The Infectious Diseases Society of America (IDSA) urged the American Board of Internal Medicine (ABIM) to make substantial changes to its maintenance of certification (MOC) requirements in a letter published Thursday.

"We assert the current ABIM MOC program is not a good metric for measuring ongoing competence in the field, and it should be reexamined and modified to meet the current demands of the workforce," IDSA president Steven Schmitt, MD, of the Cleveland Clinic, wrote in the letter to ABIM President and CEO Richard Baron, MD.

"We strongly request that corrective action be taken and substantive changes be made to the program that address the important concerns of the ID community," Schmitt wrote in the letter, which was published in Clinical Infectious Diseases.

IDSA asked ABIM for several reforms, including a reduction in MOC fees, changes in the Longitudinal Knowledge Assessment questions (an alternative to the 10-year board exam), and eliminating redundant continuing medical education (CME) requirements.

In September, IDSA conducted a member survey about MOC requirements that garnered more than 800 responses. Overall, it revealed that the "majority of physician respondents reported the MOC program adds no clinical value, does not positively impact clinical practice, and contributes to burnout," Schmidt wrote.

In the survey responses, over 80% agreed with the following statements about MOC: "time required is a burden," "annual cost is a burden," and "points and assessment are a burden." Nearly 70% disagreed that MOC "positively impacts my clinical practice."

The IDSA's letter comes amid wider criticism of and pushback against MOC. Four cardiology societies announced in September that they planned to break away from ABIM and create a new, separate board for cardiovascular medicine.

Oncologists have also been questioning MOC, with the American Society of Clinical Oncology launching a member survey earlier this year to better understand their membership's feelings about certification. The American Society of Hematology also sent a letter to Baron, urging "immediate action" to establish a new and improved MOC program.

Baron announced earlier this year that he plans to retire in September 2024.

Critics have argued that there is limited evidence that MOC improves physician performance and patient outcomes. Previous MedPage Today reporting has shown that some specialty boards can be lucrative businesses, complete with highly paid executives and luxury trips.

Among IDSA's criticisms of the MOC program were its clinical relevance and the time and cost burden of the MOC exams and points system.

Infectious disease in particular has become increasingly more specialized, with a focus on certain diseases or populations, the letter stated. "Rather than issue a standardized, one-size-fits-all set of assessment questions and activities, it would be more relevant to allow physicians to be self-directed in their learning, requiring instead that they partake in a specific number of hours or credits in their medical educational training of choice," it said.

Cost, too, can be a problem, the letter noted. "ID physicians are among the lowest paid physicians in the United States, and the current MOC fees are cost-prohibitive for our members overall -- and particularly so for those early in their careers."

In general, to maintain board certification for internal medicine and infectious disease, physicians must take either a long assessment every 10 years, or a shorter test of 120 questions each year, and earn 100 MOC points every 5 years through CME activities, among others. These are requirements that can take anywhere from 25 to 62 hours per year, the letter stated.

In the specialty, physicians may have to maintain both internal medicine and infectious disease board certification, which can total as much as $4,100, according to the letter. Physicians are also responsible for costs associated with CME courses.

Though board certification is not always needed to practice, employment for many physicians is contingent on this credential, which many hospitals and insurers require.

Sophie Putka is an enterprise and investigative writer for MedPage Today. Her work has appeared in the Wall Street Journal, Discover, Business Insider, Inverse, Cannabis Wire, and more. She joined MedPage Today in August of 2021. Follow

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Another Medical Society Turns Up the Heat on MOC - Medpage Today