Maintenance of Certification—Why?

March 1, 2012


Dr. Bruce Sigsbee

Perhaps within the medical specialties, the most controversial topic relates to the requirement for maintenance of certification (MOC) by the Boards. It is perhaps worthwhile reviewing the history to understand where this requirement has come from.

The American Board of Medical Specialties (ABMS) was formed initially as a coordinator amongst the multiple boards that certified each specialty. ABMS traditionally has been a bottom–up organization. The boards themselves had the budgets and have the power to determine requirements for certification within the respective specialty. This is unlike the Accreditation Council for Graduate Medical Education (ACGME), which certifies graduate medical education. However, beginning about 10 years ago, the relationship changed.

At that time, there was pressure from Congress, the public, and third–party payers to assure that physicians caring for patients were skilled in what they did. There actually was a move for the federal government to take over certification of physicians. In response, ABMS began to establish a more rigorous certification process, particularly for those who were recertifying. There was a sense that the current mechanism in place was not adequate and was felt to have no credibility. ABMS, under the leadership of Executive Director Kevin Weiss, embraced the concept of maintenance of certification. In fact, all of the component boards were required to comply with the process.

The maintenance of certification process is divided into five components: knowledge, professionalism, specialty–specific CME, self–assessment, and performance in practice. The assessment of knowledge parallels what has happened in the past. Boards differ in their approach to measuring professionalism. The American Board of Psychiatry and Neurology (ABPN) elected to use state licensure as the measure. The criterion set on CME is more than just any specialty–related CME but is specific to certified sources of CME by the Board. Eight hours per year of CME must include self–assessment as determined by examination. There is no requirement for a set score on the examination. Finally, there needs to be ongoing assessment of quality measures referred to as “Performance in Practice.”

Going forward, it is important to begin the process of MOC on a yearly basis. MOC cannot be left until just before the next certifying examination. On the other hand, it is important to explore ways to keep the burden of this requirement as low as possible. There are relatively low–cost resources that meet the MOC requirements, such as courses at the AAN Annual and Regional Meetings, NeuroPI, NeuroSAE®, and Continuum®, to mention a few. Some subspecialty organizations also have developed products that meet the certification requirements.

The most burdensome requirement in the view of many is the requirement for Performance in Practice. It is worth visiting the ABPN website at to familiarize yourself with just how to meet this criterion. Organizations have developed products to meet this criterion. It is also possible that quality initiatives at your organization may meet the criterion as well. Members who have questions about whether their institution’s quality initiatives meet requirements may wish to contact the ABPN.

In sum, complying with the new maintenance of certification generally captures activities that most of us do anyhow on a yearly basis such as obtain a license, participate in CME activities and perform self–assessment. The one activity that is difficult and requires a new effort is Performance in Practice. There are relatively easy ways to comply with this requirement, but it is important that one starts soon because the requirement extends over several years. It is unlikely that these requirements will go away. However, if you have suggestions as to how to meet these requirements in a cost–effective and efficient manner, it is worth contacting the AAN. For more information on maintenance of certification and AAN resources, visit

Bruce Sigsbee, MD, FAAN
President, AAN