Maintenance of Certification

The Background and History of Maintenance of Certification (MOC)

Before 1990, US physician board certification was once a voluntary assessment test administered by one of 24 member boards of the American Board of Medical Specialties (ABMS) that physicians could take at the end of their specialty residency training to document successful completion and understanding of their ability to practice medicine in that specialty. Becoming “board certified” was a life-time professional credential, not too dissimilar from the bar examination lawyers take at the end of their training to practice law. To remain licensed in their states, physicians perform in a certain number of Continuing Professional Development (or continuing medical education (CME)) courses to maintain licensure in their state each year. Physicians chose and paid for CME products that were relevant to their practice setting.

If the late 1970’s, the American Board of Internal Medicine (ABIM), the largest ABMS member board that “certifies” one quarter of all U.S. physicians, decided to have full-time paid staff members. To derive additional funds, the ABIM considered voluntary “recertification” testing, but enrollment dwindled year after year it was administered. By the late 1980’s with a growing need for revenue and a limited number of new physicians becoming “board certified” each year, the ABIM decided to make the process of “recertification” mandatory and threatened that physicians could lose their standing as a “certified internist” unless they participated. That is except those physicians who received their board certification before 1990 and were considered “grandfathered.” This recertification testing was later trademarked as “Maintenance of Certification (MOC)” by the American Board of Medical Specialties. and had to be completed every 10 years , or face physicians might face “uncertain consequences.” This high-stakes re-testing made “board certification” time-limited and remarkably lucrative for the boards while discriminating against younger, more vulnerable physicians who were increasingly female and people of color as this credential is no longer voluntary to maintain admitting privileges at many hospitals n the United States.

Since that time, the boards have systematically marketed their unproven continuing professional development product MOC to the hospital and insurance industry that increasingly require this repetitive testing for obtaining hospital credentials and insurance panel participation. As physicians have become employees at these systems, the purchase of MOC “longitudinal assessment” programs is no longer “voluntary” as the ABMS and the American Medical Association suggest. Physicians are forced, then, to purchase and participate in the ABMS member boards’ MOC programs or lose their ability to practice medicine. It is the tie of MOC products to a physician’s initial board certification that Practicing Physicians of America believes violates US antitrust laws and forms the basis of the lawsuits filed against several of the ABMS member boards.

It’s Time for Change

PPA helped fund the investigation and support of the Plaintiffs in the antitrust lawsuits against the American Board of Internal Medicine (ABIM), the American Board of Radiology (ABR), and the American Board of Psychiatry and Neurology (ABPN) challenging MOC. We continue to need assistance raising the necessary funds to continue this support, including discovery and other pre-trial preparation. If any one of these trials succeeds, it will serve as a precedent for litigation against all of the ABMS member boards who mandate the purchase of MOC nationwide.

Want to Help?

First, join PPA. It’s a simple and free process that allows us to know more about our supporters, be they physicians or patients.

Second, donate at our GoFundMe page created just for this purpose. Over $400,000 have already been raised, but more will be needed if these cases progress.

For More Information About MOC

These resources offer insight into our ongoing investigation.

History of MOC

Medical specialty certification in the United States—a false idol?

Boarded to Death

Why Maintenance of Certification Is Bad for Doctors and Patients.

The ABIM Foundation

Choosing Wisely®, and the $2.3 Million Condominium.

Offshore Accounts

ABIM Foundation Off-shores $6.5 Million to the Cayman Islands

MOC Time Investment

No difference in care quality or safety in physicians with time-limited vs. time-unlimited board certification.

ABIM Lobbying Efforts

ABIM fails to disclose lobbying efforts to the public and the IRS.

MOC Background

The problem: how does one define physician excellence?

MOC Raising Costs

Commentary: How These Useless Doctors’ Exams Are Raising Health Care Costs


Dr. Westby G. Fisher

PPA Board Member

Dr. Fisher is a Practicing Physicians of America Board Member and the Director of Cardiac Electrophysiology at a large health care system in the Chicago Metro area. He is board certified by the American Board of Internal Medicine (ABIM) in three specialties in medicine: Internal Medicine, Cardiovascular Diseases, and Cardiac Electrophysiology. Because he is nearly 60 years of age, he has watched the ABIM’s Board certification process go from an entirely voluntary credential to one that is time-limited requiring recurrent payments to the ABIM throughout one’s lifetime.



ABIM’s Ongoing Financial Deterioration