NEW YORK (Reuters Health)—The American Board of Internal Medicine (ABIM) maintenance-of-certification (MOC) program could cost $5.7 billion in physicians’ time and fees over the next decade, according to a new model study.
“We estimate that physicians will spend 33 million hours over 10 years to fulfill MOC requirements,” Dr. Dhruv S. Kazi from the University of California, San Francisco, told Reuters Health by email.
“This is approximately equivalent to the total clinical work load of 1785 physicians over 10 years,” Dr. Kazi said. “This demand on physician time comes during a period of expanding insurance coverage and anticipated physician workforce shortfalls; it may therefore adversely affect access to care, particularly elective care.”
The ABIM’s substantial expansion in 2014 of its MOC requirements for the more than 250,000 board-certified internists, hospitalists and internal medicine subspecialists ignited an intense debate about the societal value of the program, resulting in temporary suspension of some of the new requirements.
Dr. Kazi’s team sought to quantify the costs of the 2015 version of the MOC program and compare them with the costs that would have been incurred had the 2013 version remained unchanged.
The new MOC requirements would cost board-certified internal medicine physicians an average of $23,607 over 10 years, including $2,349 in fees to the ABIM and $21,259 in time costs, the researchers report in Annals of Internal Medicine, online July 28.
Average costs would range from $16,725 for general internists to $40,495 for hematologists-oncologists.
The overall program would cost $5.7 billion ($561 million in fees to ABIM and $5.1 billion in time costs) over the next 10 years, an increase of $1.2 billion over the previous MOC program.
“The ABIM has previously suggested that participation in MOC will cost $200 to $400 per year,” the researchers note. “This is a substantial underestimate precisely because it overlooks time costs.”
“While we had anticipated that physician time would be an important driver of costs of the program, we were surprised to see that 9 out of every 10 dollars in MOC costs were related to the program’s demands on physician time,” Dr. Kazi said. “In fact, every additional hour spent by physicians on MOC increased the costs of the program by approximately 13 million dollars.”
“The internal medicine community has embraced the principle of evidence-based medicine in clinical practice; expensive policy interventions such as MOC should be held to the same evidentiary standards,” Dr. Kazi concluded.
