Board Approves Action Items on Maintenance of Certification

APA Trustees last month approved six action items related to Maintenance of Certification (MOC), including one stating that APA will work with the American Board of Psychiatry and Neurology (ABPN) to develop its own society-based alternative to the board’s MOC program.

If accepted by the ABPN, this would allow APA to develop an MOC program that would be administered by APA and fully recognized by the ABPN for meeting MOC requirements. The Board also voted to approve a feasibility study of what would be involved in APA’s developing its own certification and MOC programs, separate from the ABPN. This study will include an examination of financial, legal, and ethical aspects of establishing its own certification board.

The action items were approved, after several hours of discussion, and described in a statement released by the Board recognizing that MOC is a “contentious issue” for many APA members. (For a list of other actions approved by the Board, see below).

The statement noted that a recent study of APA members participating in MOC showed that nearly equal numbers of individuals felt that MOC helps them keep up to date with current information as those who do not (41.3% agree; 37.8% disagree; 20.9% neutral). “The same study showed that most felt that participating in MOC is a time-consuming, expensive, overly complicated, and burdensome process,” according to the statement.

The Board reaffirmed its previous position that MOC should not be used as a condition of employment, insurance paneling, or state licensure. “Simultaneously, the APA acknowledges that many members need access to ABPN-approved activities in order to meet MOC requirements and that APA is well positioned to provide relevant, high-quality educational materials at a low cost to support members who are participating in the current MOC process,” according to the Board statement.

Trustees approved an action item calling on APA to continue the creation of MOC products. Additionally, the Board acknowledged the National Board of Physicians and Surgeons (NBPAS) as a possible alternative to the ABPN’s MOC program. NBPAS certification is recognized at only 136 hospitals as compared with the more than 6,000 hospitals that recognize ABPN certification, but it could be an alternative for some psychiatrists.

Trustees also approved publicizing the results of an APA survey of member reactions to the ABPN’s MOC requirements and areas of APA member dissatisfaction with MOC (see next issue of Psychiatric News). Further, APA will ask the ABPN to respond to the member concerns.

Finally, to support the continued development of MOC products for members and to support the PsychPRO registry, the Board of Trustees voted to accept a $2 million grant from the ABPN for APA educational programs and APA’s mental health registry, PsychPRO; a similar unrestricted grant was awarded to the American Academy of Neurology.

“The acceptance of these grant funds will not dampen or interfere with the several ongoing activities and negotiations to improve the ABPN MOC process or to create and recognize alternative professional boarding processes,” according to the Board statement. “These funds are accepted as an unrestricted educational grant from the ABPN to APA and, as such once granted to APA, cannot be influenced by the ABPN.

“The Board of Trustees acknowledges that MOC is a complex issue and that there are not simple answers to questions about the current status of maintenance of certification. APA’s elected leadership will continue to fight for MOC reform, including seeking program changes with the ABPN and examining alternatives to the ABPN’s MOC process. In the larger view, many specialties have had concerns with the current American Board of Medical Specialties (ABMS, the parent organization of ABPN), and like other medical specialties, APA and psychiatry are awaiting a revision of the standards of the ABMS. It was the ABMS that mandated that the ABPN design and implement the MOC process. The Board of Trustees hopes that APA members will stay engaged in the debate regarding how specialist competency is best recognized and certified.

“The APA membership will have an opportunity to comment on the ABMS Vision Document and the new standards when the ABMS posts them for public comment. APA urges all members to submit their comments to the ABMS site and copy APA. An email link will be provided once the document is released. APA will also distribute the link to the final document once it is published.” ■

Other Board Actions

APA Trustees last month voted to approve the proposed Presidential Task Force on the Social Determinants of Mental Health to begin work this month and sunset in May 2022.

In a report to the Board, APA President-elect Vivian Pender, M.D., said the mission of the task force is to develop sustainable political and social policies and programs that will bring about change in the psychiatric health care of disadvantaged populations.

Specifically, the task force will develop a strategic plan for APA implementation of the five statements in the 2018 Position Statement on Mental Health Equity and the Social and Structural Determinants of Mental Health. The position statement indicates that APA

• supports legislation and policies that promote mental health equity and improve the social and structural determinants of mental health and formally objects to legislation and policies that perpetuate structural inequities.

• advocates for the dissemination of evidence-based interventions that improve both the social and mental health of patients and their families.

• urges health care systems to assess and improve their capabilities to screen for, understand, and address the structural and social determinants of mental health.

• supports medical and public education on the structural and social determinants of mental health, mental health equity, and related evidence-based interventions.

• advocates for increased funding for research to better understand the mechanisms by which structural and social determinants affect mental illness and recovery.

Trustees also approved a number of recommendations from the Presidential Task Force to Address Structural Racism Throughout Psychiatry to enhance diversity and inclusion in the Association’s governance. These include a requirement that every standing committee, task force, work group, council, and committee shall demonstrate having attempted to achieve representation of minority and underrepresented groups among the component membership.

Additionally, trustees voted to mandate that APA widely disseminate information and solicit nominations for component membership, including annual reminders to district branch executive directors and presidents.

Finally, the Board also approved several changes to DSM recommended by the DSM-5 Steering Committee; these changes are subject to Assembly approval. Among the changes is the addition of olfactory reference disorder (olfactory reference syndrome), which had been included in DSM-5 under the term “Jikoshu-kyofu,” an older term that is used in traditional Japanese psychiatry. The term olfactory reference disorder is more commonly used in research literature; moreover, using the Japanese name for this disorder may incorrectly imply that olfactory reference disorder is a culture-bound syndrome.

Other DSM changes approved by the Board include elimination of extraneous specifiers in persistent depressive disorder, changes in the text of the specifiers for bipolar and depressive disorders, and changes to the text of other specified dissociative disorder and other specified schizophrenia spectrum or other psychotic disorder.