The Accreditation Council for Graduate Medical Education (ACGME) is currently accepting comments regarding updates to its Common Program Requirements. A quick glance at its proposed strikeouts and additions might suggest a routine and bureaucratic exercise, far removed from the minds or priorities of busy practicing physicians. In reality, ACGME’s update presents an important and urgent opportunity for physicians to be a voice for change in academic medicine. Physicians have until October 22 to comment and should not miss this chance to challenge ACGME’s de facto maintenance of certification (MOC) requirements for physicians who wish to serve as academic faculty in the United States.
The ACGME is the sole national accreditor for all graduate medical education (GME), also known as residency programs. ACGME accreditation is not merely an operational rubber stamp. Accreditation is an absolute requisite to unlocking a piece of the $22 billion pie in federal subsidies earmarked for hospitals that host residency programs. No accreditation means no funding, and no funding means a string of downstream losses: loss of a training pipeline, loss of physicians practicing in a state, and loss of high-quality, low-cost resident physician labor that powers about 20 percent of U.S. hospitals. In short, you must comply with the ACGME rules.
ACGME’s gatekeeping to these federal dollars is a monumental responsibility that demands commensurate accountability. Of concern, ACGME continues to require its program directors and faculty to hold “current” board certification through ABMS/AOA member boards.
A stipulation for “current” board certification translates to a de facto requirement for MOC participation or, indefensibly, grandfathered status. KevinMD’s platform has long supported a forum for the MOC debate, and twenty-six years since its inception, much remains the same. Despite reboots, rebranding, and repackaging, MOC is just as disliked and unproven as when it began. And that’s where the ACGME has some explaining to do.
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Why would ACGME, as a condition of federal funding, continue to require a program known to lack clinical evidence and, worse yet, a program that is a known contributor to burnout and physicians’ premature exit from clinical practice? And what role does ACGME’s partnership with ABMS play in continuing to require a program that has failed by nearly all objective evaluation? Conflicts of interest are defined as conflicts actual or perceived, and requiring “current” certification squarely meets both definitions.
It is a useful exercise to examine ACGME’s requirements before MOC ever existed. During the pre-MOC era, ACGME’s Core Program Requirements for academic faculty were straightforward and sensible. Its standards back then read more like a college application to an Ivy League institution, with a bar set high but with latitude to broadly demonstrate compliance through educational, professional, and clinical excellence as seen here:
“The program director should be certified by the specialty board in the discipline of the program or should possess suitable equivalent qualifications as a teacher, clinician, and administrator.”
“The teaching staff should have a strong interest in teaching, and be willing to contribute the necessary time and effort to the educational program. The key professional personnel, as teachers, clinicians, and/or administrators, should: a) have adequate special training and experience, b) actively participate in appropriate national scientific societies, c) participate in their own continuing medical education, d) engage in specific presentations as appropriate, and e) exhibit active interest in medical research related to their specialties.”
Refreshingly absent is a reliance on mandatory, proprietary, never-ending multiple-choice questions with no bearing on clinical expertise or outcomes.
In other words, the program director and teaching staff should be leaders, scholars, and mentors with a passion for teaching the next generation of our nation’s physicians. They should have achieved an initial board certification, demonstrate exceptional clinical, educational, and administrative talents, and remain active in their professional societies and/or research and teaching, while engaging in lifelong learning in their area of clinical practice and scholarship.
In the setting of ACGME’s current opportunity for public comment, the solution is as simple as it is straightforward. Where ACGME calls for “current” board certification, delete “current” and replace it with “initial,” while bringing back a nuanced, holistic, and comprehensive evaluation of those who wish to serve.
A return to such an evaluation would not be a step backwards, but a modern return to sense and excellence. Replacing “current” with “initial” would be a step that is appropriate to the intellectually demanding environment ACGME seeks to create and maintain, one that challenges and elevates its programs and participants while continuing to train the best physicians in the world.
ACGME also has asked for guidelines to evaluate physicians that may never be eligible for ABMS/AOA certification. It should look no further than its excellent standards from years past. Real patient care and teaching sits at the complex nexus of diagnosis and disease, guidelines and judgment, and human patients who bring their own ideas and objections to the exam room. Gifted teaching is an art as well as a science, requiring talents and dedication that cannot be evaluated solely by checkboxes.
ACGME can do better. It can turn to the rigorous, comprehensive standards that once defined its approach to academic faculty and recognize that excellence in medicine cannot be reduced to a maintenance requirement, a multiple-choice examination, or a certification status. The opportunity is here, and the time to act is now, before ACGME’s deadline on October 22.
They don’t make the process easy (there are more clicks than an Epic chart), but it is worth physicians’ time. If physicians want a voice in shaping the future of academic medicine, this is the moment to use it. Take the time, make the comments, and make your voice heard.
Karen Schatten is associate director of policy and external relations at the National Board of Physicians and Surgeons.
The National Board of Physicians and Surgeons (NBPAS) was founded in 2015 by twenty distinguished academic and practicing physician leaders to provide a rigorous, clinically relevant alternative for demonstrating continuing physician competence. Today, NBPAS is accepted by more than 260 hospitals and health systems nationwide and certifies physicians in all fifty states. NBPAS gives physicians greater autonomy to pursue education relevant to their patients and practice while reducing unnecessary administrative and financial burdens.
Learn more at NBPAS.org, and follow NBPAS on X, Instagram, Facebook, and YouTube.
