A couple years ago, I reached the seven-year mark after my initial board certification with the American Board of Anesthesiology (ABA). At the time, it was a significant milestone. I was eligible to take the all-important Maintenance of Certification in Anesthesia (MOCA) exam.

Diplomates of the ABA — that’ right, I’m considered a diplomate — in other words, a board-certified anesthesiologist. Diplomates were encouraged and incentivized to take the $2,100 exam early in the three-year eligibility window.

The exam was only offered twice a year. There were testing dates during a few weeks in the summer or a few weeks in the winter. You could take the exam up to three times to pass and maintain board certification.

In other words, if you fail, you could take it six months later, and if you fail again, you get one more shot. Waiting until the last opportunity would take away your ability to retake the exam before initial board certification could expire.

Like a dutiful diplomate, I signed up.

I really didn’t feel much like studying in the spring and summer for the exam, so I passed on my first opportunity, signing up for winter window.

I didn’t feel much like studying for this test at all, but I knew that I had better put the time in. Just like I’d rather work a bit longer and retire with more money than I need, I’d rather go into an exam with more knowledge than required.

I also felt a need to study because the vast majority of the material on the exam had little relevance to my actual job. The exam covered all topics that an anesthesiologist might encounter, such as chronic pain (which I don’t manage), open heart surgery (which I haven’t seen in years), and brain surgery (don’t see that, either).

There were esoteric facts to memorize, and memorize I did.

I committed to memory all sorts of minutiae that might be only peripherally related to anesthesia. Facts that are taught to be tested, and serve little practical purpose.

For a couple months, I studied when I could. I took advantage of down time at work in the afternoons and evenings, and took myself to the library on some days off.

I would be taking the exam in the second of six opportunities. As much as I wasn’t planning to fail, failure was a viable but expensive option since I’d have four more testing windows in which to retake the test.

Taking the test early seemed prudent.

About a month after the exam, I received wonderful news via mail. I passed!

This was the last of my MOCA requirements for the initial ten-year period. According to the letter accompanying the score report, “Upon successful completion of all MOCA requirements, you will be issued a certificate that well be valid for 10 years from the date of issuance.”

Two months after receiving that letter, I received more news. A MOCA redesign that the ABA had beta tested the prior year was to be implemented for all. The exam that I just passed was replaced with MOCA 2.0. Thousands of fellow diplomates who certified the year I did or the year before who had not yet spent the $2,100 were now excused from having to take the exam.

Wait … wait. What?!

That’s right. Doing the responsible thing, the thing that the ABA encouraged, turned out to be a huge waste of time and money.

I’m not so naive to believe that decision was made casually or abruptly. In other words, when I took the exam in January, the Board had to have known that changes were coming, but had not been finalized, or at least not announced. They gladly took my money and time, anyway. One last money grab before the next one.

The next money grab? Yes, I was told I would also be enrolled in the new computerized MOCA 2.0 program, and expected to pay $210 a year for it. There would be no “grandfathering in.” I would essentially receive no credit for the exam I took, and of course, there was no getting back all the time I put into studying for and taking the exam.

I called the ABA and expressed my extreme displeasure. Others did, too. Eventually, the ABA actually backpedaled a bit and decided I wouldn’t be charged for MOCA 2.0 for ten years since we had just paid the equivalent of ten years worth of the program to take the exam. I would still be required to enroll in the program, and answer quiz questions on a quarterly basis.

That $2,100 test, by the way, was a 200 question multiple choice exam that took me 100 minutes to complete. That’s $1,260 per hour for those keeping score at home. I traveled five hours roundtrip to a computerized testing station to take it, too, as there were no computers offering the test any closer to my home.

Since my original board certification is valid through the end of this year, I have not yet enrolled in MOCA 2.0, but will be required to start in January, 2018 if I want to maintain my certification.

The problem with maintenance of certification

Before MOC was born, we physicians were already required to do continuing medical education, subject to peer review, and many of us maintain many other time-limited certifications, such as ACLS, BLS, and PALS.

It’s not that physicians are not interested in keeping up our knowledge and skills, it’s just that MOC has not been shown to be an effective way to maintain skills or improve patient care. However, it has been shown to be a costly burden in terms of both time and money.

Do I feel slighted? Yes, but I am far from alone. Dozens of doctors have been sharing their MOC stories, and tens of thousands of others feel slighted, too. The number of physicians currently being subjected to unproven costly MOC requirement likely measures in the hundreds of thousands.

I can’t reclaim the time I’ve spent on MOC, but I am encouraged by the pushback, the resolutions from state and national societies, and the bravery of the physicians who are challenging the status quo.

“Physician on FIRE” is an anesthesiologist and can be reached at his self-titled site, Physician On FIRE.  

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