The Cost of Keeping Up

Reading “A Cost Analysis of the American Board of Internal Medicine’s Maintenance-of-Certification Program released yesterday by the Annals of Internal Medicine, it seemed to me that the study should have been titled “The Cost of Keeping Up”; the focus of the article was on the cost of the time physicians spent staying up to date in their discipline. In their findings, the researchers only attribute 10 percent of the costs to Maintenance of Certification (MOC) program fees.

Overall, the study estimates physicians spend about 14 hours per year—approximately 1.25 hours per month—engaging in MOC activities. Every tenth year when an exam is due, the authors’ time estimate increases to a total of 42 hours for that year to study and sit for the exam. The study then monetizes that time for each specialty in internal medicine to determine “cost.” Interestingly, the researchers value some specialists’ time at almost 40 percent more per hour than they value general internists’ time.

It’s always challenging to extrapolate costs across populations and time periods; the numbers seem to get really big really quickly. But if one is going to use such an approach, a recent study in The Journal of the American Medical Association offers an estimate of the magnitude of the cost savings that might be attributable to MOC, and they are three times as high in one year as the 10-year number calculated by the Annals study authors.

Methodology aside, the research raises an important question about whether keeping up and learning is a good use of physicians’ time. In our conversations with physicians, we are consistently hearing that “keeping up” is a core value that all of us share. The challenge for all of us is to avoid redundancy and busywork while recognizing, through MOC, high-value activities in which physicians engage to stay current in knowledge and practice.

As physicians, we are part of a knowledge profession, and knowledge changes rapidly. With or without MOC, most physicians will spend significant time staying abreast of changes in medicine. For example, the first-line drugs used to treat hypertension today didn’t even exist when many of us finished training. Staying current in knowledge and practice has an impact on the quality of care we are able to offer to patients.

Working as intended, MOC provides a peer-defined formal structure for physicians to keep up to date that does not exist with CME alone. Importantly, it also includes a high-stakes, secure examination of knowledge, currently done once every 10 years. As we work to improve the process, we are expanding the exam feedback we provide physicians so they can better identify areas where knowledge is strong, and potential areas for improvement. And we will be looking at other options for knowledge assessment.

Ultimately we all know that it is good for our patients when physicians spend time keeping up. And in a world where we all have so many things competing for our time and attention, having a framework to help us—and our patients and colleagues—do what we do every day is a core part of controlling our destiny as a profession. Our goal is to make the time maximally relevant, so that physicians can stay at the top of the knowledge base in their chosen specialty and demonstrate this to their peers and patients. Staying current matters to all of us.

Please continue to share your feedback with me via e-mail, and I encourage you to subscribe for regular updates on how we’re incorporating physician feedback and other ways you can get involved.