The NBPAS alternative to MOC
Paul Teirstein, M.D.
Chief of Cardiology
Scripps Clinic
Director Scripps Prebys
Cardiovascular Institute
Scripps Health
Teirstein.paul@scrippshealth.org
858 554 9905
• NBPAS is a new alternative for continuous
physician certification.
• NBPAS relies on ACCME accredited CME for lifelong learning instead of computer modules and
repeat testing.
• Interest in the NBPAS.org alternative is spreading
rapidly.
• This grass roots movement is now in discussions
with hospitals, physician groups and payers to
accept NBPAS continuous certification
What’s wrong with MOC?
• The majority of available data indicates MOC has
no impact on patient outcomes
• The overwhelming majority of physicians believe
the medical knowledge modules and recertifying
exams are onerous, and a poor use of their time.
• Even the ABIM now agrees that the patient safety
modules and practice improvement modules
should be suspended.
• MOC is costly for physicians and has become a
money-making enterprise
• Arguments against the 10 year Recertification Exam
– The exam questions are often not relevant physician’s practice.
Questions often relate to parts of their specialty they do not
practice.
– The questions are often outdated. Most of the studying is done
to learn the best answer for the test, which is very often not the
current best practice.
– Testing often uses “Guidelines” as gold standard but there is a
long history of Guidelines changing and often reversing
– Closed book tests are no longer relevant. We care for patients
with our colleague’s input (ie conferences, the Heart Team,
curbside consults etc) and we are connected to the internet all
day long
– There are no re-certification or MOC programs outside the U.S.
Petition Attracts >22,000 Signatures
• The following slide is a screen shot of the
petition to ABIM to recall the MOC with over
22,000 signatures
ABIM Admits they “Got it Wrong”
• The following slide shows an apology
offered by the NBPAS for MOC
ABIM is now
under fire
from many
organizations!
ABIM Apologizes-a good first step
• Part IV is suspended. Very good decision
• Other changes, however, are not meaningful: Changing public
reporting language of diplomat status, freezing fees, and
promises to consider further changes
• We are still left with parts 2 and 3 that are onerous, time
wasting and expensive (self assessment modules and repeat
secure testing)
• The self-admitted poor roll-out of MOC by ABIM illustrates the
need for alternative certifying organizations.
• Different physicians have different needs.
• One size does not fit all.
• Applications for NBPAS tripled after there apology. Physicians
are not satisfied
SCRIPPS CLINIC
CME Vs MOC for Life-long Learning
• Why ACCME accredited CME is a better approach to
lifelong learning.
– Organizations providing recognized CME programs are regulated
by a rigorous accreditation body (ACCME) requiring each CME
offering provide an educational gap analysis, “needs assessment,"
speaker conflict of interest, course evaluations and many other
performance standards.
– ACCME accredited CME is NOT permitted to be influenced by
industry.
– MOC focuses on established knowledge while CME often goes
further, offering new and future directions that keep the physician
on the "cutting edge."
– CME offerings are highly competitive and provide choice. If
physicians do not perceive value in a particular CME offering, they
will go elsewhere. This contrasts with the monopoly ABIM has on
MOC.
NBPAS Criteria for Certification
• NBPAS supports the initial ABIM certification criteria
and secure test
• NBPAS strongly objects to the ABIMS’s
requirements for MOC
• NBPAS supports choice. Physicians who believe
they benefit from MOC, should participate in MOC
• Life-long learning is not one size fits all. No single
program will meet everyone’s needs.
• NBPAS provides physicians with an important
alternative.
• The next slide provides the complete NBPAS criteria
for continuous certification
Complete criteria for NBPAS certification:
■ Candidates must have been previously certified by an American Board of Medical Specialties member board.
Currently, NBPAS certifies physicians in non-surgical ABMS specialties.
■ Candidates must have a valid, unrestricted license to practice medicine in at least one US state. Candidates who only
hold a license outside of the U.S. must provide evidence of an unrestricted license from a valid non-U.S. licensing
body.
■ Candidates must have completed a minimum of 50 hours of continuing medical education (CME) within the past 24
months, provided by a recognized provider of the Accreditation Council for Continuing Medical Education (ACCME).
CME must be related to one or more of the specialties in which the candidate is applying. Re-entry for physicians with
lapsed certification requires 100 hours of CME with the past 24 months. Physicians in or within two years of training
are exempt.
■ For some specialties (ie interventional cardiology, electrophysiology, surgical specialties), candidates must have
active privileges to practice that specialty in at least one US hospital licensed by a nationally recognized credentialing
organization with deeming authority from CMS (ie Joint Commission, HFAP, DNV).
