be given due consideration at that time.”

The proposed program would need to meet all of the ABPN’s and ABMS’s MOC program requirements, including any new program requirements released in 2021.

“APA members have sent a message loud and clear that they want a lifelong learning and continuing certification process that is less burdensome, less expensive, and more relevant to their clinical practice,” APA CEO and Medical Director Saul Levin, M.D., M.P.A., told Psychiatric News. “The APA administration, the Board, and the Assembly have heard that message, and we have brought it to the ABPN.

“We are encouraged that the ABPN is willing to work with us,” Levin said. “The possibility of a certification program created by specialty societies is an intriguing one, but we will have to await the new ABMS program requirements. In the meantime, we are committed to improving the continuing certification process.”

Levin also noted that on July 24, APA emailed a survey to 5,000 board-certified APA members to ascertain data on the burden imposed by the certification process. Survey results are being tabulated and analyzed.

In addition to Levin, present at the July meeting were APA President Jeffrey Geller, M.D., M.P.H.; APA President-elect Vivian Pender, M.D.; APA Secretary Sandra DeJong, M.D.; Mary Jo Fitzgerald, M.D., speaker-elect of the APA Assembly; Carver Nebbe, M.D., member of the Assembly Committee on MOC and Assembly representative from the Iowa Psychiatric Society; Ranga Ram, M.D., chair of the APA Caucus on MOC; Tristan Gorrindo, M.D., chief of APA’s Division of Education; and Nitan Gotay, M.D., chief of APA’s Division of Research.

Exam Costs in Thousands for Some

As mandated by the ABMS, the current continuing certification process includes four components:

• Part I: Professionalism and Professional Standing

• Part II: Lifelong Learning (CME), Self-Assessment and Patient Safety

• Part III: Assessment of Knowledge, Judgment, and Skills

• Part IV: Improvement in Medical Practice (also known as Performance in Practice, or PIP)

Diplomates must also sit for a certification examination at least once every 10 years unless they are enrolled in an alternative to the proctored 10-year examination, such as the three-year ABPN pilot project offering an open-book assessment based on reading journal articles (see Psychiatric News).

Ram told Psychiatric News that there were signs of progress at the July meeting, particularly in the ABPN’s willingness to consider a program designed by a specialty society. “Members of the caucus hope that in ongoing negotiations with the ABPN, we can influence the board to move away from the 10-year exam to a more reliable assessment of continuing certification based on the education of psychiatrists in areas relevant to their everyday practice,” he said.

He said caucus members ideally prefer an assessment based on reading journal articles and responding to questions generated by APA. He said the 10-year exam—a “high stakes” exam since candidates either pass or fail—includes questions that test candidates on information not relevant to their practice. Moreover, the costs of taking the exam—including time off from practice to prepare and take the exam and travel expenses for those who do not live near a testing site—can be in the thousands of dollars.

“I feel APA should push hard to be the professional society that provides all products for continuing certification, as long as the quality of the product is high,” Ram said.

Faulkner said that the ABPN has taken a number of steps to minimize the burden on diplomates seeking continuing certification. “Options to fulfill Self-Assessment and Improvement in Medical Practice requirements have been expanded, and examination fees have been reduced over the last decade,” he said.

Faulkner also pointed to the early success of the pilot project. “The vast majority of diplomates who have participated in the pilot project have indicated that they are pleased with it and find it to be ‘helpful to [their] practice,’ ” he said. Based on this success, he said the ABPN asked ABMS for permission to convert the project into a permanent alternative for all ABPN primary and subspecialty certificates beginning in 2022.

“While early feedback from the relevant ABMS committees has been positive, a final decision about the ABPN request will be made by the ABMS Board of Directors later this fall,” Faulkner said.

Other issues discussed at the July meeting included the following:

• The ABPN will begin including articles on structural racism in reading lists for the journal-based alternative.

• The ABPN is exploring the possibility of scholarships for psychiatrists who cannot afford initial certification fees or the annual MOC fee.

• APA has asked the ABPN to investigate options for home-proctoring of the initial certification exam so that examinees will not have to travel to testing centers, especially during the COVID crisis.

Additionally, APA reported at the meeting that it had completed its requirements as part of the ABPN’s unrestricted educational grant to APA earlier this year. The grant was provided when the 2020 Annual Meeting could not be held.

The terms of this agreement required that APA allow ABPN diplomates free access to the virtual APA Spring Highlights Meeting, the APA’s Annual Meeting self-assessment activity, and two online FOCUS Live events. The goal of the grant was to ensure that ABPN diplomates have access to high-quality CME and self-assessment activities to meet MOC requirements. Archived sessions of the Spring Highlights Meeting can still be accessed here.

With the unrestricted educational grant from the ABPN, APA was able to make these activities available to all psychiatrists at no charge. ■