Action Alert: Stop MOC/MOL in New York State


Dear New York AAPS members and friends:

The time is NOW to speak out against new licensure requirements in New York State before they are implemented.  Please read the below letter from Lawrence Huntoon, MD, PhD for more information including links to sample MSSNY resolutions. Ask your county medical societies to support these resolutions and submit them to MSSNY before February 15. 

Thank you,


To my Fellow Physicians:

As you may or may not know, the Federation of State Medical Boards (FSMB) has voted to pursue implementation of new “maintenance of licensure” (MOL) requirements in all states, including New York State.

This is a “hot button” issue with physicians nationwide.

Physicians, who currently provide high quality care,will lose their medical license unless they can meet these new MOL requirements. 
“Maintenance of Certification” (MOC) is already a reality for many physicians.  Medical staff membership in hospitals, participation on insurance panels, etc. often require board-certification. And, if physicians fail to pass the examination and numerous other requirements for MOC so as to maintain their board-certification status, their medical staff privileges are revoked and their participation on insurance panels are terminated.  Already, we have seen physicians who have been practicing high quality medicine for many years, who have been ejected from hospital medical staffs because they chose not to go through these new onerous, costly, and time-consuming bureaucratic hoops and hurdles known as MOC.
At the present time only about 1/3 of practicing physicians participate in MOC.
Recognize that if you fail to successfully complete any one of the numerous bureaucratic requirements of MOC, you will lose your ability to practice medicine.
The basic components of MOC include :
  • Self-Assessment Examinations (modules) on an ongoing basis
  • Proctored Written Examination
  • Practice Performance Assessment (modules) which include such things as:

    • Providing quality metrics for your practice
    • Completing Practice Improvement modules which includes:

      • Developing a written plan for improvement
      • Documenting that you implemented the plan for improvement, and documenting the results
      • Comparison of your performance in practice with clinical guidelines
      • Assessment of interpersonal communication skills (sometimes requiring patient/physician surveys)
      • Adherence to “Systems-Based” care
    • Practice Improvement modules may have to be completed in “stages” (e.g. 2-3 year cycles)
If the physician has let his board-certification lapse, then the physician often must complete a “Re-Entry” process involving completion of self-assessment modules, practice performance modules, completion of a specified number of specialty-specific AMA Category I continuing medical education (CME) credits, compliance with guidelines for professionalism, and successfully pass a written examination before being “allowed” to enter the maintenance of certification process.
Also, be aware that currently about 25% of practicing physicians are not board-certified.
As you can see from the above, “maintenance of certification” involves more than simply taking a written test every 10 years or so. 
Maintenance of Licensure (MOL) essentially seeks to make maintenance of certification (MOC) mandatory for ALL physicians.  While there has been talk about creating an alternative process for MOL for physicians who are not currently board-certified, no such process has yet come forward.  It is anticipated that if an alternative process is promulgated, it will be equivalent to the MOC process, and will involve many of the same complex bureaucratic
requirements (which many physicians consider to be a complete waste of time and energy).
Physicians who have a lifetime board certificate need to be aware that they are not necessarily exempt from MOL requirements.  And, indications are that the FSMB and medical boards will promulgate requirements for physicians who are currently “grandfathered in” for their specialty boards.  States can implement any requirements they deem appropriate. The effect will be that MOC will essentially become mandatory for all physicians who currently hold a lifetime board certificate.
Approximately 50% of board-certified physicians currently hold a lifetime certificate. 
Many physicians who currently hold a lifetime board certificate, who are in the 55 to 65 age range or older, are likely not going to subject themselves to these onerous new requirements and will retire early.  This will create an access problem for many patients as many good physicians, with years of clinical experience, retire early. 
Independent studies which prove that physician participation in MOC improves quality of care are lacking.  That means that MOC is not “evidence-based.”  That also means that MOL, which has mandatory MOC at its core, is also not “evidence-based.”
The truth is that these new mandatory MOC and MOL requirements are more about money, power and control than they are about “quality” in medicine. 
New mandatory MOC requirements have created a huge new revenue stream (windfall profits) for specialty boards and specialty societies which provide the education modules and CME physicians need to comply with MOC.  MOL will similarly create a new highly profitable revenue stream (at the expense of physicians) for medical boards.
Here are links to 2 “model” resolutions regarding opposition to new maintenance of licensure requirements and opposition to mandatory maintenance of certification.
Please feel free to fill in the blanks and use these resolutions for your own county medical society to submit to the MSSNY House of Delegates if you deem appropriate.
Recognize that neither of these resolutions advocates against physician lifelong learning.  Also, neither of these resolutions is “anti-CME.” 
Good physicians are committed to lifelong learning, and participate in CME so as to keep their knowledge and skills current.  However, physicians should be free to choose specific courses and continuing medical education which is relevant to their specific medical practices. 
It does not benefit patients or “quality” care, for example, to mandate that a spine surgeon participate in MOC and MOL which will require that he or she be tested in the latest developments for knee surgery.  Each individual physician, as opposed to a distant bureaucrat, is in the best position to choose the specific CME that is relevant to his or her practice.
The resolution that opposes mandatory MOC, only opposes the mandatory aspect of MOC.  There is nothing wrong with physicians voluntarily choosing to participate in MOC.  This does not discourage physicians from voluntarily
participating in MOC. 
The Medical Society State of New York (MSSNY) currently does not have a policy regarding new maintenance of licensure requirements or mandatory maintenance of certification.
The AMA does have a policy which can be reviewed at the following link: AMA Policy – H-275.923
You will note, however, that the AMA policy is basically on board with MOL as long as it does not require anything in addition to MOC.  So, this policy would in effect support MOL = mandatory MOC, should states decide to implement new MOL requirements as per the Federation of State Medical Board’s plan. 
The AMA policy appears to be an “appeasement” of these new onerous mandates on physicians, which have no proven clinical benefit.  The apparent hope is that such “appeasement” will provide for a “seat at the table” so that physicians will have input as this onerous process proceeds. 
However, experience teaches that physicians’ “seat at the table” often ends in physicians as the “main course” for dinner. 
History also teaches that when it comes to tyranny, appeasement does not work.
Other States, most notably Ohio, have taken a proactive stance in opposing these new bureaucratic burdens to be placed on practicing physicians.
The Ohio State Medical Association passed a strong resolution last year.
Here is a link to an informational flyer describing what they did: Maintenance of Licensure (MOL) Facts
As a result of passing a strong resolution opposing MOL in the state of Ohio, the medical board of Ohio backed off of its plan to implement new MOL requirements in Ohio.  This was a tremendous victory for physicians in Ohio.  Physicians in other states, including New York, should learn from the courageous actions of Ohio physicians and take similar action in their own state.
Physicians are often heard to complain, “Why can’t we DO something to prevent some of the new laws, regulations and bureaucratic requirements which adversely affect physician’s ability to practice medicine before they are implemented?
This IS an opportunity to DO something to speak out against and oppose new MOL requirements in New York State before they are implemented.  Once implemented, it will be too late – impossible to undo. 
Physicians need to muster the courage to move beyond the “appeasement” and “go along to get along” approach, which has not worked, to a more vocal and confrontational approach in opposing what many believe will have an adverse impact on our ability to practice medicine and serve our patients.  Creating a new access to care problem for patients, due to physicians retiring early if MOL is implemented, does not serve the best interest of patients.
This is the opportunity for physicians to take that action.
The "ostrich approach” will not work.
For those who wish to educate themselves on this MOC MOL issue, below I list a number of links to articles which you may wish to review.  By way of full disclosure, I am the editor-in-chief of the medical journal which published many of these articles.  Our medical journal has published more articles on MOC and MOL than any other medical journal, and we have investigated these issues in ways that others have not.
For those who would rather watch a talk than read articles,I have also attached a couple of links to excellent talks on these topics.
In particular, the first talk listed below, was given by Paul Kempen, M.D., Ph.D., who is a highly respected anesthesiologist who practices at the Cleveland Clinic.  Dr. Kempen has researched these topics and knows more about these
topics than anyone I know. 
Also, please feel free to share this e-mail and attachments with other colleagues so that they can become better informed about these “hot button” issues that will adversely affect physician practice.
I am also happy to answer any questions either by e-mail [email protected] or by phone (716) 627-7759.
Call or e-mail your county medical society leadership today, and ask them to support and submit these resolutions to the MSSNY House of Delegates.  The Deadline for submission of Resolutions is February 15, 2013.
Resolutions should be submitted to Michelle Nuzzi at Executive Headquarters of MSSNY.  The e-mail for submission of resolutions is [email protected]
L.R. Huntoon, M.D., Ph.D., F.A.A.N.
MSSNY Member
Journal of American Physicians and Surgeons
Lake View, NY
(716) 627-7759

