April 2019


ASCRS supports options, choice, and competition in board recertification

by Liz Hillman EyeWorld Senior Staff Writer

Given diversity in learning styles among individuals, ASCRS supports and encourages educational options and physician choice for those seeking to maintain medical board certification and continue a mindset of lifelong learning.
“There are different ways to learn. Some people want to attend lectures, others want to take online courses, and some want to do Quarterly Questions. The one thing we all want is options,” said John DeStafeno, MD, ASCRS liaison to the American Board of Ophthalmology (ABO).
Dozens of surveys, studies, and opinion articles have been published with conflicting information on the benefits—or lack of benefits—of lifelong learning programs among various medical specialties.
“There are conflicting ideas as to whether the maintenance of certification programs implemented by societies are any better than CME education. There are no conclusive studies,” Dr. DeStafeno said. “This is why ASCRS supports options in lifelong learning programs.”

ASCRS research and discussion

In the past few years several legal challenges have elevated discussion of the pros and cons associated with Maintenance of Certification (MOC), which is put forth by member societies of the American Board of Medical Specialties (ABMS). After hearing concerns from ASCRS members, the ASCRS Membership Committee and Executive Committee began looking into the board recertification process.
“One of the major frustrations we were hearing was that ongoing MOC was expensive and burdensome, and members did not feel like it created value in a meaningful way,” said John Berdahl, MD, chair of the ASCRS Membership Committee. “ASCRS, because we take the concerns of our membership seriously, did a deep dive, looking into options in this area.”
In its research and extensive discussions on the merits of ABO’s MOC requirements, ASCRS recognized the strides ABO has made toward MOC reform. It also evaluated other avenues for the maintenance of lifelong learning. The National Board of Physicians and Surgeons (NBPAS), for example, was formed in 2015 and bases its recertification on obtaining sufficient continuing medical education credits, after initial board certification. According to Dr. Berdahl, the committees found NBPAS’ approach streamlined, cost-effective, and based on CME.
“With ABO’s MOC recertification program and NBPAS recertification, we think there are two reasonable ways for ophthalmologists to maintain certification in a manner that best suits their learning style and practice needs,” Dr. Berdahl said.
ASCRS is not alone in encouraging availability of options and competition in board recertification. In 2018, a Maryland House delegate requested an opinion on specialty board certification. The response letter from the Maryland Department of Justice, Antitrust Division, stated that when an organization has a monopoly on the certification of physicians it “functions as a de facto requirement for practice by physicians in certain specialized fields.” Under these circumstances, the letter said, certifying bodies may “adopt certification requirements more stringent than those necessary to verify that providers have the knowledge and skills required of specialty practice and the ability to deliver quality care.” These requirements, if unnecessary, could “raise the cost of specialty practice and constrain the supply of specialized practitioners, thereby harming competition and increasing the cost of healthcare services to consumers.”
In this letter, the state’s DOJ encouraged Maryland legislators to “consider ways to facilitate competition by legitimate certifying bodies, consistent with patient health and safety.” It also encouraged the state legislature to “continue allowing hospitals and insurers independently to decide whether to consider a physician’s MOC status when making business decisions, such as granting hospital privileges.”

Updated requirements

In January 2019, ABO officially revised its MOC requirements. Physicians are now asked to answer a series of online Quarterly Questions, a departure from the previous in-person Demonstration of Ophthalmic Cognitive Knowledge exam taken every 10 years. Diplomates choose five peer-reviewed journal articles from an ABO-curated list and answer questions related to these articles. The completion of Quarterly Questions can earn 8 CME/self-assessment credits and does not cost ABO diplomates an additional fee outside the $200 annual certification maintenance fee. According to the ABO’s program specs for the Quarterly Questions, diplomates with ABO certification that expires on Dec. 31, 2020 “need to meet the annual passing standards for Quarterly Questions 3 times” before their certificate expires. Those with ABO certificates expiring on Dec. 31, 2021 need to meet this annual passing standard five times before this date. ABO diplomates who are not required to seek recertification because they received their certification before 1992 can still participate in ABO’s Quarterly Questions program for $200 annually.
NBPAS requires initial certification through an ABMS member board, a valid, unrestricted state medical license, and completion of at least 50 CME hours within a 24-month period, among other stipulations. Initial NBPAS certification is $169 for MDs and $189 for DOs; recertification is $145 for MDs and $165 for DOs. Members of the U.S. military and fellows/physicians-in-training can receive discounted certification.
NBPAS sees several benefits associated with certification through CME completion. “CME can provide education in both established knowledge and also future directions that keep the physician on the ‘cutting edge.’ CME offerings are highly competitive and provide choice. There are numerous organizations offering high value CME activities. If physicians do not perceive value in a particular CME offering, they will go elsewhere. Additionally, most states require CME activities to maintain licensure. Therefore, using CME to fulfill life-long learning requirements provides efficiency and minimizes redundant activities.”
Many employers and insurers require board certification, and as such, there is not universal acceptance of NBPAS certification. In an effort to address questions around the options, ASCRS has prepared an online toolkit, where members can find information as well as form letters for those looking to initiate the acceptance process with their hospital system. The toolkit is available at https://nbpas.org/ascrs-members.
“Through our research and discussions, we think that ABO has made meaningful strides over the last couple of years at MOC reform, but we also think that competition is good and alternative recertification options, like that provided by NBPAS, should exist,” Dr. Berdahl said.

Questions? ASCRS and NBPAS created a toolkit detailing the different options for lifelong learning programs and board recertification, available at https://nbpas.org/

Read more. EyeWorld reported on some of the perspectives surrounding board recertification in January 2018. Search “Taking a hard look at board certification and recertification” on www.eyeworld.org.

About the doctors

John Berdahl, MD
Vance Thompson Vision
Sioux Falls, South Dakota

John DeStafeno, MD
Clinical instructor
Wills Eye Hospital

Financial interests
: None
DeStafeno: None

Contact information

Berdahl: john.berdahl@vancethompsonvision.com
DeStafeno: jdestafeno@gmail.com

ASCRS supports options, choice, and competition in board recertification ASCRS supports options, choice, and competition in board recertification
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