■ A candidate who has had their medical staff appointment/membership or clinical privileges in the specialty for which
they are seeking certification involuntarily revoked and not reinstated, must have subsequently maintained medical
staff appointment/membership or clinical privileges for at least 24 months in another US hospital licensed by a
nationally recognized credentialing organization with deeming authority from CMS (ie Joint Commission, HFAP, DNV).
NBPAS Board Members
• NBPAS board members are high profile
members of the academic medical
community
• Current NBPAS board members are listed
on the next slide
The NBPAS Advisory Board Members are physicians who value patient care, research, and life long learning. Board
members (all unpaid) believe continuous physician education is required for excellence in patient care.
NBPAS Board Members:
Paul Teirstein, M.D., President NBPAS, Chief of Cardiology, Scripps Clinic
David John Driscoll, M.D., Professor of Pediatrics, Mayo Clinic College of Medicine
Daniel Einhorn, M.D., Immediate-Past President, American College of Endocrinology; Past President, American Association
of Clinical Endocrinologists
Bernard Gersh, M.D., Professor of Medicine, Mayo Clinic College of Medicine
C. Michael Gibson, M.D., Professor of Medicine, Harvard Medical School
Paul G. Mathew, M.D., FAHS, Director of Continuing Medical Education, Brigham & Women's Hospital/Harvard Medical
School, Department of Neurology
Jordan Metcalf, M.D., Professor and Research Director, Pulm. & Crit. Care, Oklahoma University Health Sciences
Center
J. Marc Pipas, M.D., Professor of Medicine, Dartmouth School
Jeffrey Popma, M.D., Professor of Medicine, Harvard Medical School
Harry E. Sarles Jr., M.D., FACG, Immediate Past President for the American College of Gastroenterology
Hal Scherz, M.D., Chief of Urology- Scottish Rite Children's Hospital, Assoc Clinical Professor of Urology Emory University
Karen S. Sibert, M.D., Associate Professor of Anesthesiology, Cedars-Sinai Medical Center, Secretary, California Society
of Anesthesiologists
Gregg W. Stone, M.D., Professor of Medicine, Columbia University College of Physicians and Surgeons
Eric Topol, M.D., Chief Academic Officer, Scripps Health; Director, Scripps Translational Science Institute
Bonnie Weiner, M.D., Professor of Medicine, University of Massachusetts Medical School
Mathew Williams, M.D., Chief, Division of Adult Cardiac Surgery, New York University Medical Center
NBPAS website
• NBPAS.org
– Website is simple to navigate
– Contains links to NEJM opposing “Perspectives” on
MOC (Teirstein Vs ABMS) along with the apologetic
press release from ABIM and the NBPAS reaction
– Contains links to sample letters to send to hospital
administrators and colleagues
– Contains link to a PowerPoint presentation
• The following slides demonstrate sample NBPAS
website pages.
www.NBPAS.org
Simple
application takes
<15 minutes to
complete
NBPAS Fees and Application
• NBPAS is a not for profit 501(c)3 organization
• The fee is $84.50 per year ($169 for two year certification),
irrespective of the number of specialty applications. This
one fee covers two years and all specialties
desired. Physicians in or within 2 years of training qualify
for a reduced rate of $29 for a two year certification
($14.50/year). Fees are used for staff, IT, offices, equipment
and marketing. The fee will be adjusted in future years,
determined by our expenses.
• The application requires less than 15 minutes to
complete.
• NBPAS currently offers certification in most non-surgical
specialties
• Go to NBPAS.org to view the website, apply for
certification, leave comments and help us educate
administrators and the public.
www.NBPAS.org
Conclusions:
The need for an alternative
• Irrespective of how the MOC issue is resolved by ABIM,
the process of evaluating MOC has shed enormous light
on how medicine is regulated in the United States
• In the past, ABMS/ABIM has made contributions to
patient care by providing initial physician certification
exam.
• But it is also clear that ABIM is a private, self appointed
credentialing organization.
• ABIM has grown into a big >$55M business, unfettered
by competition, with zealous economic goals, selling
proprietary, copyrighted products
• It is time for other organizations to compete with ABIM
and offer alternative credentialing options.
Vol.CLV18. .No. 34,682
NEW YORK. November 6th, 2010
Breaking News:
Physicians Finally Extract Heads From Sand
Docs came close to ceding
control of entire profession
•Sentinel event for many physicians
•Physicians are waking up to the fact that their profession is
controlled by individuals who are not involved with the day to day
care of patients
•When confronted with the inequities of MOC, many initially reacted
with jaded pessimism, saying "Its too late. MOC is here to stay. The
horse is out of the barn."
•But ABIM is making changes and alternatives have appeared
•We CAN put the horse back into the barn
•It is time for practicing physicians to take back the leadership of
medicine