MOC/MOL Resources:
Talks on MOC/MOL:
What to do About MOC and MOL
Paul Kempen, M.D., Ph.D.
AAPS Regional Meeting  Somerset, NJ May 18, 2012
MOC/MOL Is Money-Making Machine For “Non-Profit” Boards
Ron Benbassat, M.D.
AAPS Annual Meeting Oct. 5, 2012
Articles on MOC/MOL:
Maintenance of Certification (MOC), and Now Maintenance of Licensure (MOL): Wrong Methodologies to Improve Medical Care
Paul Kempen, M.D., Ph.D.
Maintenance of Certification (MOC), Maintenance of Licensure (MOL), and Continuing Medical Education (CME): the Regulatory Capture of Medicine
Paul Kempen, M.D., Ph.D.
Maintenance of Certification (MOC), Maintenance of Licensure (MOL), and Continuing Medical Education (CME): How the Regulators Prosper
Kenneth D. Christman, M.D.
Why Do Patients Select and Stay with Their Doctor? Implications Regarding Board Certification and Maintenance of Certification and of Licensure (MOC/MOL)
Paul Kempen, M.D., Ph.D.
White Paper in Opposition to Federation of State Medical Boards (FSMB) Proposal on Maintenance of Licensure
Jane M. Orient, M.D.
Board Certification/Recertification/Maintenance of Certification: A Malignant Growth
Martin Dubravec, M.D.
Down the Rabbit Hole of Recertification
Lee D. Hieb, M.D.
Mature Physicians May Quit Rather than Recertify
MOB: Maintenance of Bureaucracy
Lawrence R. Huntoon, M.D., Ph.D.
Federation of State Medical Boards Report from the Maintenance of Licensure Implementation Group, February 14, 2011
Resolutions on MOC/MOL:
AAPS Model Resolution on Maintenance of Licensure (MOL)
AAPS Resolution on Mandatory Maintenance of Certification
Ohio State Medical Association Resolution on Maintenance of Board Certification and Maintenance of Licensure Requirements, submitted by AAPS Member Kenneth D. Christman, M.D.
MOLestation of Physicians Stopped In Ohio!
Maintenance of Certification: Historical Context, by Joshua A. Hirsch and Philip M. Meyers.  J NeuroIntervent Surg 2012;0:1-3
Other Sources of Information:
Association of American Physicians and Surgeons website:
Change Board Recertification website (Dr. Ron Benbassat)

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