The recent debate surrounding the American Board of Medical Specialties (ABMS) Maintenance of Certification (MOC) program is a microcosm for a transformation in medical practice that is long overdue. The profession of medicine is going through a fundamental shift from a traditional craft-based practice to a more sophisticated, data-driven profession-based practice. The solo-based practice is dying. As the ABMS program suggests, the awareness and acceptance of this shift is already occurring at the national medical board level, but it is not happening as quickly at the individual physician level. It is time for all clinicians to consider a new, more effective and more empowering approach to clinical care.
Let’s take a look at the details. As you may know, the MOC program consists of six Core Competencies for Quality Patient Care that physicians must demonstrate to maintain certification. These competencies are over and above the traditional board certification requirements. The core competencies are professionalism, patient care, medical knowledge, practiced-based learning and improvement, interpersonal and communication skills and systems-based practice. Descriptions of each competency can be found here. In addition to being a new requirement, the program encourages a new style of practice for physicians.
The MOC program has generated considerable friction, especially among physicians, some of whom argue that the requirements place an additional burden on their increasingly burdensome work experience. Others have joined the program and are fulfilling its requirements. As of May 2014, 150,000 physicians were enrolled in the program, but tens of thousands have also signed protest petitions.
As the debate over the value of MOC illustrates, transformational journeys are difficult. Those who believe it ought to be easy can often end up confused and frustrated. Those who embrace it, despite some painful realities, find opportunity. The friction of change, the challenges we encounter in life, the ebb and flow of the unexpected, work together to help us see the future and our role in it. Friction can wear us down or help us to see a powerful new reality.
Regulatory requirements like the MOC program are a burden when they are layered on top of an antiquated system. The requirements are much less of a burden when the work environment allows them to be satisfied as a byproduct of work. In recognition of this reality, the ABMS has allowed 32 major health systems, including the Mayo Clinic and M.D. Anderson Cancer Center, to satisfy some MOC requirements for their physicians via their existing quality improvement projects and programs. 51 additional health organizations are applying to do the same. These organizations allow physicians to satisfy the MOC requirements as they deliver care.
Working in an improvement environment can be an exciting and energizing experience for involved clinicians because the reform debate suddenly shifts to what matters most to them and their patients — the value and outcomes of care. It also allows participating physicians to satisfy MOC requirements as a byproduct of their work. It is no longer an add-on. It is what they do. To date, the ABMS health system arrangement has produced 529 quality improvement projects and more than 3,250 physicians have received MOC Part IV credit for their participation.
In creating these arrangements with health systems, the ABMS is tacitly implying that organizations with effective, data-driven quality improvement programs integrated into their care environments are the future of care. They are correct. Increasingly, more physicians will seek such an environment, if for no other reason than to improve their professional lives. The good news is they will encounter a better way to practice clinical care when they do.
Care has simply become too complex not to go in a new direction. As I stated, the profession of medicine is going through a fundamental shift from a traditional craft-based practice to a more sophisticated, data-driven profession-based practice that is centered on continuous improvement. This new environment implies that clinicians are operating in a highly supportive and rational care delivery and improvement system that allows them to optimally manage care processes while collecting data to support continuous improvement and learning.
There are signs of this change everywhere, not only within the MOC requirements. Most patients already have multiple physicians and dozens of other caregivers involved in their care. Accountable care delivery systems are being formed. Care delivery environments are increasingly supported by advanced information technology, including electronic health records (EHRs), decision support systems and analytic systems. The number of reported data-driven care improvement projects is growing exponentially.
These and other signs point to the fact that these trends are real, inevitable and lasting. It’s time for us to embrace them. We need to simplify the environment in which we work and create an environment that will allow us to be the best we can be. The sophistication of the structure to support such an environment may be complicated, but that does not mean that the environment in which clinicians work need be. We need an environment that helps us better manage complexity, not one that adds to it. That is possible and it is happening.
With every major transformation, people strive to escape an unpleasant existing reality. Some do so by denying and resisting; others search for a better way. The latter are the achievers. They strive to get the job done. They do not ask simply “How can I get by?” and remain mired in frustration. Rather, they ask, “How can I solve this?” With the vision inspired by this question, they set out in pursuit of solutions. This is not merely activity, but activity driven by a deep sense of purpose. They have a commitment to excellence. They do the best they can to solve the challenges confronting them. Increasingly, they will succeed and those around them will recognize them as champions and leaders.
Listen to these pioneers. Imagine a new reality. The future is calling.
John Haughom, MD, former senior vice president of clinical quality, safety and IT for PeaceHealth, is a senior advisor to Health Catalyst and the author of “Healthcare: A Better Way. The New Era of Opportunity.”