Physicians Passage of MOC Exam Linked to Fewer State Disciplinary Actions Interview with:

Dr. Furman S. McDonald MD MPH Lead author of the research and  Senior Vice President for Academic and Medical Affairs American Board of Internal Medicine (ABIM)

Dr. McDonald

Dr. Furman S. McDonald MD MPH
Lead author of the research and
Senior Vice President for Academic and Medical Affairs
American Board of Internal Medicine (ABIM) What is the background for this study? Would you briefly explain how the MOC examination works?

Response: To earn Board Certification from the American Board of Internal Medicine (ABIM), doctors take an exam after completing a medical education training program accredited by the Accreditation Council for Graduate Medical Education to demonstrate they have the knowledge to practice in a specialty. Previously, ABIM conducted research that showed that physicians who passed a certification exam were five times less likely to be disciplined by a state licensing board than those who do not become certified.

After becoming board certified, physicians can participate in ABIM’s Maintenance of Certification (MOC) program, which involves periodic assessments and learning activities to support doctors in staying current with medical knowledge through their careers. ABIM has been in conversations across the medical community and many people have expressed interest in whether performance on the MOC exams doctors take is also associated with important outcomes relevant to patients.

For this study, my ABIM colleagues and I studied whether there was any association between Internal Medicine MOC exam performance and disciplinary actions by state licensing boards. We studied MOC exam results and any reported disciplinary actions for nearly 48,000 general internists who initially certified between 1990 and 2003. What are the main findings? 

Response: We found that physicians who did not pass the Internal Medicine MOC exam within 10 years after initial certification had more than twice the risk of disciplinary actions than those who did pass the exam within the 10-year MOC requirement window. Furthermore, the rate of disciplinary actions against physicians declined linearly as scores on the MOC exam increased, indicating that more medical knowledge is associated with fewer disciplinary actions. For those physicians who did have a disciplinary action, they were more likely to be very severe actions if they did not pass the MOC exam in the 10-year requirement window.

We do know that many doctors complete Continuing Medical Education (CME) required for state medical licensure, but we saw no difference in the risk of disciplinary actions associated with the amount of CME required for state medical licensure. This finding suggests that completing CME alone in the amounts required for state licensure does not reduce the risk of disciplinary actions.

By comparison, passing the Internal Medicine MOC exam was the single strongest factor associated with fewer disciplinary actions in our analysis of this population. The percentage of total disciplinary actions in this population that can be attributed to not having passed the Internal Medicine MOC exam within 10 years of initial certification is 35 percent. What should readers take away from your report?

Response: As we wrote in our discussion section, state medical board disciplinary action is an important outcome that matters to patients because it is directly related to quality of care and, in many cases, patient safety. We estimated that the number of patients potentially cared for by physicians with disciplinary actions in our study could total many hundreds of thousands to a few million.

This signals that MOC is an important factor that can inform the public’s choice of physicians. Our research adds to a growing body of evidence indicating that the efforts doctors undertake to achieve and maintain certification do make a difference for their patients. Is there anything else you would like to add?

Response: It is important to note that most internists will never face disciplinary actions, but the study revealed an important association between medical knowledge as demonstrated on the MOC exam and lower risk of disciplinary actions.

Our data suggests that the amount of medical knowledge a physician has acquired and maintains is itself associated with better performance and care independent of other acts of medical professionalism. It is possible that physicians staying more current in knowledge and practice may well be more likely to recognize and provide appropriate care, thus avoiding actions considered as negligence or incompetence.

As we disclosed in the research article, all authors are employed by ABIM. 


J Gen Intern Med. 2018 Mar 7. doi: 10.1007/s11606-018-4376-z. [Epub ahead of print]

The American Board of Internal Medicine Maintenance of Certification Examination and State Medical Board Disciplinary Actions: a Population Cohort Study.

McDonald FS1,2,3,4, Duhigg LM1, Arnold GK1, Hafer RM1, Lipner RS1. 

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Last Updated on March 16, 2018 by Marie Benz MD FAAD